Frozen shoulder: the three stages and how physiotherapy helps

Frozen shoulder, or adhesive capsulitis, happens when the capsule around the shoulder joint becomes inflamed and then thickened and tight. The result is pain and a steady loss of movement, especially reaching up, out to the side, or behind your back.

It's most common between ages 40 and 60, and more common in women and in people with diabetes or thyroid conditions. It can also follow a period of not moving the arm, for example after an injury or surgery.

The three stages

1. Freezing (painful stage)

Pain builds gradually and is often worse at night. Movement starts to reduce. This stage can last a few weeks to several months.

2. Frozen (stiff stage)

Pain often eases, but stiffness is at its worst. Everyday tasks like dressing, combing hair or reaching a shelf become difficult.

3. Thawing (recovery stage)

Movement slowly returns. Many people recover most of their movement, although full recovery can take one to two years or more.

How physiotherapy helps

Physiotherapy can't switch off the condition, but it helps you through it with less pain and better movement:

• Pain relief and advice in the painful stage, including sleeping positions and how to keep using the arm without flaring it up
• Gentle stretching and mobility work, pitched to the stage you're in. Too aggressive too early tends to make it worse.
• Strengthening of the shoulder blade and rotator cuff muscles as movement returns
• A home programme you can do little and often

When other treatment may help

If pain is severe or progress stalls, an orthopaedic specialist may discuss options such as an image-guided steroid injection or hydrodilatation. At Physio Central, your physiotherapist can refer you to Dr Nitin Sunku for an orthopaedic opinion if needed.

Book a shoulder assessment or read about orthopaedic physiotherapy.