Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, occurs when the capsule surrounding the shoulder joint becomes inflamed, thickens and tightens, progressively restricting movement. It typically develops gradually over weeks to months, without an obvious injury, and can significantly limit your ability to reach overhead, get dressed, or sleep on the affected side. It’s most common in adults over 40, and somewhat more common in women, though anyone can develop it.

Left untreated, frozen shoulder tends to follow a long natural course, often taking one to three years to fully resolve on its own. Physiotherapy doesn’t necessarily shorten every stage of this process, but it can meaningfully ease pain and speed the return of movement, which is why starting treatment early — as soon as restricted movement is noticed — tends to make a real difference to how the condition is experienced.

What causes frozen shoulder

The exact trigger for frozen shoulder often isn’t clear, though it’s more common in people with diabetes, thyroid conditions, or following a period of shoulder immobility — after surgery or an injury elsewhere in the body, for example, where the shoulder simply hasn’t been moved through its full range for an extended period. Frozen shoulder typically progresses through three recognisable stages: a painful “freezing” stage where movement becomes increasingly restricted and pain is often worst at night; a “frozen” stage where pain may begin to ease but stiffness remains severe and limiting; and a “thawing” stage where movement gradually returns, sometimes over many months.

When to see a physiotherapist

Most shoulder stiffness that develops gradually, without an obvious injury, is worth having assessed reasonably promptly, since frozen shoulder tends to respond better the earlier treatment starts — particularly during the painful freezing stage. That said, sudden, severe shoulder pain following a fall or direct injury, an obvious deformity, or an inability to move the arm at all after trauma should be assessed urgently to rule out a fracture or dislocation rather than assumed to be frozen shoulder. Shoulder pain accompanied by fever, feeling unwell, or significant swelling and redness also warrants prompt medical review. Andrew’s assessment can also help distinguish frozen shoulder from a rotator cuff injury, since the two can feel similar early on but need different treatment approaches.

Physiotherapy treatment for frozen shoulder

Treatment is matched to which stage you’re in, since the priorities — and what the shoulder can tolerate — change considerably from the painful freezing stage through to the stiffer frozen stage. Andrew draws on the full range of tools available for this condition:

• Manual therapy to gently mobilise the joint and surrounding tissue, protecting it during the painful stage and progressively restoring range of motion as stiffness becomes the main issue.
• Dry needling to help ease the muscle guarding and tension that often builds up around a painful, restricted shoulder.
• Shockwave therapy as an additional option for managing pain and stimulating tissue healing, particularly where progress has plateaued.
• Electrotherapy, such as TENS, to help manage pain — particularly useful during the freezing stage when pain, rather than stiffness, is the main limiting factor.
• Exercise rehabilitation — a progressive, staged stretching and strengthening programme that becomes the main focus once the acute pain has settled, aimed at actively restoring the range of motion that’s been lost.

Activity modification advice is also part of early treatment, helping protect the joint from unnecessary provocation during the most painful phase without becoming so protective that stiffness is allowed to worsen unchecked.

What to expect from treatment

Andrew will identify which stage of frozen shoulder you’re in and explain what to expect over the coming weeks and months, since this shapes the whole treatment approach — pain relief and protection early on, then a shift toward more assertive stretching and strengthening once the acute pain has eased. Progress with frozen shoulder is often slower and less linear than with other shoulder conditions, given how long the underlying capsular changes take to resolve, so realistic expectations from the outset help avoid frustration partway through.

Distinguishing frozen shoulder from other shoulder pain

Because frozen shoulder shares some features with other shoulder conditions — pain with overhead movement, discomfort at night — an accurate diagnosis matters for choosing the right treatment approach. The hallmark of true frozen shoulder is a global restriction affecting movement in every direction, including passive movement where someone else moves your arm for you, rather than pain or weakness limited to specific movements. Andrew’s assessment looks specifically for this pattern to confirm the diagnosis before treatment begins.

Recovery timeline

Frozen shoulder’s natural course can take one to three years without treatment, though many people find that consistent physiotherapy through each stage noticeably improves both pain and how quickly useful movement returns, compared with no treatment at all. Because the condition can, rarely, recur in the same shoulder or develop in the other shoulder over time — particularly in people with diabetes — staying attentive to early signs of stiffness afterward is worthwhile.