What Is Frozen Shoulder: Causes, Symptoms, Treatment, and How Physiotherapy Can Help

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain and limited range of motion in the shoulder. It can significantly impact daily activities and quality of life. In this detailed article, we will delve into various aspects of frozen shoulder, including its causes, symptoms, available treatment options, and the crucial role of physiotherapy in managing this condition.

Understanding Frozen Shoulder

Definition and Overview

Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed and thickened, leading to stiffness and restricted movement. The exact cause of frozen shoulder remains unclear, but certain risk factors make some individuals more susceptible to developing this condition.

Key Causes and Risk Factors

While the exact cause of frozen shoulder remains unknown, several factors may contribute to its development. Some common risk factors include:

  1. Age and Gender: Individuals between the ages of 40 and 60, particularly women, are at higher risk of experiencing frozen shoulder.
  2. Diabetes: People with diabetes have an increased likelihood of developing frozen shoulder. Elevated blood sugar levels may affect the shoulder’s connective tissues, leading to inflammation.
  3. Previous Shoulder Injury: A history of shoulder injury or surgery can trigger frozen shoulder, as prolonged immobilization and inflammation play a role in its development.
  4. Immobility or Lack of Use: Prolonged immobility of the shoulder due to certain medical conditions or sedentary lifestyles can contribute to the onset of frozen shoulder.

Recognizing the Symptoms

Three Stages of Frozen Shoulder

Frozen shoulder typically progresses through three stages:

  • Freezing Stage: In this initial phase, the shoulder experiences increasing pain, and the range of motion begins to decrease. This stage can last from a few weeks to several months.
  • Frozen Stage: During this stage, the pain may start to subside, but stiffness intensifies, leading to further restriction of movement. This stage can last from 4 to 6 months.
  1. Recovery Stage: In the final stage, the shoulder’s range of motion gradually improves, and most patients experience a reduction in pain. This stage can last up to a year or more.

Common Symptoms

The symptoms of frozen shoulder can vary in severity and may affect one or both shoulders. Some common signs and symptoms include:

    • Persistent Pain: Dull and continuous shoulder pain, often worse at night and during movements.
  • Limited Range of Motion: Difficulty in moving the shoulder freely in all directions, such as raising the arm overhead or reaching behind the back.
  • Stiffness: Gradual loss of shoulder mobility, making routine tasks challenging and uncomfortable. Hanging washing or putting on a seat belt.

Diagnosing Frozen Shoulder

Diagnosing frozen shoulder involves a thorough evaluation of the patient’s medical history, physical examination, and imaging tests. A healthcare professional, typically an orthopaedic specialist or a physiotherapist, will perform a comprehensive assessment to accurately diagnose frozen shoulder.

Physical Examination

During the physical examination, the healthcare provider will assess the shoulder’s range of motion, muscle strength, and joint stability. They will also inquire about the patient’s medical history, including any previous injuries or medical conditions.

Imaging Tests

To confirm the diagnosis and rule out other potential causes of shoulder pain and stiffness, imaging tests such as X-rays, MRI, or ultrasound may be recommended. These tests help visualize the internal structures of the shoulder joint and identify any abnormalities.

Treating Frozen Shoulder

Non-Surgical Approaches

In the early stages of frozen shoulder, non-surgical treatments are usually the first line of management. These approaches aim to reduce pain and inflammation while improving shoulder mobility.

    1. Physiotherapy: Plays a vital role in the treatment of frozen shoulder. A skilled physiotherapist will design a customized exercise program to stretch and strengthen the shoulder muscles, gradually improving range of motion.
  • Pain Medications: Over-the-counter pain relievers, such as ibuprofen, may help alleviate pain and reduce inflammation.
  • Heat and Ice Therapy: Applying heat packs or ice packs can provide relief from pain and reduce swelling.
  • Corticosteroid Injections: In some cases, corticosteroid injections may be administered to reduce inflammation and pain in the shoulder joint.

The Role of Physiotherapy in Frozen Shoulder Treatment

Stretching and Range of Motion Exercises

Physiotherapists employ gentle stretching and range of motion exercises to gradually improve the shoulder’s flexibility and reduce stiffness. These exercises help in breaking up adhesions and scar tissue, which contribute to the restricted movement.

Strengthening Exercises

Strengthening exercises target the muscles surrounding the shoulder joint, enhancing its stability and function. A physiotherapist will guide patients through a series of strengthening exercises, progressively increasing resistance as the shoulder improves.

Home Exercise Program

A well-structured home exercise program is integral to the success of frozen shoulder treatment. The physiotherapist will provide patients with a set of exercises to perform at home, ensuring continuous progress and recovery.

Manual Therapy

Manual therapy techniques, such as joint mobilization and soft tissue massage, are essential components of physiotherapy for frozen shoulder. These techniques help improve blood circulation, reduce inflammation, and enhance the shoulder’s range of motion.

Preventing Frozen Shoulder

While it may not always be possible to prevent frozen shoulder entirely, certain measures can help reduce the risk:

  • Regular Exercise: Engage in regular shoulder exercises to maintain joint flexibility and strength.
  • Avoid Immobilization: If you experience a shoulder injury or surgery, consult a physiotherapist to prevent prolonged immobilization.
  • Diabetes Management: If you have diabetes, managing your blood sugar levels can potentially reduce the risk of frozen shoulder.


We know that a Frozen shoulder is a challenging condition that can cause pain and restrict daily activities. Understanding its causes, symptoms, and available treatment options is crucial for effectively managing the condition. Physiotherapy, with its range of exercises and manual techniques, plays a pivotal role in the treatment of frozen shoulder, helping patients regain shoulder mobility and improve their overall quality of life.