How can physiotherapy treat frozen shoulder?


How can physiotherapy treat frozen shoulder?

“Difficult to define, difficult to treat and difficult to explain from the point of view of pathology”.[1]

That’s how shoulder guru Ernest Codman described frozen shoulder when he first documented it back in 1934.

Since then, the painful condition known as frozen shoulder has also picked up some other names, not all of them entirely accurate.

  • Adhesive or retractile Capsulitis – even though it’s not actually associated with capsular adhesions[2]
  • Idiopathic frozen shoulder
  • Periarthritis Scapulohumeralis


Who does frozen shoulder commonly affect?

Frozen shoulder most commonly affects people in their 50s and is one of the major conditions that alters daily activities and disturbs sleep. It is a rare diagnosis before the age of 35 years and is unusual in patients over 70 years, with women marginally more likely to suffer it than men.[3]

What does frozen shoulder feel like?

Frozen shoulder usually comes on gradually and is commonly brushed off as a general ache or pain before developing rapidly over a day or two.[4]

Frozen shoulder is characterised by a number of symptoms that can vary between each individual patient, but normally includes:

  • Shoulder stiffness
  • Shoulder pain in the deltoid insertion area
  • Pain during the night pain that may wake you from sleep
  • An inability to lie on the affected side
  • Restriction of active movement and external rotation of the shoulder
  • Pain that radiates down the arm

How does physiotherapy treat frozen shoulder?

Frozen shoulder has been observed as passing through three distinct phases.[5]

  • Phase 1: 2–9 months – The painful phase, with progressive stiffening and increasing pain during movement
  • Phase 2: 4–12 months – The joint stiffening or freezing phase, where there can be a slight reduction in pain but increase in stiffness and restriction in range of motion
  • Phase 3: 12–42 months – The thawing phase, where with physiotherapy treatment there is improvement in range of motion and resolution of stiffness

Physiotherapy has been shown to be an effective supporting treatment for frozen shoulder, speeding up recovery, improving mobility and decreasing pain levels. A sports specialist physio can assess your shoulder and use several evidence based methods to increase movement and decrease pain, usually over a six to twelve week course of prescribed physiotherapy.

The goals of your treatment will depend on what stage of frozen shoulder you are currently in. These could be a mix of:

  • Relieving pain
  • Increasing arm movement
  • Reducing the duration of symptoms
  • Returning to normal activities

Regardless of treatment, studies have shown that patient success is directly influenced by the amount of knowledge they have about their frozen shoulder condition.[6] At Lane Cove Physio, we believe that patient education is essential to managing your recovery.


What to remember about frozen shoulder:

  • At first, the pain will be your main problem: worse in bed, especially if lying on that side
  • The pain slowly eases, but stiffness then increases, becoming the main problem,
  • The whole process could last from a few months to two to three years without treatment
  • Using your arm will not do you any harm, but avoid doing too much
  • The treatment options are most effective depend on your circumstances; discuss treatment with your sports physio or musculoskeletal physio based on your needs

If you’ve got questions, Sports specialist physios are experts in injuries, movements and activities related to sport, work and the day to day activities that were aggravating your shoulder so that you can get back to what you were doing before the pain.

[1] Codman EA. Arthritis, periarthritis, and bursitis of the shoulder joint. In: The shoulder. Boston: Thomas Todd Co; 1934. p. 216e24.

[2] Maund E et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012; 16: 1-264

[3] Hand GC, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br 2007;89B:928–32.

[4] Dias R et al. Frozen shoulder. BMJ 2005; 331: 1453-6.

[5] Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ 2005;331:1453–6.

[6] Jones S, Hanchard N, Hamilton S, Rangan A. A qualitative study of patients’ perceptions and priorities when living with primary frozen shoulder. BMJ Open 2013;3:e003452. doi: 10.1136/bmjopen-2013-003452. pmid:24078753.