Frozen Shoulder: Medically Known as Adhesive Capsulitis
Why Frozen Shoulder Is a Distinct Condition of the Shoulder Capsule — Not Just General Stiffness or Pain-Limited Movement
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Frozen shoulder is one of the most talked-about shoulder conditions — and one of the most commonly mislabelled.
It is frequently used as a catch-all term for any painful, stiff shoulder. In reality, true adhesive capsulitis is a very specific condition with a recognisable pattern and predictable behaviour. Accurate diagnosis matters.
A shoulder that is stiff because it hurts is not the same as a shoulder that is stiff because the joint capsule has physically tightened. The management is different. The progression is different. The expectations are different.
Understanding that distinction is the starting point so this page will explain:
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A Specific Capsular Condition — Not Just a Stiff Shoulder
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Why Frozen Shoulder Is Often Over-Diagnosed
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Who Typically Develops Frozen Shoulder?
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The “Freezing, Frozen, Thawing” Model
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How Patients Commonly Describe It
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The Role of Diagnostic Imaging
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Treatment and Management
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Management During the Freezing Phase
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Management During the Frozen Phase
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Management in the Thawing Stage
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Recovery Timescales
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When It Is Probably Not Frozen Shoulder
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Summary
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Frozen Shoulder FAQ's
A Specific Capsular Condition — Not Just a Stiff Shoulder
Frozen shoulder is a condition affecting the shoulder joint capsule — the strong fibrous envelope that surrounds the ball-and-socket joint and helps stabilise it.
The capsule is not just a passive wrapping. It is a layered structure containing collagen fibres, synovial tissue, and mechanoreceptors. It allows movement while maintaining joint integrity. In a healthy shoulder, it has enough elasticity to permit full range in multiple planes.
In adhesive capsulitis, this capsule undergoes a pathological process.
Initially, there is inflammation within the synovial lining of the capsule. This inflammatory phase is often responsible for the early pain and night discomfort patients describe. Over time, that inflammation triggers fibrotic change — meaning the capsule begins to thicken and lay down denser collagen tissue.
As this fibrotic process progresses, the capsule becomes:
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Thicker
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Less elastic
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Less compliant under stretch
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Mechanically tighter around the joint
The joint volume effectively reduces. The capsule physically restricts movement. This is why the restriction is not simply protective or pain-related — it is structural.
The key word here is mechanical.
In many shoulder problems, movement is limited because the body is guarding against pain. The muscles tighten reflexively. The nervous system increases protective tone. If pain is reduced — through reassurance, analgesia, or time — movement often improves.
In frozen shoulder, even when the inflammatory pain begins to settle, the capsular contraction remains. The joint does not move further because it cannot move further without physically stretching a thickened, fibrotic structure.
This persistence of restriction — particularly loss of external rotation and global passive range — is one of the defining clinical features of adhesive capsulitis.
It is not simply that the shoulder hurts to move. It is that the capsule no longer allows normal excursion. That distinction changes how we manage it.
Why Frozen Shoulder Is Often Over-Diagnosed
Reduced shoulder movement is common. In fact, it is one of the most frequent findings in musculoskeletal shoulder assessment.
But reduced movement on its own does not define adhesive capsulitis.
A shoulder may appear stiff for many reasons. Pain alters movement patterns. Muscles tighten protectively. The nervous system increases guarding around an irritated joint. Patients instinctively avoid positions that provoke symptoms. All of this can create the impression of a “frozen” joint when, in reality, the underlying issue is pain rather than true mechanical restriction.
Several common shoulder conditions can present with reduced range of motion:
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Rotator cuff pathology
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Subacromial pain
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Post-injury guarding
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Osteoarthritis
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Biceps tendon irritation
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Post-surgical stiffness
In many of these cases, the limitation is primarily pain-driven. The patient may stop moving because it hurts. The muscles may tighten reflexively. The shoulder may feel blocked — but when pain is reduced, or when the examiner carefully guides the movement, range often improves.
That improvement is clinically significant.
In true adhesive capsulitis, passive movement remains restricted even when the examiner moves the joint and the patient relaxes.
The limitation is not simply a protective response. It is structural.
The capsule has thickened and contracted. The joint volume has reduced. The tissue physically resists stretch. Even with reassurance, careful positioning, and controlled handling, the end range feels firm and restricted.
This is the distinction that is often missed.
If a shoulder can be moved significantly further once guarding settles, or once pain is controlled, it is unlikely to be true frozen shoulder.
Over-diagnosis tends to occur when any middle-aged patient with shoulder pain and stiffness is labelled with adhesive capsulitis without confirming the defining features. A diagnosis should not be made based on age and stiffness alone.
There are specific clinical characteristics that support the diagnosis:
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A progressive pattern of increasing stiffness
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Marked loss of external rotation, abduction and internal rotation
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Similar restriction in active and passive movement
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Persistence of restriction even as pain fluctuates
Without these features, the diagnosis should be reconsidered.
If stiffness is primarily pain-related, treatment should focus on load management, tendon rehabilitation, or addressing the primary pathology. If the capsule is genuinely contracted, expectations and management strategies change.
Misdiagnosis can lead to either overtreatment — repeated aggressive stretching during an irritable phase — or undertreatment, where a patient is simply told to “wait it out” without structured guidance. Accurate diagnosis is not about attaching a name. It is about understanding the mechanism driving the restriction.
Who Typically Develops Frozen Shoulder?
Frozen shoulder most commonly affects people between the ages of 40 and 60.
It is unusual in younger individuals unless there has been surgery, significant trauma, or an underlying systemic condition. Likewise, while it can occur outside this age range, its peak incidence is very clearly within midlife.
It is also more common in women than men. The reasons for this are not fully understood, but hormonal and autoimmune influences are thought to play a role. Frozen shoulder is not simply a mechanical wear-and-tear problem — it appears to have a biological component that makes certain individuals more susceptible.
One of the strongest associations is with diabetes.
Individuals with diabetes are significantly more likely to develop adhesive capsulitis, and when they do, it can be more severe and more prolonged. The exact mechanism is still debated, but altered collagen metabolism and glycosylation of connective tissue are thought to reduce tissue elasticity and promote capsular thickening.
In practical terms, if someone with diabetes develops progressive shoulder stiffness, frozen shoulder moves higher up the diagnostic list.
Thyroid disorders are also associated with an increased risk. Both hypothyroidism and hyperthyroidism have been linked to adhesive capsulitis. Again, the underlying mechanism likely relates to systemic inflammatory and connective tissue changes rather than simple mechanical overload.
Autoimmune conditions appear to increase susceptibility as well, supporting the idea that frozen shoulder is not purely a mechanical problem but involves an inflammatory and fibrotic process within the capsule.
In some cases, frozen shoulder develops following shoulder injury or surgery. This is sometimes referred to as secondary adhesive capsulitis. Here, the inflammatory process may be triggered by trauma or post-operative irritation, eventually leading to capsular tightening.
However, many cases arise without a clear mechanical cause at all. There may be no single injury, no obvious overload event, and no clear trigger. The shoulder simply becomes painful and progressively stiff.
This is important.
Frozen shoulder is not typically caused by gym training errors, posture, sleeping position, or poor lifting technique. It is not a condition that develops because someone “did something wrong.”
While reduced movement following pain can contribute to stiffness, adhesive capsulitis itself is a capsular pathology — not a simple consequence of underuse or poor mechanics.
Understanding who is at risk helps frame expectations and supports accurate diagnosis. But risk factors alone are not diagnostic. They increase probability; they do not confirm the condition.
The “Freezing, Frozen, Thawing” Model
Frozen shoulder is commonly described in three phases: freezing, frozen, and thawing.
Most patients will have heard these terms before. They sound neat and predictable — almost as if the shoulder follows a seasonal calendar, moving obediently from one phase to the next.
In reality, it is rarely that tidy.
The stages do not switch cleanly. They overlap. The timelines vary. Some people move through them more quickly, others more slowly. That said, the model is useful — provided we understand what each stage actually represents.
Stage One: The Freezing Phase
The freezing phase is typically the most painful stage of the condition.
Pain develops gradually and often becomes more noticeable at night. Many people describe difficulty sleeping on the affected side or waking with deep shoulder discomfort. At the same time, movement begins to reduce — particularly external rotation. Reaching behind the back or rotating the arm outward often becomes noticeably restricted.
During this stage, the capsule is inflamed and irritable. It is not simply tight; it is biologically active. The inflammatory process within the capsule makes the joint sensitive and reactive.
This is also the phase where frozen shoulder is frequently mismanaged.
Aggressive stretching is often prescribed in an attempt to “prevent stiffness.” However, forcing movement in an inflamed capsule does not speed recovery. In many cases, it increases irritability and prolongs discomfort.
The aim during this stage is not to aggressively restore range, but to manage symptoms while maintaining gentle, tolerable movement.
The freezing phase can last several months.
Stage Two: The Frozen Phase
As the condition progresses, pain often reduces compared to the earlier stage. It does not necessarily disappear, but it tends to be less intense and less reactive.
Stiffness, however, becomes more pronounced.
The defining feature in this phase is global restriction of movement. External rotation is usually the most limited direction, but elevation and internal rotation are also reduced. Importantly, active and passive movements are restricted to a similar degree.
This is not weakness. It is not fear avoidance. It is not simply guarding. It is capsular tightness. The joint physically cannot move through its previous range because the capsule has thickened and contracted. Everyday tasks such as dressing, fastening a bra, placing a wallet in a back pocket, or reaching overhead become mechanically difficult rather than simply painful.
The frozen phase may persist for several months.
Stage Three: The Thawing Phase
Gradually, the capsule begins to regain elasticity.
Movement improves slowly and progressively. The shoulder does not suddenly “unfreeze.” Gains in range tend to occur incrementally over time. Some days feel better than others, but the overall trajectory is toward improvement.
Strength often lags behind the return of range. Even as movement improves, the shoulder may feel weak or hesitant due to prolonged underuse. The thawing phase can continue for many months. Some individuals regain near-normal range and function. Others retain mild long-term restriction, particularly in external rotation.
The key point is that recovery is gradual. Understanding this natural progression helps set realistic expectations and prevents overreaction to temporary plateaus or fluctuations.
How Patients Commonly Describe It
True adhesive capsulitis has a recognisable story.
Patients rarely describe a single dramatic event. Instead, they often talk about something that began subtly and gradually worsened over time. The early complaint is usually a deep, poorly localised shoulder ache. It is not sharp in the way tendon pain can be. It often feels internal — “in the joint” — rather than in the muscle. Many describe it as a dull, persistent discomfort that becomes more noticeable at night.
Sleep disturbance is common in the early phase. Patients frequently report waking when rolling onto the affected side, or struggling to find a comfortable position. Night pain is often out of proportion to daytime activity. As the condition progresses, stiffness becomes more noticeable than pain.
People start to describe difficulty with specific movements:
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Reaching up into a cupboard feels restricted rather than simply sore.
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Putting on a coat becomes awkward.
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Fastening a bra or reaching into a back pocket becomes difficult.
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Washing or tying hair becomes surprisingly challenging.
One of the most consistent complaints is difficulty reaching behind the back. Another is loss of external rotation — the ability to rotate the arm outward — although patients rarely describe it in those technical terms. Instead, they say:
“It just won’t go any further.”
That phrase is important. In adhesive capsulitis, the shoulder feels blocked by something firm and unyielding. Patients often demonstrate the movement stopping abruptly, even when they are trying to push through it.
The pattern is typically progressive. Range reduces over weeks to months. It does not usually disappear overnight. Patients often report that they first noticed mild discomfort, then increasing stiffness, then greater difficulty with daily tasks. This gradual progression distinguishes it from other shoulder problems.
If symptoms began after a clear traumatic event — such as a fall — and were immediately accompanied by marked weakness or inability to lift the arm, rotator cuff pathology should be considered first.
Similarly, if movement fluctuates significantly day to day depending on pain levels, or improves markedly once pain settles, true adhesive capsulitis becomes less likely.
Another important feature is that patients often report frustration more than sharp pain during the later stages. They feel limited rather than acutely injured. They may say:
“It doesn’t really hurt as much now — it just won’t move.”
That shift from pain-dominant to stiffness-dominant symptoms is characteristic of the transition from the freezing to the frozen phase.
Understanding how patients describe the condition helps differentiate adhesive capsulitis from:
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Pain-driven movement restriction
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Tendon overload
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Acute injury
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Postural or muscular tightness
The history tells you a great deal before you even examine the shoulder.
The Role of Diagnostic Imaging
Frozen shoulder is primarily a clinical diagnosis. It is diagnosed based on history and physical examination — particularly the pattern of progressive stiffness and the presence of a capsular restriction pattern.
Imaging is not required to confirm adhesive capsulitis in most straightforward cases.
What Imaging Can Show
MRI and ultrasound can demonstrate features associated with frozen shoulder, including:
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Thickening of the joint capsule
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Reduced joint volume
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Thickening of the coracohumeral ligament
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Inflammatory changes within the capsule
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However, these findings are not always necessary to make the diagnosis. In many cases, imaging simply confirms what is already clinically apparent. It will not change your advice or recovery process.
What Imaging Cannot Tell You
Imaging cannot determine:
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Which phase the shoulder is in
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How irritable the capsule is
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How functionally limiting the stiffness feels
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How quickly recovery will occur
Most importantly, imaging cannot replace physical examination. Frozen shoulder is defined by its mechanical restriction pattern — particularly loss of passive external rotation — not by a scan result alone.
The Risk of Over-Imaging
MRI scans of middle-aged shoulders often reveal incidental findings:
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Rotator cuff tendinopathy
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Partial tears
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Bursal thickening
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Mild degenerative change
These findings are common and frequently unrelated to the primary complaint. If imaging is performed early and these findings are overemphasised, it can distract from the correct diagnosis and create unnecessary concern.
A patient may be told they have a tear, when in fact their primary limitation is capsular.
When Is Imaging Appropriate?
Imaging may be considered when:
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The presentation is atypical
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There is a history of significant trauma
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Weakness is disproportionate to stiffness
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Symptoms fail to follow a typical frozen shoulder pattern
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Another pathology needs to be excluded
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In cases where diagnosis is uncertain, imaging can help clarify the picture. But in a clinically classic presentation, it is not routinely required.
A Practical Perspective
If the history and examination demonstrate:
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Progressive stiffness
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Global restriction
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Marked loss of passive external rotation
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No significant traumatic trigger
then the diagnosis can usually be made confidently without immediate imaging. The focus should remain on management rather than scanning for confirmation. Imaging should support clinical reasoning — not replace it.
In some cases, your practitioner may recommend imaging to rule out alternative causes for your symptoms — particularly if the presentation is atypical or not following the expected pattern. That is entirely appropriate when clinical findings are unclear.
However, in the majority of cases, frozen shoulder follows a recognisable course and improves gradually over time.
Because of this natural history, it is important that management remains proportionate. When recovery is biologically likely to occur, treatment should support that process — not attempt to aggressively accelerate it beyond what the tissue can tolerate.
Over-treatment, particularly during irritable phases, can prolong symptoms rather than shorten them. It can also create unrealistic expectations about how quickly a capsular condition should resolve.
Ethically, the goal is not to “do more” for the sake of doing more.
It is to intervene thoughtfully, support the shoulder appropriately, and allow the biological process to unfold without unnecessary escalation. In most cases, steady and measured management leads to good long-term outcomes.
Treatment and Management
Management of frozen shoulder is stage-dependent.
The mistake often made is applying the same treatment approach throughout the entire condition. Adhesive capsulitis changes over time. The biology changes. The irritability changes. The goals of rehabilitation change.
Understanding what phase the shoulder is in determines how assertive — or restrained — treatment should be.
Management During the Freezing Phase
In the early freezing stage, the capsule is inflamed and irritable. Pain is usually the dominant symptom. Night pain is common. Movement is progressively reducing. This is not the stage for aggressive stretching. Repeated end-range mobilisation, forceful stretching, or high-intensity strengthening does not “break down adhesions” in this phase. In many cases, it simply increases irritation and prolongs discomfort.
The priorities during the freezing phase are:
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Symptom management
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Maintaining tolerable movement
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Preventing unnecessary deconditioning
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Educating the patient about the likely progression
Gentle, controlled mobility work can help maintain range without provoking flare-ups. Load modification may be needed — particularly reducing repeated overhead or sustained end-range activities.
Physiotherapy at this stage is less about forcing mobility and more about guiding the condition appropriately. It involves pacing, reassurance, and helping the patient understand what is happening. It does not need to be regular - just intermittant guidance at most.
Interventions such as corticosteroid injections may be considered in some cases during this irritable stage, particularly when pain is severe and significantly affecting sleep or daily function. It should be clear however that there is no quality evidence that shows injections at this stage change either the course or duration of the process, only the acute pain in the initial phase. For this reason the risk and reward has to be carefully managed. These decisions are individual and context-specific. The key message is restraint.
Overly aggressive therapy during this phase often worsens symptoms rather than improving them.
Management During the Frozen Phase
As the condition progresses, pain often reduces and stiffness becomes the dominant issue. By this stage, the capsule is typically less inflamed and more fibrotic. The acute biological irritability has settled to some degree, even though the mechanical restriction remains. Range may still be significantly limited, but the shoulder is generally less reactive than it was during the early freezing phase.
This shift changes the emphasis of management.
The frozen phase is not about forcing movement back quickly. Nor is it about passively waiting for recovery to begin.
It is about preparing the shoulder for the thawing phase. At this point, more structured mobility work can become appropriate — but only if the shoulder is sufficiently beyond the highly irritable stage. Timing matters. If stretching is introduced too early or progressed too aggressively, it can trigger renewed inflammation and increased pain, effectively pushing the condition backwards.
Clinical judgement here is key.
Signs that the shoulder may be ready for more structured mobility work include:
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Reduced night pain
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Minimal prolonged flare following activity
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Symptoms that settle within a predictable timeframe
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Improved tolerance to low-level loading
If mobility work repeatedly increases night pain or leads to prolonged soreness lasting days, the capsule is not yet ready for that level of intervention.
When irritability is lower and the shoulder tolerates controlled loading without significant flare, progressive stretching and mobilisation can be introduced more confidently. Even then, the goal is not dramatic short-term gains.
The aim during the frozen phase is to:
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Maintain as much tolerable mobility as possible
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Prevent secondary stiffness in surrounding tissues
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Preserve strength within available range
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Maintain movement confidence
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Avoid setbacks that reintroduce inflammatory irritability
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Gradual stretching within tolerance can help encourage capsular adaptation, but progress is typically slow and incremental. The capsule does not remodel quickly.
Manual therapy may provide short-term improvements in mobility for some individuals, but it should not be presented as a cure. The primary driver of change remains consistent, repeated, tolerable movement over time.
Education is equally important during this stage. Many patients become frustrated because pain has improved, yet function has not returned. Understanding that this phase is about positioning the shoulder for recovery — rather than rapidly reversing stiffness — helps set realistic expectations. Rehabilitation during the frozen phase is strategic preparation.
The goal is to ensure that when capsular elasticity begins to return during the thawing phase, the shoulder is strong, mobile within its limits, and ready to progress — not deconditioned or repeatedly inflamed.
Frozen shoulder rarely responds well to force. It responds better to steady, measured input over time.
Management in the Thawing Stage
In the thawing phase, movement begins to return more noticeably. Patients often describe this as the shoulder feeling “looser” or less blocked. Range improves gradually, particularly in external rotation and elevation. The sharp night pain of the early stage is usually much reduced, and the joint feels less reactive overall.
However, as range improves, another issue becomes clearer: weakness.
Months of reduced movement and guarded use often lead to significant deconditioning of the rotator cuff and surrounding musculature. The shoulder may have adapted to limited range by relying on compensatory movement patterns — excessive scapular elevation, trunk side-bending, or avoidance of end range positions.
When the capsule begins to loosen, those compensations become more obvious. Rehabilitation during this phase shifts from protection and preparation toward restoration.
The focus becomes:
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Rebuilding strength through progressively loaded exercise
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Restoring muscular endurance for sustained activity
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Improving coordination and movement quality
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Gradually reintroducing higher-level functional tasks
Strengthening now becomes central rather than secondary. The goal is not simply to regain range, but to ensure that the regained range is usable, controlled, and confident. Mobility work may still be required, particularly if specific ranges remain limited. However, stretching is no longer the dominant focus. Instead, mobility is integrated into active movement and strengthening work.
Another common feature in this phase is hesitation. Even as range improves, patients often feel vulnerable using the shoulder near end range. There may be a psychological reluctance to load it fully. This is understandable — the shoulder has felt restricted and unreliable for months.
Progressive strengthening plays an important role here. It restores not just muscle capacity, but trust in the joint. As strength improves and movement feels more stable, confidence follows. Functional reintroduction should also be deliberate.
Tasks such as:
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Reaching overhead repeatedly
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Lifting weight away from the body
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Returning to sport
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Performing sustained manual work
should be phased in gradually, rather than resumed abruptly.
Although the thawing phase often feels more positive and encouraging, it still requires patience. Range does not return overnight. Strength takes time to rebuild. Fatigue can still occur more quickly than expected. Some stiffness may persist at end range for months.
The goal during this phase is full functional recovery — not just improved range. With steady progression, most individuals regain strong, confident shoulder use, even if minor range differences remain compared to the unaffected side.
Recovery Timescales
Frozen shoulder has a prolonged and biologically driven course. It is not a condition that resolves in a few weeks with stretching. It represents a capsular inflammatory and fibrotic process, and connective tissue remodelling occurs slowly.
Understanding this biology is important because expectations shape decision-making.
How Long Does It Last?
The classical description suggests:
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A freezing phase lasting several months
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A frozen phase that may persist for a similar duration
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A thawing phase extending overall recovery to 12–24 months
Those timelines are averages, not rules.
Some individuals move through the stages more quickly. Others take considerably longer. In clinical practice, a total course of 12–18 months is common. For some, mild residual stiffness may persist beyond that.
The length of recovery does not automatically reflect poor treatment. It reflects the pace at which capsular tissue remodels.
Why Does It Take So Long?
The capsule is dense connective tissue. In the freezing phase, inflammation alters its structure. In the frozen phase, fibrosis and contracture develop. In the thawing phase, gradual remodelling and length adaptation occur.
Collagen does not reorganise rapidly. Capsular elasticity returns slowly. Attempting to accelerate this aggressively often increases irritability rather than shortening the course.
Recovery is therefore governed by biology as much as by rehabilitation.
What Does “Recovery” Actually Mean?
Recovery in frozen shoulder does not always mean:
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Perfect symmetry with the opposite side
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Identical external rotation
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Complete elimination of every sensation of stiffness
For many people, recovery means:
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Minimal or no pain
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Functional range for daily tasks
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Strength restored
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Confidence in shoulder use
Mild residual end-range restriction can remain in some individuals without causing meaningful limitation. The goal is functional restoration, not cosmetic symmetry.
Factors That Influence Recovery
Several factors can influence the course:
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Diabetes (often associated with longer duration and increased stiffness)
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Thyroid disorders
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Previous shoulder surgery
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Bilateral involvement
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Severity at onset
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Prolonged immobilisation
People with diabetes are statistically more likely to experience prolonged stiffness and, in some cases, involvement of the opposite shoulder at a later stage.
Importantly, frozen shoulder can occasionally affect both shoulders — either simultaneously or sequentially.
Plateaus and Fluctuations
Recovery is rarely linear. There are often periods where progress seems to stall. Temporary flare-ups can occur, particularly if loading increases too quickly.
A short-term increase in discomfort does not necessarily indicate regression of the condition. It often reflects exceeding current tissue tolerance rather than structural worsening.
Understanding this prevents two common mistakes:
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Over-treating aggressively in an attempt to “speed it up”
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Abandoning rehabilitation prematurely because improvement feels slow
The Role of Treatment in Timeline
Treatment does not eliminate the biological phases.
However, appropriate management can:
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Reduce unnecessary irritability
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Prevent secondary stiffness
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Maintain strength
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Improve function during each stage
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Reduce frustration and uncertainty
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The aim is not to rush the capsule beyond what it can tolerate. It is to support the shoulder through each phase in the most effective and least disruptive way possible.
When It Is Probably Not Frozen Shoulder
Not every stiff shoulder is adhesive capsulitis. There are several situations where the diagnosis should be reconsidered.
If movement improves significantly once pain settles, the restriction is likely pain-driven rather than capsular. If there was a clear traumatic event followed by immediate weakness — particularly difficulty lifting the arm — rotator cuff pathology should be considered first.
If stiffness is isolated to one direction without a global capsular pattern, alternative causes such as tendon pathology or joint degeneration may be more likely. If passive range is near normal but active movement is limited, weakness rather than capsular contracture is usually responsible.
Similarly, if symptoms fluctuate dramatically from day to day depending on activity or fatigue, the pattern may not fit adhesive capsulitis.
True frozen shoulder has a recognisable progression:
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Gradual onset
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Progressive loss of passive range
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Marked restriction of external rotation
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Persistence of stiffness even as pain changes
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When those features are absent, careful reassessment is appropriate. Applying the frozen shoulder label too quickly can delay the correct diagnosis and lead to management that does not address the real underlying issue.
Summary — What You Need to Know About Frozen Shoulder
Frozen shoulder, or adhesive capsulitis, is a specific capsular condition — not simply a painful or stiff shoulder. It involves an inflammatory and fibrotic process affecting the shoulder joint capsule, leading to progressive mechanical restriction of movement. The defining feature is true capsular stiffness, particularly loss of passive external rotation, rather than movement limited only by pain.
Not every stiff shoulder is frozen shoulder.
Accurate diagnosis depends on pattern recognition — progressive onset, global restriction, and persistent loss of passive range.
The condition typically progresses through phases commonly described as freezing, frozen and thawing. While these stages are helpful conceptually, they rarely follow a perfectly neat timeline. Recovery is gradual and biologically driven.
Management must be stage-specific:
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During the freezing phase, treatment focuses on irritability control and avoiding unnecessary aggravation.
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During the frozen phase, the emphasis shifts toward maintaining mobility and preparing the shoulder for recovery.
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During the thawing phase, rehabilitation becomes more active, rebuilding strength, endurance and functional confidence.
Aggressive treatment early on does not shorten the condition and can sometimes worsen symptoms. Equally, doing nothing without guidance can lead to unnecessary deconditioning.
Most individuals make a good recovery over time.
Recovery does not always mean identical symmetry with the other shoulder, but it usually means:
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Minimal or no pain
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Functional range for daily activities
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Restored strength
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Confidence in shoulder use
Frozen shoulder is frustrating because of its duration — not because it is typically destructive. With appropriate diagnosis, realistic expectations, and proportionate management, the condition can be navigated effectively without unnecessary intervention.
Understanding the biology, respecting the stage, and progressing strategically are the keys to good outcomes.
Educational Notice
This content is intended for educational guidance only and reflects current evidence and clinical reasoning at the time of publication. It does not replace individual assessment, diagnosis, or treatment provided by your healthcare practitioner. Management decisions should always be based on personalised clinical evaluation.
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Frozen Shoulder FAQ’s
1) How do I know if I have frozen shoulder?
Frozen shoulder usually starts with a gradual increase in pain, especially with reaching and twisting movements, followed by a noticeable loss of movement in all directions. Tasks such as fastening a bra, reaching into a cupboard, or putting on a jacket become difficult. A proper assessment can distinguish frozen shoulder from rotator cuff problems, bursitis, arthritis, or simple stiffness.
2) Why does frozen shoulder happen?
The shoulder capsule — a thin, flexible envelope surrounding the joint — becomes irritated and thickened. As it tightens, movement becomes painful and restricted. For many people there’s no clear trigger, but it can also follow injury, surgery, or periods of reduced shoulder use. Conditions such as diabetes or thyroid disorders increase the likelihood of developing it.
3) Will frozen shoulder get better on its own?
In most cases, yes — but often very slowly. Frozen shoulder follows a natural cycle that can last from several months to a few years. Without guidance, people often limit movement because of pain, which can slow recovery. With accurate staging and structured rehabilitation, symptoms are usually more manageable and recovery more predictable.
4) How long does recovery normally take?
Recovery depends on which phase you’re in and how irritated the shoulder currently is. Many people improve gradually over 12–36 months. Some regain full movement, while others have a small amount of long-term stiffness that doesn’t affect daily life. Early management can make the painful phase easier to tolerate and reduce overall disruption.
5) Do I need an injection?
In rare cases, yes, but I would suggest these are unusual nowadays. Corticosteroid injections can be helpful during the painful early phase by reducing night pain and calming inflammation enough for you to move more comfortably. There are risks involved however and many people in the NHS will not be able to access this potential treatment early enough for it to help at all. Most importantly however injections don’t resolve the underlying process and they do not spedd up your recovery. They are for initial pain only if appropriate.
6) Which exercises should I do for frozen shoulder?
It depends entirely on the stage. Early on, movements need to be gentle and within a comfortable range to avoid aggravating symptoms. Later, as stiffness becomes more dominant, more active stretching and strengthening are added. Doing the wrong type of exercise for your phase can make things worse, so tailoring is essential.
7) it safe to keep using my shoulder?
Yes — within sensible limits. Complete rest is rarely helpful. Controlled, comfortable movement maintains mobility and prevents unnecessary stiffness. Pushing aggressively into pain, however, often backfires. The goal is consistent, measured use rather than “no pain, no gain.”
8) Do I need a scan to confirm frozen shoulder?
Not usually. Frozen shoulder is primarily a clinical diagnosis based on your symptoms and how the joint behaves during examination. Scans are sometimes used to rule out other issues, such as rotator cuff tears or arthritis, if something in your presentation doesn’t quite fit.
9) Can frozen shoulder recur in the other shoulder?
Sadly, yes — especially if you have diabetes or other metabolic conditions. It doesn’t happen to everyone, but the risk is slightly higher once you’ve had it once. Early recognition of symptoms can help keep things under control.
10) How can physiotherapy help?
Physiotherapy clarifies which stage you’re in, what movements are safe, and how best to manage pain. Treatment may involve hands-on work, stage-appropriate mobility exercises, education about what to expect, and gradual progression to restore functional movement. Good physiotherapy guides you through the process rather than forcing the shoulder in ways that irritate it.
Why You Should Choose Chris Heywood Physio
The most important thing when seeking help is finding a practitioner you trust—someone who is honest, responsible, and clear about your diagnosis, the treatment you really need, and whether any follow-up appointments are necessary.
I’m not here to poach you from another therapist, but if you’re looking for a new physiotherapist in Northamptonshire or simply want a second opinion, here’s why many people choose to work with me (read my reviews):
Over 25 Years of Experience & Proven Expertise
With 25+ years of hands-on physiotherapy experience, I’ve built a trusted reputation for clinical excellence and evidence-based care. My approach combines proven techniques with the latest research, so you can feel confident you’re in safe, skilled hands.
Longer Appointments for Better Results
No two people—or injuries—are the same. That’s why I offer 60-minute one-to-one sessions, giving us time to:
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Thoroughly assess your condition
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Provide focused, effective treatment
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Explain what’s really going on in a clear, simple way
Your treatment plan is tailored specifically to you, aiming for long-term results, not just temporary relief.
Honest Advice & Support You Can Trust
I’ll always tell you what’s best for you—even if that means you need fewer sessions, not more. My goal is your recovery and wellbeing, not keeping you coming back unnecessarily. I have low overheads nowadays and I do not have pre-set management targets to maximise patient 'average session per condition' (yes it does happen commonly and I hate it with a passion - read my article here)
Helping You Take Control of Your Recovery
I believe the best outcomes happen when you understand your body. I’ll explain your condition clearly, give you practical tools for self-management, and step in with expert hands-on treatment when it’s genuinely needed.
Looking for a physiotherapist who values honesty, expertise, and your long-term health?
Book an appointment today and take the first step towards feeling better.
Contact Info
On a Monday and Tuesday I work as a advance musculoskeletal specialist in primary care but I can still be contacted for enquiries. You are welcome to call but it is often faster for me to reply via an email or watsapp message, simply as my phone will be on silent in clinic. Either way, I will reply as soon as possible, which in the week, is almost always on the same day at the latest.
Clinic Opening Hours
** Please note that online sessions and Aquatic sessions be arranged outside of normal clinical hours on request.**
Sat -Sun
Closed
0900 - 1430
Closed - FCP
Weds - Fri
Mon - Tues