What frozen shoulder is
The shoulder joint capsule is a flexible sleeve that, in a healthy joint, allows a very large range of movement. In frozen shoulder, inflammation develops in it, and the capsule then thickens and contracts. The joint literally loses its slack – which is why movement is restricted not only when you lift the arm yourself, but also when a therapist tries to move it. Outward rotation of the arm suffers the most.
The condition most often affects people between 40 and 60. It usually appears without a clear cause, although it is more common in people with diabetes or thyroid disease and after a period of immobilisation of the arm. Frozen shoulder is not the result of “sitting in a draught”, nor of a lack of movement that is your fault, and early diagnosis helps avoid months of ineffective, painful stretching.
The three phases of the condition
The first phase – the painful one, also called the freezing phase – usually lasts a few months. Severe pain, including at night, dominates, and movement gradually starts to decrease. In the frozen phase the pain eases, but the shoulder is at its stiffest: it is hard to reach behind your back, comb your hair or put on a jacket. The thawing phase is a slow return of movement.
The whole process usually takes from one to three years. In most people it ends with good function regained, although some are left with some restriction of movement or discomfort, usually minor. The phases do not have sharp boundaries and often overlap.
What treatment looks like in each phase
At the first visit we check whether the symptoms really fit frozen shoulder. A similar restriction of movement can be caused by, among other things, advanced degenerative changes in the joint, calcifications or a dislocation missed after an injury, which is why an X-ray, arranged by a doctor, is sometimes needed. Pain when lifting the arm, with passive movement still full, points more towards the problems described on the page about shoulder pain.
In the painful phase the priority is controlling pain, not fighting for range. We use gentle manual therapy techniques and movement within a comfortable range, because strong stretching at this stage usually makes the symptoms worse. If the pain is costing you sleep and making exercise impossible, it is worth talking to a doctor about a steroid injection – the decision is theirs, and we adapt the exercise plan to it. In the following phases the intensity goes up: joint mobilisations, stretching of the capsule, and then strength exercises.
What to expect
Physiotherapy will not make frozen shoulder go away in a few weeks, and we say so honestly. What it does make is a real difference to how you get through the successive phases: less pain, better sleep, more movement in everyday activities and a faster return of strength once the joint starts to thaw. In that last phase we bring in medical training to rebuild the muscles weakened by many months of protecting the arm.
A large part of the work, however, is done by you between visits: a short set of exercises repeated every day at home matters at least as much for the shoulder as the treatment at our practice itself. That is why we make sure you can do the exercises confidently and without excessive pain. We match how often you come in to the phase of the condition and how well you are managing the exercises on your own. We sort out the details at the visit.