Some patients who visit the “Comprehensive Shoulder Evaluation Clinic” have diligently read every Facebook post and experienced significant improvement after their first shoulder capsule distension treatment. However, when they share this experience with friends and family, they often hear something like:“
That’s just temporary relief. If you don’t do strength training, frozen shoulder will come right back!”
Naturally, this leaves patients anxious, worrying that the effects won’t last and that their recovery is just a flash in the pan.
But statements like these stem from a misunderstanding—a confusing mix of concepts boiled into an unclear soup of information. Let’s set the record straight.
Concept 1: Frozen Shoulder Is “Adhesive” + “Capsule” + “Inflammation”
First and foremost, patients need to clearly understand that frozen shoulder is caused by adhesions in the joint capsule. The medical name is adhesive capsulitis. While the exact cause isn’t fully understood, several factors are known to be highly correlated.
The mechanism is like this: when the body undergoes inflammation in the shoulder area (due to injury or other causes), it tries to heal by creating scar tissue—like glue. If the body “uses too much glue,” not only does it patch the damaged tissue, but it ends up sticking the whole capsule together. Imagine using super glue to fix a broken object but accidentally gluing your fingers together—that’s essentially what happens inside the shoulder.
Concept 2: Two Major Risk Factors—Immobility and Systemic Conditions
What causes “too much glue” and prolonged immobility that leads to frozen shoulder?
1. Excess Glue: Inflammation, Systemic Disease, or Bleeding in the Capsule
- Localized Inflammation: Often surrounding tissues—ligaments, tendons, muscles—are inflamed (e.g., calcific tendinitis or rotator cuff issues), which irritates the capsule and causes it to inflame and scar.
- Systemic Conditions: Diseases like diabetes, thyroid disorders, and heart disease put the body in a constant state of low-grade inflammation, reducing the ability to clear waste products and making frozen shoulder more likely and recovery slower.
- Bleeding in the Capsule: Blood is sticky. If bleeding occurs inside the joint capsule—from injury, surgery, or overly aggressive rehab—it can lead to adhesions. That’s why even after invasive procedures, maintaining mobility is key.
2. Immobility: Medical Immobilization or Lack of Activity
If glue (inflammatory adhesions) is present and the joint doesn’t move, it dries and locks the capsule together. The longer the shoulder stays still, the worse the adhesion becomes—just like how a 3M hook needs 24 hours of stillness to stick properly. This is why the first 3 months after treatment are crucial for rehab.
The most common source of long-term immobility is doctor-prescribed immobilization, like a cast after an accident. Even if the bone heals, if the arm isn’t moved, the shoulder may develop frozen shoulder. Similarly, those recovering from major illness, surgery (e.g., breast or neck cancer), or bedridden for months may lose shoulder mobility due to disuse.
Though not everyone who’s immobilized gets frozen shoulder, among high-risk groups, the prevalence is significantly higher. For example, 25–33% of diabetics are affected by frozen shoulder.
Concept 3: Strength Training and Range of Motion Are Different
“Strength training” builds muscles, while “joint mobility” enhances range of motion (ROM). Many people confuse movement with exercise.
Let’s look at two examples:
- A muscular man lifting heavy dumbbells is doing strength training—developing strong muscles that can bear heavy loads. This helps prevent injury when doing everyday tasks like carrying groceries or lifting grandchildren.
- A flexible child doing yoga shows excellent joint mobility—her body moves gracefully, reaching full joint angles with ease. This is the goal of mobility training: fluid, flexible, full-range movement coordinated by joints, muscles, and tendons.
Both strength and mobility are critical for frozen shoulder patients, whose primary symptom is restricted movement. Weak muscles and stiff joints both contribute to that limitation.
Even after capsule adhesions are released through treatment, full recovery depends on improving both muscle tone and joint flexibility. In other words, being pain-free is just the first step—restoring full movement is the real goal.
Concept 4: Treating Frozen Shoulder Is Simple—If You Understand the Root Causes
Combining Concepts 1 and 2, we know frozen shoulder is caused by too much internal “glue” and immobility. So, the solution is simple:
- Address excess inflammation through integrative treatment of the entire shoulder, not just the capsule. Also manage underlying conditions like diabetes, high blood pressure, and high cholesterol to reduce the body’s inflammatory burden.
- Prevent immobility by staying active—especially in the first few months after treatment or surgery. Whether your shoulder is recovering from frozen shoulder or affected by another condition, daily gentle movement is essential. Small, frequent, progressive exercises are highly effective in prevention and recovery.
Concept 5: Why Is Shoulder Capsule Distension Effective?
So why is shoulder capsule distension such a successful treatment for frozen shoulder—and why doesn’t it require in-clinic physical therapy afterward?
1. It reduces the “stickiness” of the glue.
The procedure injects a large volume of saline into the joint capsule. The tiny injection point typically doesn’t cause bleeding. The saline dilutes inflammatory substances and stretches the capsule open—like inflating a balloon. With the capsule walls no longer in contact, the sticky “glue” can’t adhere again. Problem solved.
2. It improves range of motion on day one.
Many patients are surprised by how much their shoulder moves right after the first injection. Why? Because the adhesions were physically separated by the expansion—just like pulling stuck pages apart.
As long as there are no complicating issues, patients can usually complete a 5-session course at home using stretch bands and wave goodbye to frozen shoulder.
In Summary: Lack of Strength and Flexibility Do NOT Cause Adhesions to Return
Let’s be clear: Frozen shoulder is defined as adhesive capsulitis—meaning inflammation causes the joint capsule to stick together. This is not the same as muscle weakness or poor flexibility.
Lack of strength or mobility may cause reduced function, increased injury risk, or even secondary issues like tendinitis—but they don’t cause adhesive capsulitis to return. Different conditions have different medical definitions and shouldn’t be lumped together.
Feeling worried is normal when your body isn’t well. But now that you understand the underlying principles, remember:
- Adhesions don’t just “come back” if you don’t strength train.
- But strength and mobility training are essential for full functional recovery.
- Early diagnosis and treatment are always best.
- And if you have concerns, our clinic’s health educators are happy to talk—either by phone or in person. Don’t hesitate to reach out!
