Frozen Shoulder

What separates frozen shoulder from a shoulder that simply hurts is stiffness that limits movement, not pain on its own ^1,2. If your shoulder is painful but the range is still there, the Rotator Cuff Tear and Shoulder Impingement pages are worth a read instead.

Diagnosis is made from your history, a physical examination and range of motion testing, and imaging isn't usually needed ¹. That's not a shortcut: the pattern of restriction is the diagnosis, and a scan doesn't show it better than a careful assessment does.

The main check is simple. We compare how far you can move the shoulder yourself with how far it goes when we move it for you. In frozen shoulder both are limited, and that pattern is the hallmark of the condition ⁷. You'll also be asked about recent injuries and your medical history ¹.

You don't need a scan to diagnose it. An X-ray may be used to look for other causes of a stiff, painful shoulder, such as arthritis, and an MRI or ultrasound can pick up soft tissue problems like a rotator cuff tear ⁷. Once frozen shoulder is diagnosed, your doctor may check for conditions linked to it, including diabetes, high blood pressure and high cholesterol ¹.

Ask "what's the best treatment" and the answer is that nobody has one ¹. What we can do is match what you're doing to the stage you're in, and stay inside the limit the evidence keeps returning to.

The pain rule comes first, in every stage. Government health guidance is explicit that treatment must not increase your level of pain ¹. This isn't caution for its own sake. A two-year study comparing intensive passive stretching and manual mobilisation against exercise kept inside pain limits found 89% of the pain-limited group reached normal or near-normal painless function, against 63% of the intensively stretched group ⁴. More aggressive wasn't better. It was measurably worse.

In the freezing stage, the job is settling pain and protecting the range you still have. Gentle movement rather than forced movement, and working out what's aggravating it: driving is a common one, and minimising it during this phase is specifically advised ¹.

In the frozen and thawing stages, mobility work earns its place. Physiotherapy is most useful in these two stages, and the treatments vary depending on which one you're in ¹. This is where Manual Therapy fits: hands-on techniques including soft tissue release and trigger point work to improve mobility in the joint ¹, always inside the same pain limit.

A home exercise programme is the part with the most evidence behind it. The largest review of frozen shoulder treatments concluded that treatment should be accompanied by a home programme of simple exercises and stretches to maximise the chance of recovery ³. That's what Exercise Prescription & Conditioning is for: a programme that changes as you move through the stages, not the same ten exercises regardless. In the thawing stage it shifts towards loading and strength, because getting range back is only half of it.

The Well Motion Recovery Path™ follows frozen shoulder's own three stages. You move up a phase when the shoulder is ready, not when a month ends.

• Reset: the freezing stage. Gentle movement, less of whatever aggravates it, and a word with your GP about an injection while you are in the first year ³. Expect pain to lead, and some range to go before things turn. We move you on once night pain is easing and stiffness is the main complaint.
• Rebuild: the frozen stage, running into thawing. Manual Therapy and a home programme that changes as the range comes back ^1,3, all inside your pain limit ⁴. Expect slow gains, measured over weeks. We move you on when the shoulder does what your daily tasks ask of it.
• Return: dressing, driving, reaching overhead and sleeping on that side, then work or sport. We check range and strength against your other arm. You leave with a strength programme and a reminder to watch the other shoulder ⁹.

How long it usually takes. In one series of 83 patients, frozen shoulder lasted 15 months on average (range 4 to 36) in those left untreated ¹⁰. That is one surgeon's retrospective review, a guide only. The usual stage lengths are clinical convention, not trial results: freezing 6 weeks to 9 months, frozen 4 to 6 months, thawing 6 months to 2 years ⁷.

The exact cause isn't known, so frozen shoulder can't be reliably prevented ¹. A few things have been studied, though:

• Keep the arm moving after surgery or an injury. Frozen shoulder can follow a spell of holding the shoulder still ⁷. In a randomised trial of 62 people who'd just had a pacemaker fitted, 2 of the 28 given physio and exercise instruction had developed it four months later, against 9 of the 34 who weren't ⁸.
• Keep an eye on the other shoulder. It rarely returns in the same shoulder ⁷. The other side is a different story: of 60 people followed for at least two years after treatment, 22 developed it in the opposite shoulder, more often those with diabetes ⁹. Early treatment can ease symptoms and shorten the time until it resolves ¹.
• Stay on top of diabetes. A return is more likely if a contributing factor such as diabetes is still present ⁷, so keep up your regular diabetes check-ups ².
• Move it, but don't force it. Keeping the shoulder completely still makes the pain worse. So can making up your own strenuous exercises ².