Frozen shoulder: stages, treatment and recovery

What frozen shoulder is

The shoulder joint is surrounded by a flexible capsule of connective tissue. In frozen shoulder, also called adhesive capsulitis, this capsule becomes inflamed and then thickens and tightens. The result is pain and a genuine loss of movement: the joint will not move fully even when someone else moves it for you, which is what separates it from most other shoulder problems.

The cause is not fully understood. Sometimes it follows a minor injury, surgery or a period of keeping the arm still, but often it appears without any obvious trigger.

Who gets it

Frozen shoulder is most common between about 40 and 60 and affects women somewhat more than men. People with diabetes are at noticeably higher risk and may have a longer course. Thyroid problems, heart disease and a recent period of shoulder immobility are also linked with it. Having it in one shoulder raises the chance of it happening in the other one later on, although it rarely comes back in the same shoulder.

If you have diabetes and a new, painful, stiff shoulder, it is worth mentioning to your GP, both for diagnosis and because good blood sugar control supports general tissue health.

It is not caused by lifting weights or training. People who were active before it started often find it frustrating, but keeping the rest of the body strong and fit usually makes the long recovery easier to live with, both physically and mentally.

The three stages and typical symptoms

Frozen shoulder usually passes through three overlapping stages. They vary a lot from person to person, so treat the timings as a rough guide rather than a timetable.

• Freezing (painful) stage: gradually increasing pain, often worse at night and with sudden movements, with stiffness creeping in. This commonly lasts a few months.
• Frozen (stiff) stage: pain often eases, but the shoulder is very stiff, especially turning the arm outwards and reaching behind the back. This can last several months.
• Thawing (recovery) stage: movement gradually returns, sometimes over many months.

Everyday tasks become awkward: fastening a bra, reaching a back pocket, putting on a coat, washing your hair or reaching up to a high cupboard. Sleep is often disturbed, which on its own can make the whole experience much harder.

What a physio assessment looks at

The key finding is a similar loss of movement whether you move the arm yourself or the physio moves it, with rotation outwards usually most affected. Strength is often fairly normal within the range you have. Your physio will also check your neck and screen for other causes of pain and stiffness.

An X-ray is often recommended to rule out shoulder arthritis or a missed dislocation, which can look very similar, particularly if there was a fall. Your physio will explain which stage you seem to be in, because that shapes what treatment makes sense right now.

What usually helps

In the painful stage, the priority is calming pain and keeping whatever movement you can without aggravating it. Forcing a painful, inflamed shoulder with aggressive stretching usually backfires. A steroid injection into the joint, arranged through your GP, can reduce pain in the early stage and is often combined with gentle exercise. Pain relief and sleep positioning help too.

In the stiff and recovery stages, the focus shifts to gradually regaining movement and strength with regular stretching and exercise. Manual therapy may help some people with stiffness. For persistent, severe cases, a specialist may discuss hydrodilatation (stretching the capsule with fluid injected under imaging), manipulation under anaesthetic or keyhole surgery to release the capsule.

What you can start with at home

1. Pendulum swings: lean forward supported on a table and let the arm hang and swing gently in small circles for 30 to 60 seconds.
2. Table slides: sitting at a table, slide your hand forward on a towel as far as comfortable, 10 times.
3. Assisted external rotation: holding a stick with both hands, elbows at your sides, use the good arm to gently push the stiff hand outwards, 10 times.
4. Wall walks: walk your fingers up a wall to a comfortable height, 5 to 10 times.
5. Keep the rest of your body active with walking, lower-body training and exercise that does not strain the shoulder.

In the painful stage, stay within a comfortable range. As things settle, you can push gently into mild stretch discomfort. Sleeping with a pillow under the affected arm often helps, and our guide to sleep for recovery has more ideas. A general mobility routine can help you keep the rest of your body moving well.

Recovery time and when to get urgent help

Frozen shoulder is usually self-limiting, but it is slow. The whole process commonly takes one to two years and sometimes longer, and some people are left with mild stiffness they barely notice. The on-site physio at Lycan Strength can help you manage each stage and keep training around it, with 20% off for members. Book a physio appointment or read about rotator cuff injury if you are unsure which fits.

• Call 999 if shoulder or arm pain comes with chest pain, breathlessness, sweating or nausea.
• Go to A&E if the shoulder became stiff and painful after a fall and looks deformed or you cannot move it.
• Call NHS 111 or see your GP urgently if the shoulder is hot, red and swollen, or you have a fever.
• See your GP if you have unexplained weight loss, a history of cancer, or numbness or weakness in the arm.

Questions