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Frozen Shoulder (Adhesive Capsulitis) Hydro-dilatation Procedure

Updated: Jan 19

Rehabilitation Guide

The hydro-dilatation injection is a procedure used to treat frozen shoulder by gently stretching the tight joint capsule with a mixture of fluid. This helps reduce pain, loosen stiffness, and create more space inside the shoulder joint so it can move more freely. Many patients notice improved mobility soon after the procedure, and a structured rehabilitation program is essential to keep those gains and restore normal shoulder function.


Following your Hydro-dilatation procedure we have created a 12 week guide to help you return to normal function. Please feel free to use this outline in consultation with your own coach or physiotherapist to help you safely return back to your best. Early, frequent movement and progressive strengthening are essential to maintain post-procedure movement gains.


Rehabilitation Exercise Overview


Phase One - Recovery /Early Motion

In this early phase, the goal is to keep the improved movement gained from the injection by gently moving the shoulder, calming inflammation, and preventing the capsule from tightening again.

Phase Two - Restore Motion / Progressive Strengthening

During this phase, we focus on gradually increasing shoulder motion and beginning controlled strengthening, helping the tissues adapt to stretching while supporting the joint with early muscle activation.

Phase Three - Maintain Motion / Functional Strengthening

Here, we work on keeping your range of motion while building strength that supports everyday tasks, allowing the shoulder to tolerate more load without slipping back into stiffness.

Phase Four - Functional & Sport Integration

The final phase aims to restore near-normal shoulder movement, confidence, and strength so you can return to daily activities and gradually progress back to work demands, hobbies, or sports.



Outcome Measures

  • Strength Symmetry (Isometric External Rotation Strength)

  • Motion Symmetry

  • Pain


Phase One - Recovery / Early Motion

In this early phase, the goal is to keep the improved movement gained from the injection by gently moving the shoulder, calming inflammation, and preventing the capsule from tightening again.


Weeks 1-3


  • Maintain motion gained from hydro-dilatation

  • Control pain

  • Prevent re-stiffening


Prescription - 4 x Daily

  • Pain <4/10 for all exercises at this stage


Phase Two - Restore Motion / Progressive Strengthening

During this phase, we focus on gradually increasing shoulder motion and beginning controlled strengthening, helping the tissues adapt to stretching while supporting the joint with early muscle activation.


Weeks 4-6


  • Restore functional ROM

  • Initiate strengthening

  • Physiotherapy - Manual Therapy


Prescription - 1-2 x Daily Motion



Prescription - 3 x Per Week Strengthening



Phase Three - Maintain Motion / Functional Strength

Here, we work on keeping your range of motion while building strength that supports everyday tasks, allowing the shoulder to tolerate more load without slipping back into stiffness.


Week 7-9


  • Improve dynamic control

  • Overhead function

  • Physiotherapy - Manual Therapy


Prescription - Daily Motion



Prescription - 3 x Per Week Strengthening


Phase Four - Return to ADL's & Sport

The final phase aims to restore near-normal shoulder movement, confidence, and strength so you can return to daily activities and gradually progress back to work demands, hobbies, or sports.

Week 10-12


  • Achieve pre-injury ROM

  • Return to normal activities

  • Achieve sufficient strength for ADLs/Sport


Prescription - Motion 2-3 x per week



Prescription - 2 x Per Week


Maintenance Strength



Criteria for discharge:

  • Pain <2/10

  • Symmetrical AROM (≥90% of contralateral side)

  • Symmetrical isometric external rotation strength

  • Functional performance restored





 
 
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