Frozen shoulder: causes, stages, and what to do
Frozen shoulder is one of the most painful and misunderstood shoulder conditions. Understanding the stages helps you manage it better.
Frozen shoulder, also called adhesive capsulitis, affects roughly one in twenty adults at some point in their life. It is more common in women, in people between 40 and 60, and in people with diabetes. The shoulder becomes progressively stiffer and more painful, often for no obvious reason. Many people wait months before seeking help, assuming the pain will go away on its own. It usually does eventually, but the process can be shortened significantly with the right treatment at the right stage.
What actually happens in frozen shoulder
The shoulder capsule is a flexible lining that surrounds the joint. In frozen shoulder, this capsule becomes inflamed and thickened, forming scar tissue that shrinks the joint space. Movements like reaching overhead, putting on a jacket, or fastening a bra become painful and then eventually impossible. The shoulder does not freeze all at once. It moves through three distinct stages, each requiring a different approach.
The three stages
- Freezing (2 to 9 months): Pain is the main feature. It is often severe at night and wakes you from sleep. Movement becomes progressively restricted. This is the most painful stage and the one where people most often seek help.
- Frozen (4 to 12 months): Pain begins to ease, but stiffness is at its worst. Daily activities like reaching a high shelf, tucking in a shirt, or driving are significantly limited.
- Thawing (5 to 24 months): Stiffness gradually improves. Movement slowly returns. Most people recover full or near-full range of motion, though this phase can take a long time without physiotherapy to guide the process.
What helps at each stage
In the freezing stage, pain management is the priority. Your physiotherapist may focus on gentle range of motion exercises, positioning advice for sleep (placing a pillow under the arm to support the shoulder), and activity modification to avoid positions that aggravate the pain. In the frozen stage, more active stretching and manual therapy can be introduced to work on the restricted capsule. In the thawing stage, progressive strengthening is added to restore full function. Skipping ahead to stretching or strengthening when the shoulder is still in the freezing stage typically makes the pain worse rather than better.
Two exercises for the thawing stage
Pendulum exercise
Objective: Uses gravity and gentle movement to reduce pain and encourage early range of motion.
- 1Stand beside a table and lean your uninvolved hand on it for support.
- 2Let the arm on the affected side hang loosely.
- 3Gently swing it in small circles clockwise, then anticlockwise.
- 4The movement comes from rocking your body slightly, not from actively moving your shoulder.
- 5Keep the circles small and the movement relaxed.
Wall walking
Objective: Gradually increases overhead reach by using the wall as a guide.
- 1Stand facing a wall about one arm's length away.
- 2Place the fingers of your affected arm on the wall at waist height.
- 3Walk your fingers up the wall as high as you comfortably can.
- 4Hold at the top for 3 seconds, then walk back down slowly.
- 5Mark your progress with a small piece of tape on the wall.
A note for those who carry bags on one shoulder
Carrying a heavy bag, whether a laptop bag, a tiffin carrier, or a chunky dupatta draped and pulled over one shoulder, places repeated load on the rotator cuff and upper trapezius. This does not cause frozen shoulder directly, but it can aggravate an already irritable shoulder and slow recovery. Try alternating sides, or switch to a backpack that distributes the weight evenly while your shoulder heals.
Frozen shoulder responds well to physiotherapy, but timing matters. Book an assessment on BookPhysio.in to understand which stage you are in and what treatment is appropriate.