Frozen Shoulder (Adhesive Capsulitis): Symptoms, Causes, Stages, Treatment & Physiotherapy in Newmarket

What Is Frozen Shoulder?

Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed, thickened and tighter, restricting movement of the shoulder.

The shoulder, or glenohumeral joint, is a ball-and-socket joint designed to provide a very large range of motion. When the joint capsule becomes restricted, movements such as lifting the arm, rotating the shoulder or reaching behind the back can become increasingly difficult.

Frozen shoulder is also called adhesive capsulitis.

One of the important clinical features is that both active and passive shoulder movement can become restricted. In other words, the shoulder may remain difficult to move even when another person is moving the arm for you.

Frozen Shoulder Symptoms

Frozen shoulder commonly causes a combination of pain and progressive loss of shoulder movement.

Common symptoms include:

• Shoulder pain
• Shoulder stiffness
• Difficulty lifting the arm
• Difficulty reaching overhead
• Difficulty reaching behind the back
• Difficulty putting on or removing clothing
• Difficulty washing or brushing your hair
• Difficulty reaching for objects on shelves
• Difficulty reaching across your body
• Pain when lying on the affected side
• Shoulder pain that is worse at night
• Disturbed sleep
• Progressive reduction in shoulder mobility

Night pain can be particularly troublesome during the earlier phase of frozen shoulder.

Why does frozen shoulder make movement so difficult?

As the shoulder capsule becomes tighter, certain movements become increasingly restricted. Many people notice that rotating the arm outward and reaching behind the back become particularly difficult.

For example, you may notice difficulty:

• Putting your hand behind your head
• Reaching into a back pocket
• Fastening a bra
• Putting on a coat
• Reaching for a seatbelt
• Reaching overhead
• Sleeping comfortably

What Causes Frozen Shoulder?

In many cases, the exact cause of frozen shoulder is not known.

Frozen shoulder can occur without an obvious injury or event. This is sometimes referred to as primary or idiopathic adhesive capsulitis.

It can also develop following another problem that causes the shoulder to remain relatively still. This is sometimes called secondary frozen shoulder.

Possible associations include:

• Previous shoulder injury
• Shoulder surgery
• Prolonged restriction of shoulder movement
• Diabetes
• Thyroid disorders
• Certain neurological conditions
• Other medical conditions

The relationship between these conditions and frozen shoulder is not always fully understood.

Who Is More Likely to Develop Frozen Shoulder?

Frozen shoulder is most commonly seen in adults between approximately 40 and 70 years of age. Estimates suggest that it affects roughly 2% to 5% of the general population.

Risk can be higher in people with certain medical conditions, particularly diabetes and some thyroid disorders.

Frozen shoulder can also develop after an injury or surgery when normal shoulder movement is significantly reduced.

The 3 Stages of Frozen Shoulder

Frozen shoulder is commonly described in three stages:

1. Freezing stage
2. Frozen stage
3. Thawing stage

However, these stages do not occur in exactly the same way or over exactly the same amount of time for every person.

1. Freezing Stage

During the freezing stage, shoulder pain gradually increases and movement begins to decrease.

You may experience:

• Increasing shoulder pain
• Pain during movement
• Night pain
• Difficulty sleeping
• Progressive loss of shoulder mobility
• Increasing difficulty performing everyday activities

This stage can last for several weeks or months. AAOS describes the freezing stage as typically lasting around 6 weeks to 9 months.

An important point about exercise

During this painful phase, aggressively forcing the shoulder through painful movements may not be appropriate.

A physiotherapist can help determine the amount and type of movement that is suitable for your current stage and irritability.

2. Frozen Stage

During the frozen stage, pain may begin to decrease for some people, but stiffness can remain significant.

You may notice that:

• Shoulder movement is substantially restricted
• Reaching overhead is difficult
• Reaching behind your back is difficult
• Dressing becomes harder
• Household tasks become more difficult
• Shoulder strength and function may be affected because movement is restricted

This stage can last for several months.

The shoulder may feel less painful than during the freezing phase, but the restriction in movement can continue to interfere with daily life.

3. Thawing Stage

During the thawing stage, shoulder movement gradually begins to improve.

You may notice:

• Increasing range of motion
• Less stiffness
• Improved ability to perform daily activities
• Gradual return of shoulder function

Recovery can be slow. The thawing phase may continue for many months. AAOS describes recovery of strength and movement as potentially taking 5 months to 2 years, while other clinical sources note that overall recovery can sometimes take one to several years.

This is one reason why frozen shoulder rehabilitation requires patience and a progressive approach.

How Long Does Frozen Shoulder Last?

There is no single recovery timeline that applies to everyone.

Some people improve within months, while others experience symptoms for considerably longer.

Clinical sources describe recovery ranging from approximately 6 months to several years, depending on the individual and the course of the condition.

Recovery may be influenced by:

• Stage of frozen shoulder
• Pain severity
• Degree of stiffness
• Duration of symptoms
• Diabetes or other medical conditions
• Previous shoulder injury or surgery
• Ability to perform an appropriate exercise program
• Individual response to treatment

Does frozen shoulder eventually go away?

Many people experience substantial improvement in pain and shoulder movement over time.

However, recovery is not necessarily quick, and some people can be left with persistent limitations in movement or function.

How Is Frozen Shoulder Diagnosed?

Frozen shoulder is primarily a clinical diagnosis.

A physiotherapist or physician will typically consider:

1. Your symptoms

Your healthcare professional may ask:

• When did the pain begin?
• Did it start gradually or after an injury?
• Is the pain worse at night?
• Which movements are difficult?
• Can you reach overhead?
• Can you reach behind your back?
• Has your shoulder movement progressively decreased?

2. Shoulder movement

Your shoulder’s:

• Active range of motion
• Passive range of motion
• Pain response
• Movement pattern

may be assessed.

A characteristic feature of adhesive capsulitis is restriction of both active and passive movement.

3. Other possible causes

Shoulder pain and stiffness can occur with several different conditions, including:

• Rotator cuff disorders
• Shoulder arthritis
• Tendon problems
• Bursitis
• Shoulder injury
• Fracture
• Shoulder instability
• Neurological conditions

Therefore, it is important not to assume that every painful or stiff shoulder is frozen shoulder.

Do You Need an X-Ray or MRI for Frozen Shoulder?

Imaging is not always required to identify frozen shoulder.

An X-ray may be used to help rule out other causes of shoulder symptoms, such as arthritis.

MRI or ultrasound may be considered when another shoulder problem, such as a rotator cuff injury, needs to be investigated.

A physiotherapy assessment can help determine whether your presentation is consistent with frozen shoulder and whether medical assessment or imaging should be considered.

Frozen Shoulder vs Rotator Cuff Injury

Frozen shoulder and rotator cuff problems can both cause shoulder pain and difficulty moving the arm, but they are not the same condition.

Frozen shoulder

Typically involves:

• Progressive stiffness
• Significant restriction of passive movement
• Difficulty with multiple directions of movement
• Difficulty with rotation
• Pain that may be worse at night

Rotator cuff problems

May involve:

• Pain with specific shoulder movements
• Pain during lifting or reaching
• Weakness
• Painful arc of movement
• Sometimes difficulty lying on the affected shoulder

These conditions can overlap, which is why a proper assessment is important.

Frozen Shoulder Treatment

Treatment depends on the stage of the condition, pain level, mobility restriction, functional limitations and individual circumstances.

Management may include:

• Physiotherapy
• Home exercises
• Mobility exercises
• Progressive strengthening
• Pain-management strategies
• Activity modification
• Medical pain management
• Corticosteroid injection in appropriate cases
• Hydrodistension in selected cases
• Surgical treatment in selected persistent cases

The NHS recommends a combination of pain management and appropriate shoulder movement, with physiotherapy used to help restore movement when needed.

Physiotherapy for Frozen Shoulder

Physiotherapy can be an important part of frozen shoulder management.

The aim is not simply to “stretch the shoulder as much as possible.”

Instead, rehabilitation should be adjusted according to:

• Current stage
• Pain irritability
• Range of motion
• Functional limitations
• Strength
• Response to exercise
• Other medical conditions

Physiotherapy may include:

Shoulder mobility exercises

Exercises may be used to gradually improve available shoulder movement.

Examples can include:

• Assisted shoulder elevation
• Wall slides
• Gentle external-rotation exercises
• Pendulum exercises
• Assisted shoulder movements
• Functional reaching exercises

The specific exercise selection and intensity should be individualized.

Manual therapy

Where appropriate, physiotherapists may use manual techniques to address shoulder mobility and help with movement.

Research supports exercise and mobilization as useful components of rehabilitation, particularly during stages where stiffness and functional limitations are prominent.

Strengthening

As pain and mobility improve, rehabilitation can gradually progress toward strengthening the:

• Rotator cuff
• Shoulder muscles
• Scapular muscles
• Upper limb

Strengthening should complement mobility work rather than replacing it.

Frozen Shoulder Exercises

People commonly search for “frozen shoulder exercises” because they want to know what they can do at home.

Some commonly used exercises include:

Pendulum exercise

Lean forward while supporting yourself with your unaffected arm and allow the affected arm to hang comfortably.

Small, relaxed movements can be performed forward and backward or in gentle circles.

Wall slides

Stand facing a wall and gradually slide your hand upward as far as comfortable.

The goal is controlled movement rather than forcing the shoulder into severe pain.

Assisted shoulder elevation

Use the unaffected arm or an appropriate support to gently assist the affected arm upward.

Gentle external rotation

An exercise using a stick or other appropriate assistance may be used to gradually work on external rotation.

Shoulder blade movement

Gentle shoulder blade positioning and controlled shoulder movements may help maintain comfortable movement.

Clinical patient resources commonly recommend gentle, regular movement rather than keeping the shoulder completely still.

Important

Not every frozen shoulder needs the same exercises.

An exercise that is appropriate during one stage may be uncomfortable or excessive during another.

Avoid forcing a severely painful shoulder through aggressive stretches. A physiotherapist can help determine the appropriate intensity and progression.

Can You Exercise With Frozen Shoulder?

In many cases, yes—but the type and intensity of exercise matter.

General activity and appropriately selected shoulder movement can help maintain function.

However, during a highly painful stage, aggressive strengthening or stretching may aggravate symptoms.

A better approach is usually:

Assess → determine irritability → select appropriate movement → gradually progress

This is particularly important when shoulder pain is interfering with sleep or everyday activities.

Can Physiotherapy Cure Frozen Shoulder?

Physiotherapy does not guarantee a specific outcome or recovery time.

However, physiotherapy can help:

• Manage movement restrictions
• Improve shoulder mobility
• Maintain or restore strength
• Improve functional use of the arm
• Guide an appropriate home exercise program
• Monitor progress
• Adjust treatment as the shoulder changes through different stages

Frozen shoulder can also improve naturally over time, so treatment should be viewed as part of an overall management strategy rather than a promise of immediate recovery.

Frozen Shoulder and Corticosteroid Injections

Corticosteroid injections are sometimes used to help manage pain and inflammation associated with frozen shoulder.

Evidence suggests corticosteroid injections can provide meaningful short-term improvements in pain and function, although the effect depends on factors such as injection technique and timing. A 2024 network meta-analysis involving 66 randomized controlled trials and 4,491 participants found evidence supporting several injection approaches, while also noting differences in certainty between interventions.

Whether an injection is appropriate is a medical decision that should be discussed with the appropriate healthcare professional.

Physiotherapy may be used alongside medical treatment to address movement and functional limitations.

What About Hydrodilatation?

Hydrodilatation, sometimes called hydrodistension, involves injecting fluid into the shoulder joint to expand or stretch the joint capsule.

It may be considered in selected people whose symptoms remain significantly limiting despite other treatment.

Evidence suggests that joint distension and intra-articular injection approaches can improve symptoms, but the appropriate treatment depends on the individual’s presentation.

This procedure is performed by an appropriately qualified medical professional, not as a routine physiotherapy treatment.

Is Surgery Needed for Frozen Shoulder?

Surgery is generally not the first treatment option for frozen shoulder.

Most people are initially managed using non-surgical approaches.

For persistent symptoms and significant functional restriction despite appropriate conservative management, procedures such as:

• Manipulation under anaesthesia
• Arthroscopic capsular release

may be considered by an orthopedic specialist.

These procedures are generally reserved for selected cases.

What Should You Avoid With Frozen Shoulder?

If your shoulder is painful and stiff, avoid assuming that more aggressive exercise is always better.

Be cautious with:

• Forceful stretching
• Heavy shoulder exercises during a highly painful stage
• Repeated movements that significantly increase symptoms
• Completely immobilizing the shoulder for prolonged periods
• Following generic internet exercises without considering your condition

The NHS specifically advises continuing gentle shoulder movement while avoiding strenuous exercises that aggravate the condition.

Frozen Shoulder and Sleep

Night pain is a common problem, particularly during the earlier stage of frozen shoulder.

You may find it uncomfortable to:

• Sleep on the affected side
• Roll onto the painful shoulder
• Place your arm in certain positions

Supporting the affected arm with pillows and finding a comfortable sleeping position may help.

If shoulder pain repeatedly wakes you at night, assessment can help determine whether frozen shoulder or another shoulder condition is contributing to your symptoms.

Frozen Shoulder and Diabetes

There is an established association between frozen shoulder and diabetes.

People with diabetes are more likely to develop frozen shoulder, although the exact biological relationship is not completely understood.

If you have diabetes and develop progressive shoulder pain and stiffness, discussing the symptoms with your healthcare professional is appropriate.

Frozen Shoulder After Shoulder Surgery or Injury

Frozen shoulder can sometimes develop after an injury or surgical procedure when shoulder movement becomes significantly restricted.

This is one reason postoperative rehabilitation often includes carefully planned progression of shoulder movement when medically appropriate.

However, after surgery, exercise restrictions depend on the specific procedure and the surgeon’s instructions.

Do not apply a generic frozen shoulder exercise program to a recently operated shoulder without appropriate clinical guidance.

When Should You See a Physiotherapist for Frozen Shoulder?

Consider a physiotherapy assessment if you have:

• Shoulder pain that is progressively worsening
• Increasing shoulder stiffness
• Difficulty raising your arm
• Difficulty reaching behind your back
• Night shoulder pain
• Difficulty dressing
• Difficulty washing your hair
• Difficulty performing work or exercise
• Shoulder stiffness following an injury
• Shoulder stiffness following surgery

Early assessment can also help determine whether your symptoms are actually consistent with frozen shoulder or another shoulder problem.

When Should Shoulder Pain Be Medically Assessed?

Not all shoulder pain is frozen shoulder.

Seek appropriate medical assessment if you have:

• Sudden severe shoulder pain
• A major injury
• Obvious deformity
• Inability to move the arm after trauma
• Significant swelling
• New neurological symptoms
• Persistent unexplained pain
• Fever or systemic symptoms associated with shoulder pain

A healthcare professional can determine whether additional investigation is required.

How Physiotherapy at RehabDNA Can Help With Frozen Shoulder

At RehabDNA Physiotherapy in Newmarket, rehabilitation begins with an assessment rather than applying the same exercise program to every shoulder problem.

The assessment may consider:

• Your pain pattern
• Shoulder range of motion
• Active and passive movement
• Functional limitations
• Strength
• Relevant medical history
• Previous injury or surgery
• Your work, exercise and daily activity requirements

Based on the assessment, your physiotherapist can develop an individualized rehabilitation plan.

Our approach

Assess → Identify → Plan → Treat → Progress → Return

Treatment may include appropriate:

• Shoulder mobility exercises
• Exercise-based rehabilitation
• Progressive strengthening
• Manual therapy where appropriate
• Home exercise guidance
• Education about activity modification
• Functional movement training

The plan can be adjusted as your pain and mobility change.

Frozen Shoulder Physiotherapy Newmarket

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RehabDNA Physiotherapy provides in-person physiotherapy at:

RehabDNA Physiotherapy
455 Harry Walker Pkwy S, Unit 7
Newmarket, ON L3Y 8T3, Canada

Phone: +1 (905) 509 8469
Email: Info@RehabDNA.com

Is frozen shoulder the same as adhesive capsulitis?

Yes. Adhesive capsulitis is the medical term commonly used for frozen shoulder.

How long does frozen shoulder take to heal?

Recovery varies considerably. Some people improve within months, while others may have symptoms for one to several years.

Can physiotherapy help frozen shoulder?

Physiotherapy can help address pain, mobility restrictions, strength and functional limitations. Treatment should be individualized according to the stage and irritability of the condition.

What is the best exercise for frozen shoulder?

There is no single exercise that is appropriate for everyone. Exercises should be selected according to your available movement, pain level and stage of the condition.

Should I stretch a frozen shoulder?

Gentle, appropriate mobility exercises are commonly used, but aggressive stretching may not be appropriate when the shoulder is highly painful. A physiotherapist can guide the intensity.

Can frozen shoulder get better without treatment?

Frozen shoulder can improve over time, but recovery may be slow and symptoms can significantly affect daily function.

Can frozen shoulder come back?

A frozen shoulder can affect the other shoulder at a later point, and recurrence in the same shoulder is possible but not typical. Individual circumstances vary.

Is frozen shoulder caused by sleeping on one side?

Sleeping on one side is not established as the primary cause of adhesive capsulitis. Frozen shoulder can develop without an obvious cause and is associated with factors such as diabetes, thyroid disorders, injury and prolonged restriction of movement.

Is frozen shoulder a rotator cuff tear?

No. Frozen shoulder and rotator cuff tears are different conditions, although they can produce overlapping symptoms.

Can I work with frozen shoulder?

Many people can continue working, but modifications may be necessary depending on the physical demands of the job and severity of symptoms.

Can I go to the gym with frozen shoulder?

You may be able to remain active, but exercises should be modified according to your symptoms and shoulder mobility. Heavy or painful shoulder exercises may not be appropriate during an irritable phase.

frozen shoulder physiotherapy Newmarket

Frozen shoulder is a condition characterized by shoulder pain and progressive stiffness.

The main points to remember are:

• Frozen shoulder is also called adhesive capsulitis.
• The shoulder capsule becomes inflamed, thickened and restricted.
• Pain is often prominent early in the condition.
• Stiffness can become the dominant problem later.
• Frozen shoulder is commonly described in freezing, frozen and thawing stages.
• Recovery can take months or even years.
• Diabetes and some other medical conditions are associated with increased risk.
• Physiotherapy can help address mobility, strength and functional limitations.
• Exercise should be matched to the individual’s symptoms and stage.
• Corticosteroid injections may be appropriate for some people.
• Surgery is generally reserved for selected persistent cases.
• Not every stiff shoulder is frozen shoulder, so assessment matters.