Acupuncture & Manual Therapy for Frozen Shoulder: A Complementary Approach Backed by Science

Manual therapy—particularly physical therapy—is widely recognized in the treatment of musculoskeletal disorders. Although several promising studies have highlighted the effectiveness of Chinese medicine for pain management, it remains largely outside standard healthcare pathways.

A meta-analysis published in December 2024 in Pain Management Nursing, titled “Efficacy of Combining Acupuncture and Physical Therapy for the Management of Patients With Frozen Shoulder: A Systematic Review and Meta-Analysis” by Bo Xu, Lei Zhang, Xudong Zhao, Shouhan Feng, Jinxia Li, and Ye Xu, explored the effects of combining acupuncture with physical therapy in managing a particularly complex condition: frozen shoulder.

Frozen Shoulder: A Therapeutic Challenge

The shoulder is a “suspended” joint that relies on a delicate balance between muscles and ligaments.Frozen shoulder—also called adhesive capsulitis—typically progresses through several stages:

• Pre-freezing: mild pain with gradual loss of range of motion

• Freezing: persistent pain and marked limitation of movement

• Frozen: severe stiffness, nighttime pain, and significant functional limitations

• Thawing: gradual recovery, often incomplete

Conventional treatments rely on physical therapy, anti-inflammatory drugs, and sometimes corticosteroid injections, though outcomes vary significantly from one patient to another.

A Meta-Analysis Offering Concrete Results

This systematic review and meta-analysis examined 13 studies comparing the effectiveness of combining acupuncture and physical therapy versus physical therapy alone. The total sample included more than 480 patients, ensuring statistically significant results.

The outcomes assessed were:

• Pain reduction (measured by Visual Analog Scale)

• Clinical effectiveness rate (improvement in symptoms and functional mobility)

• Range of motion in active and passive movements (flexion, extension, abduction, rotation)

Key findings included:

• Pain: Adding acupuncture led to a significantly greater reduction in pain than physical therapy alone.

• Clinical effectiveness: The odds ratio indicated that patients receiving acupuncture were nearly 3.7 times more likely to experience improvement compared to those treated with physical therapy alone.

• Range of motion: Both active and passive movements improved. The most significant gains were in flexion and abduction, indicating a faster recovery of shoulder mobility.

These results suggest a synergistic effect between acupuncture and physical therapy, where pain relief through acupuncture enhances patients’ active participation in rehabilitation.

Acupuncture and Physical Therapy: A Therapeutic Alliance

In Chinese medicine, acupuncture promotes the circulation of Qi and Blood, removes energetic blockages, and reduces local inflammation. Its efficacy in musculoskeletal pain is partly attributed to the release of endorphins and modulation of the nervous system.

It is important not to confuse acupuncture with dry needling. This study specifically addresses traditional acupuncture based on Chinese medicine principles. Unlike dry needling—which focuses solely on myofascial trigger points using a biomechanical approach—acupuncture acts on an energetic meridian network, providing a more holistic effect on the body.

Toward a More Integrative Therapeutic Approach?

Although Chinese medicine is still struggling to gain full acceptance in conventional care pathways, the findings of this meta-analysis support a combined approach to improve outcomes in patients with frozen shoulder.

Osteopathy, when used alongside acupuncture, could also play a key role in managing complex musculoskeletal conditions—by releasing physical restrictions and improving joint dynamics. A comprehensive and integrative approach involving these therapeutic systems may offer an effective alternative to standard treatments.