Frozen Shoulder: Symptoms, Stages & How Physiotherapy Can Help

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain, stiffness, and a significant loss of shoulder movement. Simple activities such as reaching overhead, putting on a shirt, fastening a bra, reaching behind your back, or sleeping on the affected side can become difficult.

Frozen shoulder usually develops gradually and can take several months to improve. Early assessment and appropriate treatment can help manage symptoms and restore shoulder movement.

What Causes Frozen Shoulder?

Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes thickened and tight, restricting normal movement.

It can develop without an obvious cause, known as primary frozen shoulder, or occur following another condition or period of reduced shoulder movement, known as secondary frozen shoulder.

Factors that may increase the risk include:

• Previous shoulder injury or surgery
• Prolonged shoulder immobilization
• Diabetes
• Thyroid conditions
• Increasing age
• Reduced shoulder movement following an injury

Common Symptoms of Frozen Shoulder

Symptoms often develop gradually and may include:

• Shoulder pain, particularly at night
• Increasing stiffness
• Difficulty raising the arm
• Difficulty reaching behind your back
• Difficulty putting on or removing clothing
• Pain when reaching overhead
• Difficulty sleeping on the affected side
• Significant loss of shoulder movement

One of the key features of frozen shoulder is that both active and passive shoulder movement become restricted.

The 3 Stages of Frozen Shoulder

Frozen shoulder typically progresses through three stages.

1. Freezing Stage

This stage is often characterized by increasing pain and gradually worsening stiffness. Shoulder movement becomes more difficult, and night pain can significantly affect sleep.

This stage may last several weeks to months.

2. Frozen Stage

Pain may begin to decrease, but significant stiffness remains. Everyday activities requiring shoulder movement can still be difficult.

Reaching overhead or behind your back may be particularly restricted.

3. Thawing Stage

Shoulder movement gradually begins to improve. Recovery can be slow, but function and mobility typically improve over time.

Not everyone experiences these stages in exactly the same way, and recovery time can vary.

How Can Physiotherapy Help Frozen Shoulder?

Physiotherapy can play an important role in managing frozen shoulder and helping you regain movement and function.

Treatment may include:

Gentle Mobility Exercises

Specific exercises can help maintain and gradually improve shoulder movement without excessively irritating the joint.

Manual Therapy

Hands-on techniques may be used to improve joint and soft-tissue mobility and help reduce stiffness.

Strengthening Exercises

As pain and mobility improve, strengthening exercises can help restore shoulder function and improve the shoulder’s ability to handle everyday activities.

Pain Management

Your physiotherapist can recommend appropriate strategies to help manage pain and improve your ability to participate in rehabilitation.

Ultrasound Therapy

Therapeutic ultrasound uses sound waves to promote tissue healing, improve circulation, and reduce muscle stiffness.

Interferential Current (IFC) or TENS Therapy

Electrical stimulation can help decrease pain, reduce muscle spasms, and encourage relaxation during the early stages of recovery.

Conclusion

Frozen shoulder can make everyday movements painful and frustrating, but the condition can be managed with the right approach. Physiotherapy can help reduce pain, improve shoulder mobility, maintain strength, and support your return to normal activities.

If shoulder pain and stiffness are making it difficult to reach, dress, sleep, or perform everyday activities, getting assessed early can help determine the cause and guide you toward an appropriate treatment plan.