Frozen Shoulder – the role of Physiotherapy
By Nick Rowe, April 2025
Frozen Shoulder is an extremely painful condition in which the shoulder is completely or partially immovable (stiff). It is one of the most painful shoulder conditions a person can experience and unfortunately often poorly diagnosed and managed.
Approximately 2 to 5% of the population will be affected by Frozen Shoulder, mostly commonly in people aged 40-70 years old. More commonly in females.
Common symptoms of a frozen shoulder
Severe pain and stiffness are the most common symptoms of a frozen shoulder. Night pain is common, making sleeping difficult, especially on the affected side.
There is also a significant decrease in both the passive and active range of motion, particularly in external rotation and hand behind-back motion. These symptoms cause limitations in activity and participation.
Activities such as reaching out and putting your hand behind your back to scratch or undo your bra strap can become increasingly difficult.
X-rays appear normal but are used to rule out serious conditions like fractures, avascular necrosis, locked dislocations, arthritis, or osteosarcomas. Ultrasound or MRI imaging can be used to confirm a frozen shoulder diagnosis.
Frozen shoulder often starts out of the blue but may be triggered by a mild injury to the shoulder. The condition usually goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take a long time, sometimes as long as two or more years.
Frozen shoulder may be associated with diabetes, high cholestrol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytrens contracture. It may follow an injury to the shoulder or surgery.
The lining of the shoulder joint, known as the ‘capsule’, is normally a very flexible elastic stucture. It’s looseness and elasticity allows the huge range of motion that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen, red and contracted. The normal elasticity is lost and pain and stiffness set in.
The three phases of a frozen shoulder
Freezing phase: Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months.
Frozen phase: Pain begins to diminish, however, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4 to 12 months.
Thawing phase: The condition may begin to resolve. Most patients experience a gradual restoration of motion over the next 12 to 42 months
Treatment / Management of a Frozen Shoulder
If nothing is done most frozen shoulders improve significantly over 2-4 years after onset. However the pain and limitations of the stiff shoulder generally require treatment. The treatment required depends on the severity of the pain and stiffness.
Physiotherapy – to prevent any further stiffness and regain range of motion. This will usually be combined with the use of painkillers and possibly anti-inflammatories.
Steroid Injections – to reduce inflammation and pain.
Hydrodilatation Procedure – shown to be more effective than corticosteroid injections in relieving severe pain and improving range of motion.
Surgery– Surgery has been shown to be of benefit in both the early and later stages of a Frozen Shoulder. This may involve an arthroscopic Capsular Release or Manipulation Under Anaesthetic (MUA). The Capsular Release procedure is usually the preferred option by Orthopaedic teams.
The role of Physiotherapy in treating Frozen Shoulder
As briefly mentioned above, frozen shoulder treatment varies according to the stage.
During the freezing stage, your primary treatment will be pain relief, which may include medication or corticosteroid injections. You should also take precautions at this stage to avoid worsening the situation with certain activities.
Gentle shoulder exercises are the best treatment plan in the frozen stage. Because overdoing it can aggravate your frozen shoulder, it’s critical that you work with a Physiotherapist during this stage.
Your best treatment options during the thawing stage (final stage) are advice, shoulder mobilisation and targeted strengthening exercises, focusing on your specific goals.
For further information get in touch on 07534261106 or nick@nrphysio.co.uk