Frozen Shoulder: Causes, Treatment, and How Physiotherapy Can Help

Frozen shoulder, or adhesive capsulitis, is a painful and often frustrating condition that severely limits shoulder movement. It tends to develop gradually, restrict daily activities, and can last months to years if untreated.

If you’ve been Googling “why can’t I lift my arm,” “shoulder pain at night,” or “treatment for frozen shoulder,” you’re not alone. This condition affects about 2–5% of the population, and up to 20% of people with diabetes.

Let’s break down the causes, treatment options, and the vital role physiotherapy plays in managing frozen shoulder.

What Is Frozen Shoulder?

Frozen shoulder occurs when the capsule of connective tissue around the shoulder joint becomes thickened and tight, restricting movement and causing pain. Over time, scar tissue forms, further limiting range of motion.

There are three classic phases:

1. Freezing Phase (painful, motion becomes limited)

2. Frozen Phase (less pain, but very stiff)

3. Thawing Phase (gradual return of mobility)

Each phase can last several months, and the entire cycle may span 1–3 years without intervention.

Primary vs. Secondary Causes

Primary Frozen Shoulder

• Occurs without a clear trigger

• Often linked to hormonal or autoimmune factors

• Most common in women aged 40–60

• Common among people with:

• Diabetes

• Thyroid disorders

• Heart disease

• Autoimmune conditions

Secondary Frozen Shoulder

• Develops after an injury, surgery, or prolonged immobilization

• Triggered by:

• Shoulder fractures or dislocations

• Rotator cuff injuries

• Post-mastectomy recovery

• Stroke or neurological conditions

• Post-surgical immobilization (e.g., after tendon repair or fracture surgery)

Understanding whether your frozen shoulder is primary or secondary can guide treatment and help address underlying factors.

Treatment Options for Frozen Shoulder

There’s no one-size-fits-all treatment, but early intervention can significantly reduce pain and recovery time.

🔹 1. Medication

• NSAIDs (e.g., ibuprofen) reduce pain and inflammation

• Oral corticosteroids for short-term relief in acute cases

• Corticosteroid injections into the shoulder joint for targeted relief

🔹 2. Heat/Ice Therapy

• Heat before stretching to loosen tissue

• Ice after activity to reduce inflammation

🔹 3. Hydrodilatation

• Injection of saline and steroid into the joint to stretch the capsule—may help in early stages

🔹 4. Surgery (rare)

• Manipulation under anesthesia (MUA) or arthroscopic capsular release

• Reserved for severe, non-responsive cases

The Role of Physiotherapy in Frozen Shoulder Recovery

Physiotherapy is the cornerstone of frozen shoulder treatment. Whether you're in the early painful phase or later recovering mobility, physio plays a role in each stage.

Key Benefits of Physiotherapy:

• Reduces pain without medication

• Prevents further stiffness and muscle wasting

• Speeds up the “thawing” process

• Improves posture and compensatory movement patterns

What Physiotherapy Typically Includes:

• 1. Passive & Active Range of Motion Exercises

  • Help maintain or restore movement, especially in abduction and external rotation

  • Gradual, controlled movement is essential to avoid inflammation

  2. Joint Mobilizations

  • Hands-on techniques to gently stretch the capsule and improve glide in the joint

  3. Manual Therapy

  • Soft tissue release and massage to reduce muscle tension and improve circulation

  4. Stretching & Strengthening

  • Targeted programs for rotator cuff and scapular stabilizers

  • As range returns, focus shifts to functional strength and endurance

  5. Postural Training

  • Correct poor biomechanics that may contribute to or result from shoulder compensation

  6. Home Exercise Program

  • Patients are given tailored exercises to perform daily at home—consistency is key

When to See a Physiotherapist

The earlier, the better—especially in the freezing stage, when pain starts to restrict movement. A physiotherapist can:

• Identify the stage of your condition

• Provide pain relief strategies

• Prevent severe stiffness and long-term mobility loss

Final Thoughts: Recovery Is Possible

Frozen shoulder can feel like it came out of nowhere—and its slow progression makes it especially frustrating. But with the right approach, including physiotherapy, most people make a full recovery and regain full shoulder function.

If you’re experiencing unexplained shoulder stiffness or pain, don’t wait. A physiotherapy assessment can help diagnose, treat, and speed up your recovery—so you can get back to reaching, lifting, and living pain-free.