Frozen shoulder

We start with how the stiffness began: on its own, or after a fall, an operation or a spell in a sling. We ask what hurts, what wakes you, and what you can no longer reach at home or at work. Then we measure how far the shoulder moves in each direction, first as you lift the arm, then as we move it for you.

That second measure is the telltale. With most shoulder problems, we can move the arm further than you can. With a frozen shoulder, the joint stops at the same point either way, and turning the arm outwards is usually the most limited. We also check your neck and the muscles around the shoulder blade, because a stiff joint changes how everything around it works.

Treatment is staged to the phase, because what helps in one stage can stir up another. The three phases:

• The painful stage: the aim is comfort. We keep the shoulder moving gently within comfort and use hands-on treatment to ease the muscles guarding it. We also work on sleep positions, such as resting the arm on a pillow in front of you. When pain is wrecking sleep, pain relief is a conversation for a doctor or nurse practitioner.
• The stiff stage: the pain eases but the shoulder stays tight. Now we work on range: longer stretches, and joint mobilization, gliding the ball of the joint in its socket to loosen the lining. See manual therapy.
• The thawing stage: range returns, on its own and with work. We rebuild the strength and control the shoulder lost while it was stiff.

Home exercise does most of the work between visits. We match a short set of stretches to the stage and show you how hard to push. The limit: no more than a little worse afterwards, settled by the next day.

If the shoulder stays very stiff despite treatment, your doctor, nurse practitioner or surgeon can discuss a procedure to release the tight lining.

There is no set date. Most sport carries on in some form while the shoulder recovers. On skis, the legs do the work; the shoulder's job is the poles and the falls. Shorter poles, and skipping terrain where a fall onto the arm is likely, keep you on the hill through the stiff stage. Swimming strokes, climbing and paddling ask the shoulder to reach overhead and behind, so they come back last, as range returns.

Before a full return, we test the shoulder against the other side for range, strength and control. The test covers the positions your sport needs, such as reaching overhead on a climb or planting a pole on a steep pitch. If you had a procedure to release the shoulder, your surgeon's timing counts alongside testing.

Book an assessment if your shoulder has been stiffening, reaching behind your back is getting harder, or shoulder pain is waking you at night. Early is useful: knowing the stage lets us match the treatment to it. After a procedure to release the shoulder, come in when your surgeon says you can start physiotherapy.

Go to the emergency department right away, or call 911, if any of these happen:

• a hot, red, swollen shoulder with a fever
• a shoulder that looks out of shape, or will not move after a fall
• chest pain or pressure, shortness of breath, or pain spreading into your jaw
• an arm or hand that is numb, cold or pale