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Frozen shoulder, medically called adhesive capsulitis, occurs when the capsule surrounding the shoulder joint becomes thickened, inflamed and stiff. This restricts both active and passive shoulder movement.
The condition typically progresses through three stages:
1. Freezing stage: Pain increases and movement gradually becomes restricted.
2. Frozen stage: Pain may settle, but stiffness becomes the major problem.
3. Thawing stage: Shoulder movement gradually returns.
Recovery is highly variable. Some people improve within months, while others may take one to three years to regain near-normal movement.
Frozen shoulder can occur without an obvious injury, known as primary or idiopathic adhesive capsulitis. It can also develop after shoulder injury, surgery or a period of prolonged immobilisation.
The risk is higher in people with conditions such as:
● Diabetes
● Thyroid disorders
● Some metabolic conditions
● Previous shoulder problems
● Prolonged shoulder immobilisation
A 2025 clinical practice guideline also identified diabetes, thyroid disease and dyslipidaemia as important risk factors.
This is usually the most painful phase. The shoulder becomes increasingly painful, and range of motion starts to reduce.
Pain may occur even at rest and can interfere with sleep. Reaching overhead or rotating the arm becomes progressively more difficult.
This stage may last roughly 6 weeks to 9 months, although individual recovery varies.
Physiotherapy focus:
● Pain education and reassurance
● Gentle, comfortable range-of-motion exercises
● Activity modification
● Heat or other symptom-relieving strategies when appropriate
● Gentle manual therapy
● Maintaining as much comfortable movement as possible
One of the most common mistakes is assuming that harder stretching will make the shoulder recover faster.
During a highly irritable, painful phase, aggressive stretching or forceful joint mobilisation can increase symptoms and make exercise harder to tolerate. Treatment intensity should be guided by irritability and response rather than by a fixed protocol.
Avoid repeatedly forcing the shoulder into severe pain, especially when pain remains elevated for hours after exercise.
As the condition progresses, pain may become less intense while stiffness becomes more noticeable.
External rotation, reaching overhead and moving the arm behind the back are often particularly restricted. Everyday activities can remain difficult despite the reduction in pain.
The frozen stage commonly lasts around 4–6 months, but this varies between individuals.
Physiotherapy focus:
● Progressive stretching
● Active and active-assisted range of motion
● Glenohumeral joint mobilisation when appropriate
● Shoulder strengthening
● Scapular control
● Gradual restoration of functional movement
At this stage, the aim is to progressively challenge the capsule without provoking an excessive flare-up.
During the thawing stage, shoulder movement gradually improves and pain generally becomes less prominent.
This is the time to progressively rebuild:
● Active range of motion
● Rotator-cuff strength
● Scapular strength
● Overhead tolerance
● Functional and work-related movements
The thawing phase may continue for many months. AAOS notes that complete or near-complete recovery of strength and movement can take 6 months to 2 years.
There is no single exercise or manual technique that “breaks” a frozen shoulder. Effective rehabilitation is usually based on education, symptom control, progressive mobility and strengthening.
Depending on the stage and irritability, a home programme may include:
● Pendulum exercises
● Table slides
● Wand-assisted shoulder flexion
● Assisted external rotation
● Wall slides
● Cross-body stretching
The number of repetitions and intensity should be individualised. A stretch should feel controlled rather than like a forced joint movement.
A physiotherapist may use glenohumeral joint mobilisation and soft-tissue techniques to reduce pain and improve movement.
Manual therapy can be useful, but it works best as part of an active rehabilitation programme rather than as a stand-alone treatment. Current clinical guidance supports manual therapy and range-of-motion exercises for improving function and shoulder movement, although the strength of evidence varies.
Strengthening becomes increasingly important as pain settles and movement improves.
Examples include:
● Isometric shoulder exercises
● Resistance-band external and internal rotation
● Scapular retraction exercises
● Wall-supported strengthening
● Progressive overhead strengthening
Strengthening should be introduced according to the patient’s tolerance and available range rather than forcing a weak shoulder through painful positions.
A simple home programme may look like this:
Morning:
Gentle pendulums and assisted shoulder movements to reduce stiffness after sleep.
During the day:
Short mobility sessions using wall slides, table slides or assisted rotation.
Evening:
Gentle stretching followed by prescribed strengthening if the shoulder is in an appropriate stage.
Consistency is more important than performing one very long exercise session. Symptoms should be monitored over the following several hours. If exercises repeatedly cause a significant increase in pain, stiffness or sleep disturbance, the programme may need to be modified.
Physiotherapy remains an important part of conservative care, but some patients need additional medical treatment.
Corticosteroid injection may be considered, particularly when pain is significantly limiting sleep, daily activities or rehabilitation. Current guidelines support intra-articular steroid injections and indicate that combining injection treatment with physiotherapy can improve pain and function.
Hydrodilatation, where fluid is injected into the joint to distend the capsule, may also be considered. However, 2026 systematic-review evidence suggests that its advantages over steroid injection alone or physiotherapy are uncertain, so it should not be viewed as a guaranteed solution.
For persistent severe stiffness or disability despite appropriate non-surgical treatment, specialists may discuss manipulation under anaesthesia or arthroscopic capsular release. These options require specialist assessment and are not first-line treatment for every patient.
Medical assessment is particularly important when:
● Shoulder pain follows significant trauma.
● There is sudden severe weakness.
● Symptoms are rapidly worsening.
● Pain is unexplained or unusually severe.
● There is fever, redness or swelling.
● Neurological symptoms such as persistent numbness occur.
● Shoulder stiffness does not improve with appropriate treatment.
A diagnosis should also be confirmed when the presentation is atypical because rotator-cuff pathology, arthritis and other shoulder conditions can produce similar symptoms.
Yes. Many people regain substantial or near-normal movement, although recovery can be slow and some patients may retain a degree of stiffness.
Yes, but the exercises should match your stage and pain level. Gentle movement is generally more appropriate during the painful freezing stage, while progressive stretching and strengthening become more important as irritability decreases.
Physiotherapy can help control symptoms, maintain movement and progressively restore function. It cannot guarantee a specific recovery time because frozen shoulder has a variable natural course.
Usually not. It is generally self-limiting, but the full recovery period can be long—sometimes one to three years.
No. Most people are initially managed without surgery. Surgical treatment is generally considered when significant symptoms and functional limitations persist despite appropriate non-surgical management.
Frozen shoulder is a slow-moving condition that requires patience and stage-specific rehabilitation. The key is to control pain during the freezing phase, gradually restore mobility during the frozen phase and rebuild strength and function as the shoulder thaws. Consistent, appropriately progressed rehabilitation is usually more useful than aggressive treatment.