Frozen Shoulder: A Pain That Won’t Let Go

A Stubborn and Mysterious Condition

Frozen shoulder, or adhesive capsulitis, is a painful and frustrating condition that affects around 2–5% of the population. It’s most common in people aged 40 to 60, and it’s seen more often in women than men. The condition is also more likely in people with diabetes, thyroid disorders, or after shoulder surgery or injury. Frozen shoulder can last for months or even years, and during that time it can limit work, sleep, and daily activities — leading to a high cost in lost time, comfort, and independence.

What’s Really Going On in the Shoulder?

Frozen shoulder starts when the capsule — the flexible tissue surrounding the shoulder joint — becomes inflamed and thickened. Over time, the capsule tightens, restricting movement and causing pain. There are three stages:

1. Freezing – increasing pain and stiffness
2. Frozen – pain may ease, but movement stays limited
3. Thawing – slow return of normal movement

The cause is often unclear, but it can develop after an injury or period of immobility. In some cases, it happens without any known trigger.

What Actually Works for Treatment?

The good news is that most frozen shoulders improve over time, and physiotherapy plays a key role in speeding up recovery. Treatments may include:

• Gentle stretching and mobility exercises
• Manual therapy to reduce joint stiffness
• Education to help manage expectations
• Strengthening once movement begins to return

Pain relief methods like heat, ice, and medications (e.g. anti-inflammatories) can help manage symptoms. In some cases, corticosteroid injections may reduce pain and inflammation, especially early on.

Patience is key — full recovery often takes 6 to 18 months.

What’s Less Likely to Help

Passive treatments like ultrasound, TENS, or acupuncture have limited evidence for improving function or speeding recovery. Surgery is very rarely required, but in long-term cases with no progress, some may consider manipulation under anaesthetic or arthroscopic release. However, these are last-resort options.

Aggressive stretching or overloading the shoulder too early can increase pain and delay recovery, so care must be taken to match the stage of the condition.

What’s Coming in the Future?

New research is exploring the role of immune system changes and inflammation in frozen shoulder, which may lead to new medication options. Advances in imaging and motion analysis could help detect the condition earlier and personalise treatment plans. There’s also increasing focus on diabetes management, as better blood sugar control may reduce the severity or duration of the condition.

Can You Prevent Frozen Shoulder?

• Keep your shoulder moving after injuries or surgeries
• If you have diabetes, monitor and manage your blood sugar
• Strengthen your shoulder and upper back muscles
• Avoid prolonged immobility — stay active where possible
• See a physio early if your shoulder starts to feel stiff or painful