The Frozen Shoulder: What You Need to Know About the Pain, and How to Treat It
Frozen shoulder arrests the range of motion, causes stiffness, and handicaps the joint capsule, causing untold misery.

Frozen shoulders are a common cause of shoulder pain and stiffness, although they are also known as adhesive capsulitis. It's estimated that 5-20% of people will develop a frozen shoulder at some point in their lives. The condition occurs when there is tissue damage, thickening or scarring around the joint capsule (the connective tissue surrounding your shoulder joint). This causes painful restriction of movement within the joint itself and can be extremely debilitating. It's important to note that a frozen shoulder isn't an illness itself - it's a secondary condition that could be caused by another injury or illness elsewhere in your body.

What is a frozen shoulder?

A frozen shoulder is a condition that causes pain and stiffness in the shoulder joint, which connects your arm to your body. The shoulder is made up of three bones: the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). The clavicle connects the shoulder to your chest area. Your scapula is part of your shoulder blade—it’s what you feel when you have a sore back. The humerus is one of two bones that make up your upper arm bone (the other being your radius).

A frozen shoulder can be caused by an injury or repetitive use of the shoulder. For example, if you fall on your outstretched hand, this may cause inflammation or damage to tendons around the shoulder joint so they cannot move as freely as they should. In other cases, it may be caused by an infection such as rheumatoid arthritis or tuberculosis.

Causes of frozen shoulder

Frozen shoulder is caused by inflammation of the bursa and tendons that surround your shoulder joint. The inflammation causes scar tissue to form, which stiffens the joint and makes it difficult to move your arm.

Several things can cause frozen shoulder, including:

  • Injury or overuse of one shoulder (for example, from throwing sports)
  • Arthritis (from long-term wear and tear on joints)
  • Infection around the shoulder joint

What are the symptoms?

  • Pain. The pain of a frozen shoulder can be felt in the neck and shoulder area, as well as down the arm. It usually starts slowly and gets worse over time.
  • Stiffness, particularly after sleeping at night or sitting for long periods during the day (such as at work).
  • Difficulty moving the shoulder joint through its normal range of motion (flexion and extension), which makes it difficult to raise your arm above your head, behind your back, and across your chest. This also affects how far you can rotate your arm outwardly or inwardly when your elbow is bent. You may find that some movements are more painful than others because they put more stress on certain parts of your shoulder joint that aren't moving properly due to frozen shoulder syndrome.
  • The inability for others to move/position your affected arm for you (e.g., when getting dressed).

When should I seek help from my GP?

You should see your GP if:

  • The pain is severe or not improving after a week.
  • You have a fever, feel generally unwell or have other worrying symptoms.
  • Your symptoms are getting worse despite taking painkillers and resting the shoulder as instructed by your doctor or physiotherapist.

How is frozen shoulder diagnosed?

Your doctor will use a combination of tests to diagnose a frozen shoulder. These include:

  • X-rays. These can help your doctor to see whether there is any damage to the bones surrounding your shoulder joint.
  • MRI scan. This test uses magnetic waves and radio waves to produce detailed images of your joints and ligaments, which may be useful for diagnosing a frozen shoulder. However, it's important to note that an MRI scan cannot show if you're at risk of developing a frozen shoulder or whether other conditions are causing symptoms.
  • Blood tests. Blood tests are used as part of routine health checks by most people over the age of 40 and can help determine how well organs like the heart or kidneys are functioning in healthy adults who have no symptoms suggestive of disease; however, they're usually not used specifically for diagnosing frozen shoulder unless there's another condition present alongside it (such as rheumatoid arthritis).

Treatment of frozen shoulders at home

If you have a frozen shoulder, you may be able to treat it yourself. You can try the following things:

  • Exercise. The aim is to stretch and strengthen your shoulder muscles so that they work properly again. Begin with gentle stretches and build up gradually as the pain eases.
  • Heat or cold packs (or a combination of both). Apply them for 20 minutes three times a day on the affected area if possible - this should help reduce stiffness and pain in your shoulder.
  • Massage therapy - including acupressure massage - may also be helpful as well as acupuncture treatments (ask your GP if they can refer you).

How does physiotherapy help?

Physiotherapy restores shoulder movement through stretching exercises. If your rotator cuff tear is causing extreme pain, an injection is also recommended by the GP. Pain may take several days, months or years to go away completely. When the shoulder becomes immobile, the treatment for frozen shoulder gets delayed. Patients with frozen shoulder can expect relief from physiotherapy as it helps to:

  • reduce pain and stiffness, by increasing movement of the shoulder.
  • improve strength and movement with exercises aimed at specific muscle groups. These can be performed in the gym, physiotherapy centre or at home, with a physiotherapist's guidance after a physical examination.
  • help improve posture surrounding the shoulder joint so that you are less likely to slouch over your desk or around the house. This is because muscles become fatigued more easily if you have poor posture, which leads them to become shorter than normal – making it harder for them to do their job properly when they're on full stretch during everyday movements like reaching out to grab something from above your head!

What is the main cause of a frozen shoulder?

The main cause of a frozen shoulder is thought to be overuse. This can include any activity that causes repeated strain on the shoulder joint and surrounding muscles, such as:

  • Carrying heavy bags or purses for long periods
  • Doing tasks that require you to keep your arms raised above shoulder height for extended periods (for example, changing light bulbs)
  • Playing golf or tennis regularly can also put extra strain on the shoulder joint and muscles.

What are the first signs of a frozen shoulder?

Sometimes, the symptoms of a frozen shoulder can be mild and you may not notice them until they get worse. The first signs of a frozen shoulder often include:

  • pain and stiffness in your shoulder
  • difficulty raising your arm out to the side
  • weakness in the muscles around your affected shoulder

How does a frozen shoulder feel?

You may experience pain, stiffness and loss of movement in your shoulder. You may also feel tenderness when you touch or move the affected area. The symptoms of a frozen shoulder can be mild or severe depending on whether inflammation is still present and how much movement has been lost. It's important to get a physical exam and discuss your hobbies, too. Talk about things you do at work or play, as well as anything that causes extra strain on your shoulder.

Frozen shoulder exercises

Follow these range of motion exercises and stretches from a physical therapist if you have a frozen shoulder. It's important to move your shoulder as soon as possible while you wait for the anti-inflammatory medications to work their magic. Stretching and movement exercises can help with your shoulder mobility issues. Symptoms improve when shoulder problems are reduced through physiotherapy.

1. Pendulum stretch: This exercise can be done anywhere, at any time. Stand with your feet shoulder-width apart and lean slightly forward. Let the arm you wish to work hang down toward the ground between your legs; don’t let it touch anything or support its weight in any way — this is just an aid for balance as well as focus. In a small circular motion swing that arm clockwise 10 times and then counterclockwise equally many times—10 revolutions per direction should suffice. When your symptoms begin to go away, swing your arm wider. However, don't force it—only increase the distance when you feel ready for more stretch. When this becomes easy and comfortable, add a light weight in the swinging arm as well.

2. Shoulder abduction: Raise your arm out to the side as far as it will go without moving your elbow or wrist. Hold for five seconds, then lower slowly back down. Repeat 10 times with each arm.

3. Shoulder external rotation: Stand with your feet about hip-width apart, holding an elastic resistance band in both hands at chest level with palms facing inward (facing each other). Bring your arms back slightly so there's tension in the band. Then slowly rotate your arms outward until they're at shoulder level with palms still facing inward. Hold for one second then return to the starting position. Repeat until you've reached 15 reps on each side.

4. Chest stretch: Stand with feet hip-width apart and knees slightly bent; cross one arm across your chest so that it rests on top of the other arm (both hands should be facing forward). Gently pull on both arms until they meet at center back; hold for one count before releasing gradually.

5. Cross-body stretch: Sit or stand with your good arm lifted straight up and your affected arm at your side, bent at the elbow. With gentle pressure, bring your affected arm across your body and hold it there for 15 to 20 seconds. Repeat this 10 to 20 times per day.

6. Towel stretch: Hold one end of a three-foot-long towel behind your back and grab the opposite end with your other hand. Hold the towel in a horizontal position. Use your good arm to pull the affected arm upward to stretch it. You can also do an advanced version of this exercise with the towel draped over your good shoulder. Hold the bottom of the towel with the affected arm and pull it toward the lower back with the unaffected arm. Do this 10 to 20 times a day. A more advanced version of this exercise is to hold the towel over your good shoulder. Tightly grasp its bottom end with the affected arm and, while keeping it against you, pull it toward the lower back with your unaffected arm. Repeat 10 or 20 times a day (as needed/performed).

7. Side arm raise: Stand straight with your feet together, then slowly lift your arms out to the side until they are parallel with the floor. Hold for five seconds and lower back down slowly.

Four stages of frozen shoulder

Stage 1: Pain and stiffness

In the first stage of a frozen shoulder, you'll likely experience some pain, especially if you've been sleeping on your arm for a few hours or more. You may also notice that it's difficult to move your arm in certain directions because it's stiff. The pain typically worsens with movement and gets better when resting.

Stage 2: Loss of range of motion (ROM)

The second stage is marked by a loss of range of motion (ROM). In this phase, you may still be able to lift your arm above shoulder level but will have difficulty reaching behind your back or forward over your head because movements in these directions have become painful and difficult. This stage typically lasts six months or less after symptoms appear.

Stage 3: Loss of strength

Strength loss comes next as muscles atrophy from disuse due to decreased mobility during sleep. It can take anywhere from three months to three years for full recovery following this stage.

Stage 4: Pain relief 

When frozen shoulder symptoms are gone, you may still experience some pain in your joints. This is because the capsule around your shoulder remains stiff and can take several months to fully recover. You may also notice some stiffness when moving your arm at first after it thaws out.

How to sleep with a frozen shoulder

The pain gets worse at night. Therefore, the best position to sleep in with a frozen shoulder is on your back, with a pillow supporting the arm and another between the knees and shoulder. You can also try sleeping on your side, but be careful not to bend or twist your body while you do so. Sleeping on your stomach isn't recommended because it can worsen the condition by putting pressure on joints and the shoulder capsule. If you're having trouble getting comfortable enough to fall asleep, try these tips to reduce the pain in the shoulder:

  • Take advantage of gravity by lying down at an angle that's more conducive to rest—such as leaning forward toward a wall or bedpost—to increase blood flow.
  • Use pillows under both sides of your neck for support (to keep from rolling onto one side).
  • Place a pillow between your shoulder blades and mattress for added comfort if needed (this will help ease tension in the muscles).

Physiotherapy can help

Physiotherapy can decrease pain and help resolve shoulder restrictions caused by adhesions and scarring. Physiotherapy can help with shoulder pain, stiffness and movement. Physiotherapists may use many techniques to improve the range of motion in the joint, including manual therapy that helps break down scar tissue, massage that improves circulation to the area, heat or cold treatment if needed, soft tissue release techniques to loosen tight muscles and stretch bands to gently increase range of motion. This will improve your ability to lift weights as well as perform everyday tasks such as reaching up high on a shelf or hanging clothes out at the laundromat!

If you want more information about how physiotherapy can help you live better with frozen shoulders – contact us today!


The key to treating frozen shoulders is to keep moving. It can take up to nine months for the inflammation in the shoulder joint to subside, so it’s important not to stop exercising even when you feel pain or stiffness. Exercises such as swimming, walking and cycling are good options because they don't put too much pressure on your joints. Physical therapy also relieves some of the pain associated with a frozen shoulder by increasing mobility in areas where muscles have become tight or weak due to disuse. Physiotherapy should be considered an alternative to surgery though some patients opt for both at some point along their treatment plan. 

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