Frozen Shoulder: The 3 Stages, How Long It Lasts, and How Physiotherapy Helps
Can't lift your arm to brush your hair, can't reach behind your back, or shoulder pain wakes you at night? If this has lasted for weeks and movement keeps getting smaller, it may be "frozen shoulder", also called adhesive capsulitis.
Frozen shoulder happens when the capsule around the shoulder joint becomes inflamed, thickened and tight. It is most common between ages 40 and 60, more common in women, and more frequent in people with diabetes or thyroid disease. Some cases start after an injury or after wearing a sling for a long time [1].
The 3 stages
• Freezing: significant pain, especially at night, with movement starting to reduce
• Frozen: pain eases, but the shoulder is clearly stiff — lifting, moving the arm out to the side and rotating are all limited
• Thawing: movement gradually returns
The whole process can take many months to more than a year, and it varies from person to person.
Frozen shoulder vs other shoulder problems
Not every painful shoulder is a frozen shoulder. Rotator cuff tendinopathy or tears and shoulder impingement can also cause pain. A key difference is that a frozen shoulder is stiff both when you move it yourself and when someone else moves it for you — especially rotating the arm outwards. Assessment matters because each condition is treated differently.
How physiotherapy helps
Physiotherapy clinical practice guidelines for frozen shoulder recommend matching treatment intensity to how irritable the shoulder is. When pain is high, the focus is on pain relief and gentle movement within comfort. When pain settles but stiffness remains, stretching and joint mobilisation are progressed [1].
• Hands-on joint mobilisation to increase range of motion
• Stretches and exercises you can do every day at home
• Pain-relief equipment such as ultrasound or TENS to make movement easier
• Regular measurement of how far you can lift your arm, to check progress against the plan
In some cases a doctor may consider a joint injection, which can be combined with physiotherapy.
What to avoid
• Forcing painful, aggressive stretches while the shoulder is still inflamed — this can prolong the pain
• Stopping using the arm altogether, which makes the stiffness worse
• Waiting for it to go away without an assessment — it may not be a frozen shoulder at all