Frozen shoulder can make it hard to reach a shelf, fasten a seatbelt or sleep through the night. It usually improves with time, and the right physical therapy can ease pain and help you get your motion back sooner.
Frozen shoulder, called adhesive capsulitis by doctors, is a painful stiffening of the shoulder joint. It tends to come on slowly, often with no clear injury, and it can last many months.
This guide explains what frozen shoulder is, who is most likely to get it, its typical stages, how it differs from rotator cuff problems and what physical therapy can do at each stage.
When to see a doctor right away
- Call 911 if left shoulder or arm pain comes with chest pressure, shortness of breath, sweating, nausea or jaw pain. This can be a heart attack.
- Fever or feeling unwell with a hot, red, swollen shoulder joint (possible joint infection).
- Sudden inability to lift your arm after a fall or injury, or a shoulder that looks out of place.
- New numbness, tingling or weakness spreading down the arm, or pain that is severe and constant, even at rest, with no clear cause.
What Is Frozen Shoulder?
Your shoulder joint is wrapped in a flexible sleeve of tissue called the capsule. In frozen shoulder, this capsule becomes inflamed, then thickens and tightens. The result is pain and a shoulder that will not move fully in any direction, even when someone else tries to move it for you. Turning the arm outward is often the first and most limited motion.
Frozen shoulder affects an estimated 2% to 5% of people. It is most common between ages 40 and 60, and more common in women.
Who Is Most at Risk?
- People with diabetes. A review of studies found that people with diabetes were about five times more likely to develop frozen shoulder, and roughly 13% of people with diabetes had it.
- People with thyroid conditions, especially an underactive thyroid.
- People whose arm has been kept still for a while, for example after an injury, surgery or a stroke.
- Adults in midlife, roughly 40 to 65 years old.
Many people have none of these risk factors. Frozen shoulder can also start without any obvious reason.
The Stages of Frozen Shoulder
Frozen shoulder usually moves through three overlapping stages. The timing varies a lot from person to person.
1. Freezing (painful) stage
Pain builds gradually and is often worse at night and when lying on the shoulder. Motion starts to slip away as pain makes you protect the arm.
2. Frozen (stiff) stage
Pain often eases, but stiffness takes over. Reaching overhead, behind your back or out to the side becomes hard, and daily tasks like dressing or doing your hair can be a struggle.
3. Thawing stage
Motion slowly returns. Many people regain most of their movement, though recovery can take a year or more, and some keep a little stiffness.
Frozen Shoulder vs. Rotator Cuff Problems
Rotator cuff problems are a more common cause of shoulder pain, and they can feel similar at first. The key difference is stiffness:
- Frozen shoulder: the shoulder is truly stiff. Neither you nor anyone else can move it fully, especially rotating the arm outward.
- Rotator cuff problems: movement hurts, but if someone else gently lifts your arm, it can usually go most of the way. Weakness lifting the arm is more typical.
A careful hands-on exam is the best way to tell them apart. If your symptoms sound more like a rotator cuff problem, read our guide to rotator cuff pain and tears and how physical therapy can help.
How Physical Therapy Helps Frozen Shoulder
The clinical practice guideline from the Orthopaedic Section of the American Physical Therapy Association recommends patient education, stretching and mobility exercise, and joint mobilization for frozen shoulder, with the intensity matched to how irritable the shoulder is.
Understanding your shoulder
Knowing that frozen shoulder follows a predictable course, and that it usually gets better, takes a lot of the worry out of it. Your therapist will explain which stage you seem to be in and what to expect.
Gentle motion when pain is high
In the painful stage, forcing a stretch tends to backfire. Treatment focuses on calming pain and keeping the motion you have with gentle, comfortable movements, such as pendulum swings and supported arm slides on a table.
Progressive stretching as pain settles
As the shoulder becomes less irritable, stretches are held longer and pushed a little further. Hands-on joint mobilization by your therapist can help the tight capsule move.
Strength and control
As motion returns, exercises for the rotator cuff and shoulder blade muscles help your arm work smoothly and with less strain.
A home program
Short, frequent sessions at home make a big difference. Your therapist will give you a few exercises to do daily and update them as you improve. Our physical therapy programs pair hands-on care with this kind of active, step-by-step plan.
Injections and Surgery
Your doctor may suggest a steroid injection into the shoulder joint. The APTA guideline notes that an injection combined with mobility and stretching exercises gives better short-term pain relief and function than exercise alone.
Most people do not need surgery. In a large UK trial of 503 adults with frozen shoulder, early structured physiotherapy with a steroid injection, manipulation under anesthesia and keyhole surgery to release the capsule all led to improvement, and none was clearly better than the others at 12 months. Surgery is generally saved for people who are still badly limited after a good trial of other care.
Sleeping and Daily Position Tips
- Avoid lying directly on the painful shoulder for now.
- If you sleep on your back, place a small pillow under the sore arm so the elbow is supported.
- If you sleep on your good side, hug a pillow in front of you to rest the painful arm on.
- Keep items you use often at waist to shoulder height.
- Use the arm for light daily tasks within comfort rather than keeping it completely still.
How Long Does Recovery Take?
Frozen shoulder has traditionally been described as running its course over one to two years, but newer research shows some people keep stiffness or limits for longer. Therapy cannot always speed up the natural course, but it can ease pain, protect the motion you have and help you get back to daily activities sooner. People with diabetes may recover more slowly. Doing your home exercises regularly is one of the biggest factors you can control.
Getting Started at Holsman
We treat frozen shoulder at 17 clinics across New Jersey and New York, including Fair Lawn, Lyndhurst and Kearny. If getting to a clinic is hard, ask about in-home therapy.
You can schedule physical therapy, occupational therapy and speech therapy directly. Some insurance plans require a referral for coverage; our staff will verify your benefits. Learn more on our insurance page, or contact us to book.
Frequently Asked Questions
Will frozen shoulder go away on its own?
Frozen shoulder usually improves over time, but it can take a year or more, and some people keep a little stiffness. Physical therapy can ease pain and help restore motion along the way.
Should I stretch through the pain?
Not in the early, painful stage. Hard, painful stretching can flare symptoms. Gentle motion works better at first, and stretching is progressed as pain settles.
How do I know if I have frozen shoulder or a rotator cuff problem?
Frozen shoulder causes true stiffness, so the arm can't be moved fully even with help. Rotator cuff problems mostly cause pain and weakness with movement. A physical therapist or doctor can tell the difference with a hands-on exam.
Is frozen shoulder more common with diabetes?
Yes. Research suggests people with diabetes are about five times more likely to develop frozen shoulder, and recovery may take longer.
Do I need surgery for frozen shoulder?
Most people do not. Physical therapy, sometimes combined with a steroid injection, is usually tried first. Procedures are generally considered only if you are still badly limited after a good trial of other care.
Sources
- Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. Clinical Practice Guidelines from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302
- Ramirez J. Adhesive Capsulitis: Diagnosis and Management. American Family Physician. 2019;99(5):297-300. aafp.org
- Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles, Ligaments and Tendons Journal. 2016;6(1):26-34. doi:10.11138/mltj/2016.6.1.026
- Rangan A, Brealey SD, Keding A, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. The Lancet. 2020;396(10256):977-989. doi:10.1016/S0140-6736(20)31965-6
This article is for general education and isn't a substitute for an evaluation by a licensed clinician.