Frozen shoulder: understanding the stages and how to keep moving

It might have started as a niggle when reaching into the back seat. Then putting on a jacket, doing up a bra or sleeping on that side became a battle. Before long the shoulder felt both painful and stuck. That is the frustrating hallmark of frozen shoulder.

The reassuring part is that frozen shoulder tends to improve over time, and there’s plenty you can do to stay comfortable and keep as much movement as possible along the way. Here’s what’s happening, what to expect, and how our Byron Bay team can help.

What is frozen shoulder?

Frozen shoulder, or adhesive capsulitis, is a condition where the capsule around the shoulder joint becomes inflamed, then thickened and tight [3][4]. The result is pain and a marked loss of movement, particularly when rotating the arm outwards and lifting it overhead. Importantly, the shoulder is stiff whether you move it yourself or someone else moves it for you.

Why does it happen?

Often there’s no obvious reason, which is called primary frozen shoulder. It can also follow an injury, surgery or a period when the arm wasn’t used much (secondary frozen shoulder). Factors linked with a higher risk include [4]:

• being aged roughly 40–65
• being female
• diabetes and thyroid conditions
• a previous frozen shoulder on the other side

How is it diagnosed?

Diagnosis is mostly clinical, based on your story and a careful examination. Typical features include:

• gradual onset of shoulder pain, often without a clear injury
• significant loss of movement in several directions, particularly rotating outwards
• night pain and difficulty lying on the affected side

Imaging such as an X-ray or ultrasound is sometimes used to rule out other problems like arthritis or a rotator cuff tear, rather than to confirm frozen shoulder [4]. Our article Do I need imaging? explains more.

The three stages

Frozen shoulder is often described in three overlapping phases [4]:

1. Freezing (painful phase): pain builds, often worse at night, and movement gradually reduces.
2. Frozen (stiff phase): pain usually eases, but stiffness remains.
3. Thawing (recovery phase): movement gradually returns.

How long each phase lasts varies a lot between people. Many improve substantially over one to three years, but a systematic review found that some people still have some pain or stiffness years later, so the old idea that it always fully resolves on its own is a little too optimistic [2]. That’s why active management matters.

What helps?

In the painful phase

The focus is on calming pain and keeping the movement you have:

• Gentle, regular movement within comfort, such as pendulum swings and assisted range of motion exercises. Avoid forcing painful stretches.
• Sleep strategies, such as a pillow under the arm or sleeping on the other side.
• Medical options: talk to your GP about pain relief. A corticosteroid injection can reduce pain in the early phase for some people [3]; our article on corticosteroid injections covers the pros and cons.

In the stiff and recovery phases

As pain settles, treatment shifts towards restoring movement and strength:

• progressive stretching and mobility work
• strengthening the shoulder blade and rotator cuff muscles that may have weakened from disuse
• gradually returning to reaching, lifting and sport

A large UK trial (UK FROST) compared physiotherapy-style care plus a steroid injection with two surgical options. All three groups improved a lot, and the surgical options didn’t offer meaningful extra benefit for most people [1]. A review comparing many treatments found that combining an injection with a home exercise program was among the more effective approaches in the short term [3].

When to see a doctor

See your GP if your shoulder pain followed a fall or injury, if you can’t lift your arm at all after an injury, if the pain comes with fever, chest pain or shortness of breath, or if you have diabetes and your pain is escalating [5].

How we can help at Retrain Health

Our osteopaths help people through every stage of frozen shoulder and other types of shoulder pain. Care may include:

• A clear assessment to confirm what’s going on and rule out other causes.
• Gentle hands-on treatment such as soft tissue work and joint mobilisation to ease pain and support movement, with remedial massage for tight surrounding muscles if helpful.
• A home program matched to your stage, so you’re not pushing too hard when it’s painful or holding back when it’s ready to move.
• Strength and return-to-activity work through exercise rehabilitation, whether your goal is paddling out, swimming, gardening or lifting the grandkids.
• Liaison with your GP if an injection or further investigations may help.

You don’t have to wait it out alone

Frozen shoulder takes patience, but you don’t have to sit on the sidelines. Book an appointment with our Byron Bay team and we’ll help you stay comfortable and moving at every stage.

This article is general information only and isn’t a substitute for individual advice. Recovery times vary from person to person.