Frozen shoulder affects up to 5% of people, turning simple tasks—like reaching for a coffee cup or brushing your hair—into painful ordeals. This condition, also called adhesive capsulitis, doesn’t just limit your movement. It can disrupt your sleep, work, and daily activities for months or even years.
The good news is, you don’t have to suffer through it alone. Physiotherapy stands out as one of the most effective treatments for frozen shoulder, especially when paired with other conservative approaches.
Research regularly shows that patients who stick with targeted physiotherapy exercises see better results than those who only reach for pain meds. The trick is knowing which exercises actually help at each stage of the condition—and how to do them safely.
Whether you’re stuck in the intense pain of the “freezing” stage or clawing back mobility in the “thawing” phase, the right physiotherapy approach can change everything. If frozen shoulder’s got you down, maybe it’s time to check out Clayton Heights 188 St Physiotherapy and Sports Injury Clinic for a treatment plan tailored to you. Getting back to what you love is possible.
Understanding Frozen Shoulder and Its Impact
Frozen shoulder, or adhesive capsulitis, is a painful condition that severely limits your shoulder movement through three distinct phases. Millions of people worldwide deal with it, and it can throw your daily routine out the window for months, sometimes years.
What Is Frozen Shoulder (Adhesive Capsulitis)?
Frozen shoulder means your shoulder joint capsule gets thick and tight. Suddenly, moving your shoulder in any direction feels nearly impossible.
Active movement suffers—you can’t lift your arm by yourself. Passive movement? Even if someone else tries to move your arm, it just won’t go.
The joint capsule wraps around your shoulder joint like a sleeve. With adhesive capsulitis, that capsule shrinks and scar tissue builds up. Your shoulder basically “freezes” in place.
Unlike other shoulder problems, frozen shoulder usually shows up without any obvious injury or rotator cuff damage. X-rays and physical exams rarely reveal anything to explain the pain and stiffness you’re feeling.
Primary frozen shoulder just happens on its own, no clear cause. Secondary frozen shoulder pops up after an injury or surgery that keeps your shoulder still for too long.
Stages: Freezing, Frozen, and Thawing
Your frozen shoulder moves through three predictable stages, each with its own symptoms and timeline.
Freezing Stage (2-9 months)
This one hurts the most. Your shoulder pain ramps up, especially at night. You might wake up several times because the pain just won’t let you sleep. During this stage, you start losing range of motion as the pain increases.
Frozen Stage (4-12 months)
Pain finally starts to ease up here. But now your shoulder turns incredibly stiff. You can’t reach overhead, behind your back, or out to the side—everything feels locked up.
Thawing Stage (5-26 months)
Movement comes back, bit by bit. Stiffness slowly fades, but you might never get your full range of motion back. This phase can really test your patience—progress crawls.
Who Is at Risk and Why It Happens
Frozen shoulder mostly hits people between 40 and 60. Women seem to get it more often than men.
High-Risk Medical Conditions:
- Diabetes – easily the biggest risk factor, and sometimes frozen shoulder is the first sign
- Thyroid disorders (overactive or underactive)
- Parkinson’s disease
- Heart disease
- Autoimmune conditions
Diabetics are much more likely to get frozen shoulder. If you have diabetes, you might even deal with it in both shoulders.
Other Risk Factors:
- Recent shoulder injury or surgery
- Prolonged shoulder immobilization (like wearing a sling)
- Hormonal changes (especially for women in menopause)
Doctors and researchers still can’t pin down the exact cause. Maybe the immune system attacks healthy shoulder tissues by mistake, leading to inflammation and scar tissue. No one’s totally sure.
Common Signs and Diagnostic Process
Key Symptoms You’ll Notice:
- Severe shoulder pain, worse at night
- Can’t sleep on the sore side
- Gradual loss of shoulder movement in all directions
- Pain reaching overhead, behind your back, or across your body
- Muscle weakness from not using the shoulder
The Diagnostic Process
Your doctor mainly relies on a physical exam to diagnose frozen shoulder. They’ll check your active range of motion (how far you move your arm) and passive range of motion (how far they can move it for you).
The big giveaway? Both active and passive external rotation are seriously limited. If your doctor can easily rotate your arm outward, frozen shoulder probably isn’t the culprit.
Tests Your Doctor Might Order:
| Test | Purpose |
|---|---|
| X-rays | Rule out arthritis or fractures |
| MRI | Check for rotator cuff tears |
| Ultrasound | Examine soft tissue inflammation |
| Blood tests | Screen for diabetes or thyroid problems |
Most of the time, these tests look normal with frozen shoulder. Doctors make the diagnosis based on your symptoms and their exam, not on test results.
Physiotherapy Approach for Frozen Shoulder
Physiotherapy for frozen shoulder aims to bring back shoulder mobility. It leans on targeted exercises and manual techniques, tailored to your current phase of recovery. Pain management and progressive movement therapy work together to help you safely regain flexibility.
How Physiotherapy Restores Mobility
Your physiotherapist goes after that tight shoulder capsule with specific movements to stretch and strengthen the joint. Range of motion exercises start off gentle, then ramp up as your shoulder gets more tolerant.
Passive range of motion exercises come first. Your therapist moves your arm while you just relax. This helps keep whatever motion you’ve got left.
Next up, active-assisted exercises. You move your arm with a little help from your therapist or special equipment. It’s a safe way to start building strength.
Then come active range of motion exercises—now you’re moving your arm on your own. Your muscles do the work, lifting and rotating your shoulder through its full range.
Therapeutic exercises target all directions—forward flexion, abduction, internal rotation. These movements usually get hit hardest by frozen shoulder, so they need extra attention.
Your physiotherapist keeps tabs on your progress. They measure how far your arm moves in every direction, every visit.
Tailored Treatment Through the Phases
Your treatment shifts depending on which phase of frozen shoulder you’re in. Each stage needs its own approach to get the best results.
Freezing phase treatment zeroes in on pain management and gentle movement. Your therapist might use ice, heat, and soft tissue techniques to calm inflammation. Gentle pendulum swings and passive stretching help ward off more stiffness.
During the frozen phase, therapy moves toward regaining mobility. Manual therapy helps break up adhesions in the capsule. Exercises get tougher as pain lets up.
The thawing phase focuses on building strength and restoring full movement. Resistance exercises help you get back to normal function. Your therapist throws in functional movements that mimic real-life activities.
How often you need physiotherapy depends on your phase. Sometimes it’s three times a week when things are really bad. As you improve, sessions might drop to once a week.
Your physiotherapist tweaks the approach based on your pain and movement. They won’t push your shoulder past what it can handle—nobody wants a setback.
Hands-On Techniques and Manual Therapy
Manual therapy is the heart of physiotherapy for frozen shoulder. Your therapist uses hands-on techniques to boost joint mobility and ease muscle tension.
Joint mobilization means gentle movements right at the shoulder joint. Grade I and II mobilizations focus on pain relief. Grade III and IV mobilizations stretch out those tight capsular tissues.
Soft tissue massage works the muscles around your shoulder. Your therapist targets trigger points in your neck, chest, and upper back—these spots often pick up the slack for your stiff shoulder.
Myofascial release goes after the connective tissue around your shoulder muscles. This technique restores tissue flexibility and clears up restrictions.
Sometimes, your therapist brings out instrument-assisted soft tissue mobilization. Tools can break down scar tissue more effectively than hands alone.
Manual therapy usually takes up 15-20 minutes of your appointment. Your therapist pairs these techniques with your exercise routine for the best shot at recovery.
Pain Management Techniques and Strategies
Managing pain well makes it so much easier to stick with your rehab. At your physiotherapy clinic, you’ll find a bunch of ways to tackle discomfort and swelling.
Heat and cold therapy can bring quick relief during sessions. Ice knocks down inflammation and pain, while heat gets your tissues loosened up for stretching.
Electrical stimulation interrupts pain signals before they really hit your brain. TENS units are handy—take one home and use it between appointments if you like.
Gentle traction decompresses your shoulder joint. That takes pressure off cranky tissues and lets you move more freely.
Your physiotherapist will show you some ergonomic adjustments for daily stuff. Just tweaking how you sleep or work can really protect your healing shoulder.
Sometimes, it’s about timing exercises to line up with when your pain meds work best. Your therapist can help you figure out when you’re most comfortable for treatment.
Activity modification is a big deal for avoiding flare-ups. You’ll learn which moves to skip and how to adapt things until your shoulder’s ready for more.