What is frozen shoulder?

Frozen shoulder, also called adhesive capsulitis, is a condition in which the capsule around the shoulder joint becomes thick and tight. The joint gradually loses movement, and everyday tasks such as reaching overhead, fastening clothes or reaching behind your back become painful or difficult. It often develops slowly, over weeks or months, and it usually affects one shoulder at a time, although some people develop it in both shoulders over time.

The condition is often described in three stages: a freezing stage, when pain increases and movement reduces; a frozen stage, when pain may ease but stiffness remains; and a thawing stage, when movement slowly returns. Not everyone moves neatly through these stages, and the pattern can vary from person to person.

What causes frozen shoulder?

The exact cause is not always clear. Frozen shoulder is more common in people over 40, and it is seen more often in people with diabetes or thyroid conditions, although it can affect anyone. It sometimes follows a shoulder injury, surgery or a period when the arm has been kept still for a long time, for example after a fracture. In many cases, however, there is no obvious trigger. What is known is that the tissues around the joint become inflamed and then tighten, which limits movement and causes pain.

• Age — most often seen in people aged 40 to 60.
• Diabetes or thyroid conditions, which are linked with a higher chance of developing it.
• A shoulder injury or surgery, or a long period of keeping the arm still.
• Other health conditions that affect the shoulder or general health.

What are the symptoms of frozen shoulder?

The main symptoms are pain and stiffness in the shoulder. Pain is often worse at night and can disturb sleep, and it may spread to the upper arm. Movement becomes limited in several directions, especially reaching up, out to the side or behind the back. Simple tasks can become hard:

• Reaching overhead, for example to a high shelf.
• Dressing, especially putting on a shirt or fastening a bra.
• Reaching behind your back or into a back pocket.
• Sleeping on the affected side.
• Lifting or carrying with the affected arm.

How is frozen shoulder treated?

There is no single treatment that suits everyone, and care depends on your stage, your pain level and what matters most to you. Physiotherapy is usually the first step. Your physiotherapist will assess your shoulder, discuss your goals and plan care around them. In some cases, your doctor may also discuss pain relief, a steroid injection or, rarely, a procedure to help restore movement. These are medical decisions, and your physiotherapist can help you understand the options and what to ask your doctor.

How can physiotherapy help a frozen shoulder?

Physiotherapy for frozen shoulder aims to reduce pain, protect the joint and gradually restore movement. Care at the clinic may include:

• Hands-on treatment, such as manual therapy and gentle mobilisation of the shoulder.
• Guided exercises to stretch and strengthen the shoulder, progressed as pain allows.
• Advice on posture, sleep positions and how to use the arm during the day.
• A home exercise plan, so you can keep working on movement between visits.
• Regular review, so the plan can be adjusted as your shoulder changes.

What can you do at home?

Small, regular habits can support your recovery. Keep the shoulder moving gently within comfort, rather than avoiding all movement, and try to use the arm for light daily tasks. Warmth before exercises can help some people, while a cold pack after activity may ease soreness. Avoid heavy lifting and sudden jerky movements with the affected arm, and be patient — progress is often slow and uneven. If an exercise increases pain sharply, or the pain lasts well beyond the activity, stop and ask your physiotherapist.

When should you seek care for shoulder pain?

Book an assessment if shoulder pain or stiffness is limiting daily tasks, disturbing your sleep or not improving after a few weeks. Seek care sooner if the pain followed a fall or injury, if the shoulder looks deformed, or if you notice weakness, numbness, tingling or swelling in the arm. People with diabetes or a history of shoulder problems should also get checked early, as frozen shoulder can take longer to settle in these cases.