Frozen shoulder can be frustrating because pain and stiffness often develop gradually and recovery can take time. Understanding the condition and matching treatment to its stage can make it much easier to manage.
What is frozen shoulder?
Frozen shoulder, or adhesive capsulitis, occurs when the capsule surrounding the shoulder joint becomes painful, irritated and stiff. Shoulder movement becomes restricted in several directions, particularly reaching overhead, behind the back or out to the side.
It may develop without an obvious cause, although it is more common after a period of immobilisation and in people with diabetes or thyroid conditions.
The stages of frozen shoulder
The freezing stage is usually dominated by increasing pain and gradually worsening movement. Night pain is common.
During the frozen stage, the shoulder remains stiff, but the severe pain may begin to settle.
The thawing stage involves a gradual return of movement and function. These stages overlap, and not everyone follows exactly the same pattern.
How is it diagnosed?
Diagnosis is usually based on the history and a clear restriction in both active and passive shoulder movement. Your physiotherapist will also screen for rotator cuff problems, arthritis, neck-related pain and other possible causes.
Imaging may be used when the diagnosis is uncertain, but a scan is not always necessary.
Early treatment and corticosteroid injection
A corticosteroid injection may provide meaningful short-term improvement in pain and function, particularly during the early painful stage. It is worth discussing this option with your GP when pain is severe, sleep is significantly affected or progress is difficult.
An injection is not a stand-alone cure. Better pain control can create an opportunity to move the shoulder and participate more comfortably in rehabilitation.
How can physiotherapy help?
Treatment should reflect the shoulder’s irritability. Manual therapy may include joint mobilisation and soft-tissue treatment to improve comfort and movement. Very forceful treatment is not appropriate when the shoulder is highly painful.
Rehabilitation often begins with comfortable range-of-motion exercises and gentle isometric strengthening. As pain becomes more stable, strengthening and movement are gradually progressed.
In suitable people, heavier resistance and eccentric exercise may later help improve strength and range. The correct timing matters—pushing too hard during a highly irritable stage can aggravate symptoms.
How long does it take?
Frozen shoulder often takes many months to improve, and some cases take one to three years to fully settle. This does not mean nothing can be done in the meantime.
Physiotherapy can help control pain, maintain available movement, restore strength and guide progression through each stage. Most people ultimately recover useful movement and function, even if the process is slower than they would like.