Frozen shoulder is one of the most frustrating shoulder problems I see. It's painful, it's stiff, and it takes its time. Understanding what's happening and what to expect makes a big difference to how you manage it.
If you've been told you have a frozen shoulder, there's a good chance you've already had a rough few months. It often starts as an ache that you put down to sleeping funny or a big day in the garden. Then it gets more painful, especially at night. Then you notice you can't reach behind your back to tuck in your shirt, do up a bra, or reach up to the top shelf.
Frozen shoulder, also called adhesive capsulitis, is a condition I see regularly, and it's one where a good understanding of what's going on really helps. In this post I'll explain what frozen shoulder is, who gets it, the stages it moves through, how long it usually lasts, and what treatment options can help along the way.
What is frozen shoulder?
Your shoulder joint is a ball-and-socket joint surrounded by a capsule, a tough sleeve of connective tissue that holds the joint together. In frozen shoulder, this capsule becomes inflamed and then thickened, tight and contracted. As the capsule shrinks and stiffens, the space inside the joint gets smaller and the shoulder loses its ability to move freely.
Despite the name "adhesive capsulitis", the problem isn't really adhesions or the joint sticking together. It's more a process of inflammation followed by scar-like thickening of the capsule. The exact cause isn't fully understood, which is part of what makes it so frustrating.
The hallmark of frozen shoulder is a loss of movement in every direction, both when you try to move the arm yourself and when someone else tries to move it for you. That second part is important. Many shoulder problems, like rotator cuff pain, cause pain and weakness when you lift your arm, but the shoulder can still be moved fully by someone else. With frozen shoulder, the joint itself is restricted, so even passive movement is limited. Turning the arm outwards, called external rotation, is usually the most affected movement.
Who gets frozen shoulder?
Frozen shoulder affects roughly 2 to 5 percent of the population. It's most common:
- Between the ages of 40 and 60
- In women, who are affected slightly more often than men
- In people with diabetes, where it is several times more common and can be more stubborn
- In people with thyroid conditions
- After a period of reduced shoulder movement, for example after an injury, surgery or a stroke
Sometimes there's an obvious trigger, like a minor injury or a period with your arm in a sling. Often there isn't, and it develops without any clear reason. This is known as primary or idiopathic frozen shoulder. It usually affects one shoulder, although some people develop it in the other shoulder later on. It's uncommon for it to come back in the same shoulder.
The three stages of frozen shoulder
Frozen shoulder classically moves through three overlapping stages. Not everyone follows them neatly, but they're a useful way to understand what's happening and why treatment changes over time.
Stage 1: Freezing (the painful stage)
This stage typically lasts from around 2 to 9 months. Pain is the dominant feature. It's often a deep ache in the shoulder and upper arm that is worse at night and with sudden or unguarded movements, like reaching for something or someone bumping your arm. Movement gradually becomes more limited as the stage goes on.
Night pain is one of the hardest parts. Many people can't lie on the affected side and struggle to get comfortable at all. This is the stage where people are most likely to seek help, and where the focus of treatment is on managing pain.
Stage 2: Frozen (the stiff stage)
This stage typically lasts from around 4 to 12 months. Pain usually starts to settle, particularly at night, but stiffness is at its worst. Everyday tasks like reaching behind your back, washing your hair, putting on a jacket or reaching up to a cupboard can be difficult. Pain tends to be felt mostly at the end of the available range, when you try to move further than the capsule allows.
Stage 3: Thawing (the recovery stage)
This stage can last from around 5 months to 2 years or more. Movement gradually returns as the capsule remodels. Progress can feel slow, but it's usually steady. Many people regain most or all of their movement, although some are left with a small amount of stiffness that often doesn't affect daily life much.
How long does frozen shoulder last?
This is usually the first thing people want to know, and the honest answer is that frozen shoulder takes a long time. The whole process commonly lasts between one and three years. People with diabetes tend to have a longer and more difficult course.
That can be hard news to hear. But knowing it upfront is useful, because it means you can stop searching for a quick fix and focus on what actually helps at each stage: managing pain, keeping as much movement as you can, and staying as active as possible while your shoulder works through the process.
How is frozen shoulder diagnosed?
Frozen shoulder is mainly diagnosed through a clinical assessment. I'll ask about how your pain started, how it has changed, and your general health, including diabetes or thyroid conditions. Then I'll assess how your shoulder moves, both actively and passively, and test the strength of the muscles around it.
The key finding is a significant loss of passive movement, especially external rotation, with a normal x-ray. An x-ray is often used to rule out other causes of stiffness, such as shoulder arthritis, which can look very similar. An ultrasound or MRI may be used in some cases, but they aren't always needed.
It's also important to rule out other causes of shoulder pain. Rotator cuff problems, calcific
tendinopathy, arthritis and pain referred from the
neck can all cause shoulder pain, and they're managed quite differently. That's why a thorough assessment matters before deciding on a plan.
What helps frozen shoulder?
Treatment for frozen shoulder depends a lot on which stage you're in. The overall aims are to reduce pain, maintain or improve movement, keep your shoulder and the rest of your body strong, and help you keep doing the things that matter to you.
Understanding and pacing
Understanding what's happening is a treatment in itself. Knowing that frozen shoulder is a self-limiting condition that usually improves, that the stiffness isn't a sign of damage, and that you won't hurt your shoulder by moving it within comfortable limits takes away a lot of the worry. I spend time on this in the first session because it shapes everything else.
Managing pain in the freezing stage
In the painful stage, the capsule is irritated, and aggressive stretching usually makes things worse. Instead, the focus is on:
- Gentle, pain-free movement to keep the shoulder moving within its comfortable range
- Positions that ease night pain, such as lying on your back with a pillow under the affected arm, or hugging a pillow when lying on the other side
- Heat, which many people find soothing
- Pain relief medication, discussed with your GP or pharmacist
- Hands-on treatment such as soft tissue release and gentle massage around the shoulder, neck and upper back, which can ease muscle tension that builds up as you guard the arm
Corticosteroid injections
A corticosteroid injection into the shoulder joint is one of the better-supported treatments for frozen shoulder in the early painful stage. Research suggests it can reduce pain and improve movement in the short term, particularly when it's given early and combined with exercise. It doesn't change the overall course of the condition, but it can make the painful stage much more bearable and make it easier to keep moving.
Some people are also offered hydrodilatation, where fluid is injected into the joint to stretch the capsule, often along with a corticosteroid. Whether an injection suits you is a decision to make with your GP or specialist. I'm always happy to share my assessment findings to help that conversation.
Exercise and movement in the frozen and thawing stages
As pain settles and stiffness becomes the main problem, we can start to push range a little more. Exercises usually include:
- Assisted movements, using your other arm, a stick or a towel to help lift or rotate the affected arm
- Pendulum exercises, letting the arm hang and swing gently
- Stretches into external rotation, reaching overhead and reaching behind your back, held at a mild, tolerable stretch
- Strengthening for the rotator cuff and shoulder blade muscles, which often weaken while the shoulder is stiff
The rule I use is that stretches should feel like a stretch, not sharp pain, and the shoulder shouldn't be more painful for hours afterwards. Little and often works better than a long, painful session once a day. Your program will change as you move through the stages. You can read more about how I build programs on my
exercise programs page.
Joint mobilisations
Joint mobilisations are gentle, controlled movements of the shoulder joint that can help ease pain and gradually restore range, particularly in the frozen and thawing stages. They work best as part of a plan that includes your home exercises, which keep the gains going between sessions.
Surgery
Most people with frozen shoulder don't need surgery. For a small number of people with severe, persistent stiffness that hasn't improved after many months of good non-surgical care, a specialist may discuss a manipulation under anaesthetic or an arthroscopic capsular release. Physio after these procedures is important to keep the movement that's gained. I see clients at home after shoulder surgery, which you can read more about on my
physio after surgery page.
Living with frozen shoulder
Because frozen shoulder takes a while, a big part of managing it is adapting daily life so the shoulder is less of a burden. Some practical tips I often share:
- Dressing: put the affected arm into sleeves first and take it out last. Front-opening tops are easier than pullovers.
- Sleeping: try a pillow under the affected arm when lying on your back, or a pillow to hug if lying on the other side.
- Reaching: move commonly used items to shelves between waist and shoulder height for a while.
- Driving: adjust your seat and mirrors so you aren't reaching awkwardly.
- Exercise: keep the rest of your body active. Walking, cycling on a stationary bike and lower body strength work are usually fine.
Frozen shoulder and diabetes
If you have diabetes, your risk of developing frozen shoulder is higher, and recovery often takes longer. Good blood sugar control is important for your general health, and it may also play a role in how your shoulder recovers. If you have diabetes and notice shoulder pain and stiffness developing, it's worth getting it assessed early. Some people are also diagnosed with diabetes or pre-diabetes after presenting with frozen shoulder, so your GP may suggest checking your blood sugar levels.
When should I see a physio?
It's worth getting your shoulder assessed if:
- Shoulder pain is waking you at night
- You've noticed it's getting harder to reach behind your back or overhead
- Pain and stiffness have been building for several weeks
- You've been told you have frozen shoulder and want a plan for managing it
See your GP promptly if shoulder pain comes with chest pain, shortness of breath, fever, unexplained weight loss, or follows a significant fall or injury.
How I help with frozen shoulder
When I see someone with a stiff, painful shoulder, my first job is to confirm what's going on, because frozen shoulder can look similar to several other shoulder problems. Once we know it's frozen shoulder, I'll explain the stages, where I think you're at, and what to expect.
From there, treatment is matched to the stage you're in. In the painful stage, that means settling pain, protecting your sleep and keeping you moving gently. In the stiff and thawing stages, it means progressing your range of motion and rebuilding strength so you can get back to everything you want to do. I'll also liaise with your GP if an injection or specialist review might help.
Because I'm a mobile physio, I come to you, which is especially handy when your shoulder makes driving uncomfortable. You can read more about how I assess and treat shoulder pain on my
shoulder pain physiotherapy page.
The bottom line
Frozen shoulder is painful and frustrating, and it usually takes one to three years to run its course. The good news is that most people get most or all of their movement back. Understanding the stages, managing pain well in the early months, and gradually building movement and strength as it settles will help you get through it with as little disruption to your life as possible. If your shoulder is stiff and sore, I'd be happy to help you work out what's going on and what to do next.
This article is general information only and isn't a substitute for an individual assessment. If you have pain or an injury, speak with your physiotherapist or GP about your situation.
