Adhesive capsulitis: how to save time and improve efficiency

In the earlier episodes of this series on saving time, we presented a range of equipment that will enable you to carry out your daily treatments more efficiently and quickly. In this final episode, we will explain how to combine the range of equipment described using a real case, that of capsulitis, which is frequently encountered in practice.

Capsulitis is one of the most complex and complicated pathologies to treat because of its very slow progression and the need for fine adjustments, tailored to each patient, particularly during the initial inflammatory phase where each patient reacts differently. So much so that frustration can set in on the side of the patient as well as the therapist. The use of different tools makes it possible to break this pattern. The use of hands-free devices (Game Ready or teslatherapy, or even Winback for the active mobilization part) or devices that permit very rapid treatment (R-SHOCK) frees up time when treating this pathology, which is very time-consuming for the therapist.

Adhesive capsulitis of the shoulder is a retraction and thickening of the lower and anterior parts of the joint capsule. This results in a progressive limit in the range of motion, associated with pain.

Common after the age of 40, capsulitis often develops spontaneously, but can also be the result of trauma (contusion, fracture, dislocation), particularly if it has been followed by prolonged immobilization. Spontaneous healing occurs within 12 to 24 months. Its evolution always follows the same three-stage process: an initial inflammatory phase with pain that is worse during the night, then a second phase corresponding to the retraction of the capsule, and finally a third phase of recovery (often complete or partially complete) (Redler et al., 2019). In 50% of cases, the causes are not clearly identified. However, we know that stress and fatigue are factors influencing its onset, which would explain the current upsurge in demand for physiotherapy care for this pathology.

First phase: painful inflammation

During this first phase, treatment mainly consists of containing the inflammation and reducing the pain. It is often the most complicated part to manage, for both the therapist and the patient, as it is often very long and the therapist may feel helpless and ineffective faced with a patient who complains a lot of pain and asks for relief. Game Ready compressive cryotherapy can be very useful for both its analgesic (Bellon et al., 2019) and anti-inflammatory properties (Baranes et al., 2020), but also for its hands-free element. Its ease of installation and use makes it a powerful asset during this long and difficult phase.

R-SHOCK also allows rapid treatments and can provide targeted pain relief, either with PULSE mode (endorphinic pain relief) or PULSE+ (rapid pain relief). Its two pain-relief modes can be personalized and adjusted based on the patient’s condition (rapid desensitization or longer-lasting pain relief). In cases where the patient is not quite in the inflammatory phase, it is possible to use SWAP mode and to adjust the proportion of TECAR (diathermy) and PULSE (pain relief).

Second phase: retraction

During this phase, treatment consists of preserving the maximum range of joint movement. Frustration can set in during this stage because there is little progress. However, the use of R-SHOCK or teslatherapy allows rapid progress to be made during the session, a positive benefit for the patient, who is able to see a change.

In the retraction phase, mobilizations become difficult and painful, in part because of defensive muscle contractures. R-SHOCK, thanks to its targeted diathermy, can release the different tension points quickly and painlessly. Using bursts of four seconds, SHOCK mode can release the tensions at the heart of trigger points in less than a minute.

Additionally, the pathology having become chronic at this stage, teslatherapy will restart cell metabolism while at the same time having an analgesic effect (Galace de Freitas et al., 2014), shortening this phase of capsular retraction. Thanks to its pulsed magnetic field, this treatment method is highly effective in recreating the electrical conditions required for the proper functioning of cells which have entered a chronic pathological state. Additionally, the rhythmic contractions generate slight joint pumping, improving the capsule-ligamentary tissue quality without any effort on the part of either the practitioner or the patient!

More generally, teslatherapy is the ideal all-in-one equipment for the treatment of adhesive capsulitis on four levels:

– Cellular: metabolic revival by recreating the necessary electrical conditions for the proper functioning of the cells, acceleration of ionic exchanges, exchanges of ATP and of O2 (Pall, 2013).

– Neurological: deep pain-relieving action thanks to the current induced by the pulsed magnetic field (Beaulieu et al., 2015).

– Muscular: relaxing action or fight against amyotrophy (the recruitment of deep muscles, unattainable in classic electrotherapy) based on the need of the patient.

– Articular: improvement of the articular and periarticular tissue quality.

Third phase: recovery

During this phase, the goal is to regain the range of motion in the joints as quickly as possible by releasing the adhesions and retractions developed during the previous phases.

Winback and/or R-SHOCK equipment can be used to break up adhesions and release the fascia and muscular tensions, and also to contribute to the revascularization of the capsule and facilitate joint mobilization (Paolucci et al., 2019).

R-SHOCK will prove to be very useful for working on trigger points (Kazalakova, 2013), but also on possible fibrosis.

Finally, Winback mode 3.0 enables a focus on the joint, with the use of two mobile electrodes (RET mode) around the joint. The goal is to promote vascularization of the capsule and to facilitate joint mobilization. The increase in movement from this active technique will be easier thanks to set-up 2.0 (an adhesive RET plate and an adhesive return plate).

Then the Fascia Tool (an accessory compatible with R-SHOCK and Winback) can be applied to areas such as the trapezius, deltoid or latissimus dorsi muscles to break up fascial adhesions and restore sliding planes.

This 2.0 assembly can be completed by placing suction cups on the tension and retraction zones to create a focus on these different points.

Case study

We compared the gain in amplitude in flexion and external rotation as well as the level of pain with and without Winback. Therapists were free to use whatever techniques they wanted, the only constraint being to carry out one session with Winback and one without.

Among the 11 cases, we were able to note, for 10 patients, a greater increase in amplitude with Winback compared with treatments without Winback, with an average gain in flexion of 24.7% compared with 16.3%, i.e. an average difference of 8.45% in favor of Winback.

External rotation was studied in five patients. For those, the average gain with Winback was 47.2%, compared with only 23.8% without Winback, i.e. a difference of 23.4%.

From the perspective of pain relief, with the help of Winback, we were able to observe an average reduction of 1.7 points on the visual analog scale (VAS), compared with only 0.6 points without Winback. The results are very positive since among all patients a benefit in terms of amplitude and pain reduction was observed.

Throughout this series, we hope to have helped you in the best possible way to identify new ways to cope with the evolution of your daily activity, to avoid being overwhelmed, and to respond in the most efficient way to the growing demand for care. Remember: while the tools highlighted will help you save time, they are only a complement and cannot replace your know-how!

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