What Is Frozen Shoulder?

Frozen shoulder, also called adhesive capsulitis, is a painful condition that causes progressive stiffness and loss of shoulder movement. It is one of several causes of shoulder pain, but it has a more distinctive pattern than problems such as rotator cuff injury or shoulder impingement. Both active and passive shoulder motion usually become limited, especially external rotation, reaching overhead, and placing the hand behind the back.

The shoulder capsule becomes irritated, thickened, and tight. As a result, everyday tasks such as dressing, fastening a bra, putting on a shirt, reaching into a cupboard, or sleeping on the sore side can become difficult. Frozen shoulder often develops gradually and may last many months, so early recognition matters.

Common signs of frozen shoulder

• Shoulder pain that gradually becomes more intense
• Marked stiffness in all directions
• Difficulty reaching overhead or behind your back
• Night pain and disturbed sleep
• Loss of both active and passive shoulder movement

Why Does Frozen Shoulder Cause So Much Stiffness?

Frozen shoulder causes stiffness because the capsule around the shoulder joint becomes inflamed and contracted. The joint loses its normal glide, so movements such as reaching up, reaching out to the side, and rotating the arm become painful and restricted. This capsular pattern helps distinguish frozen shoulder from more isolated tendon or bursa problems.

What Are the 3 Stages of Frozen Shoulder?

Frozen shoulder usually progresses through three overlapping stages, although timelines vary from person to person.

1. Freezing stage

This early stage often lasts several months. Pain becomes more noticeable, especially at night or with sudden movement. Shoulder motion starts to reduce, and many people avoid using the arm because it hurts.

2. Frozen stage

During this stage, stiffness becomes more obvious. Pain may settle slightly, but everyday movement is still limited. People often notice difficulty washing their hair, fastening clothing, or reaching into the back seat of the car.

3. Thawing stage

Movement gradually improves in the thawing stage. Recovery can be slow, but a structured program may help restore mobility, strength, and function over time.

Common Causes of Frozen Shoulder

Many cases develop without one clear trigger. However, frozen shoulder is more common after a period of reduced shoulder use, after trauma, or after surgery. It is also more likely in people with diabetes, thyroid disease, or other metabolic and inflammatory conditions. If your symptoms started after another shoulder problem, it is worth checking whether issues such as shoulder bursitis, biceps tendinopathy, or shoulder arthritis may also be contributing.

Who Gets Frozen Shoulder?

Frozen shoulder is most common in adults aged 40 to 60. Women appear to be affected more often than men. Risk is also higher in people with diabetes, thyroid disorders, prolonged shoulder immobilisation, recent surgery, or a previous history of frozen shoulder on the other side. Because of that link, it can also help to consider broader health factors such as diabetes and musculoskeletal health.

How Is Frozen Shoulder Diagnosed?

Diagnosis is usually based on your history and a physical examination. A physiotherapist will assess how your symptoms started, which movements are painful, and whether both active and passive motion are restricted. Frozen shoulder often shows a typical capsular pattern, with external rotation usually most limited.

Imaging such as X-ray, ultrasound, or MRI may be used to rule out other causes of shoulder pain. Imaging does not always diagnose frozen shoulder directly, but it can help exclude tears, arthritis, or other structural problems when the diagnosis is unclear.

Frozen Shoulder Treatment

Frozen shoulder treatment depends on the stage of the condition, your pain levels, and how much your function is affected. In the painful stage, treatment often focuses on symptom relief, sleep comfort, activity modification, and gentle movement. In the stiffer stages, treatment usually shifts toward mobility restoration, muscle control, and gradual return to normal activities.

A physiotherapy program may include education, joint mobilisation, stretching, exercise progression, and guidance on how much activity is helpful without flaring symptoms. Some people are also referred for medical management such as pain relief or injection options. If you are looking for broader care options, shoulder physiotherapy and post-operative shoulder physiotherapy can be useful pathways depending on the cause and stage.

In selected cases, acupuncture or other pain-relief strategies may help settle symptoms enough to let you move more comfortably. Surgery is usually reserved for more stubborn cases that do not improve with appropriate conservative care.

Can Physiotherapy Help Frozen Shoulder?

Yes. Frozen shoulder physiotherapy often aims to reduce pain, improve shoulder mobility, restore muscle control, and help you return to normal tasks at the right pace. Treatment should match the stage of the condition. Overly aggressive stretching in the painful freezing stage can make symptoms worse, while staged progression is often more helpful.

Prevention and Risk Reduction

Not every case can be prevented, but early shoulder movement after injury or surgery may reduce the risk of developing severe stiffness. It also helps to follow rehabilitation advice after shoulder procedures and to manage relevant health conditions well. If you have shoulder pain that is progressively worsening and your range is shrinking, early assessment may prevent delays in diagnosis.

When Should You Seek Professional Help?

You should seek help if shoulder pain is getting worse over weeks, sleep is regularly disturbed, or you cannot lift your arm normally, reach overhead, or place your hand behind your back. Assessment is also important if you recently had shoulder surgery, have diabetes, or are unsure whether your symptoms are coming from frozen shoulder, a tendon injury, or another shoulder condition.

What to do next

If your shoulder is becoming painful and progressively stiffer, a physiotherapy assessment can help confirm whether you are dealing with frozen shoulder or another cause of shoulder pain. Early diagnosis can guide the right stage-based management plan and help you avoid unhelpful exercises or unnecessary delays.

Many people improve with a tailored combination of education, pain management, mobility work, and progressive rehabilitation. If you are unsure where to start, book an assessment so your shoulder can be examined properly and your next steps can be clearly explained.

References

1. Achilova F, Karahan M, Baysal D, et al. Frozen Shoulder: Diagnosis and Treatment of Adhesive Capsulitis. Med Clin North Am. 2024;108(6):1027-1040. doi:10.1016/j.mcna.2024.05.008
2. Kirker K, Harris JD, Haunschild ED, et al. Manual therapy and exercise for adhesive capsulitis: a systematic review. J Shoulder Elbow Surg. 2023;32(6):e293-e307. doi:10.1016/j.jse.2022.12.015
3. Salamh P, Lewis J, Mattocks A, et al. Quality of clinical practice guidelines for frozen shoulder: a systematic review. Physiother Theory Pract. 2025;41(7):1495-1502. doi:10.1080/09593985.2024.2421881

For a general Australian overview, Healthdirect also provides useful public information on frozen shoulder.