# Frozen shoulder Frozen shoulder (adhesive capsulitis) is a shoulder that turns stiff and painful because the lining around the joint tightens. The telltale sign is stiffness in every direction, even when someone else moves the arm for you. It often starts for no clear reason. We stage treatment to the phase: settle the pain first, then restore range, then rebuild strength for work, study and sport. ## Symptoms - A shoulder that stiffens gradually, often without an injury - A deep ache in the shoulder and upper arm - Pain at night, or when lying on that side - Trouble reaching behind your back, up to a shelf or across your body - Difficulty dressing, washing your hair or fastening a bra - Stiffness that stays even when someone else moves the arm for you - Sharp pain with sudden movements, such as reaching to catch something ## Assessment 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 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](https://backinactionphysiotherapy.com/services/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. ## Getting back to sport 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. ## When to come in 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](https://backinactionphysiotherapy.com/services/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 ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Manual Therapy](https://backinactionphysiotherapy.com/services/manual-therapy) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Frequently asked questions ### Will a frozen shoulder get better on its own? Usually, yes. The tightened lining tends to loosen over time, but it can take a long while, and some stiffness may stay. There is no set date. Treatment does not skip the stages. It aims to keep you sleeping, working and moving through each one, and to win back as much range as the shoulder allows. ### What causes a frozen shoulder? Often nothing obvious. The lining of the joint (the capsule) thickens and tightens, and the reason is not always clear. Sometimes it follows an injury, an operation or a spell with the arm in a sling, when the shoulder has been kept still. It is more common in middle age, and in people with diabetes or thyroid problems. ### Should I stretch it hard to loosen it? No. Forcing a frozen shoulder, especially in the painful stage, stirs up pain without winning range. Early on, movement stays gentle and within comfort. Once the pain settles and the shoulder is mainly stiff, stretches can be firmer and held longer, and joint mobilization helps. The test at every stage is the same: a stretch that leaves the shoulder sore into the next day was too hard. ### Would an injection help? Sometimes. A doctor or nurse practitioner can talk through pain relief, including whether an injection into the joint suits you. In the painful stage it can take the edge off enough to let you sleep and do your exercises. It does not loosen the shoulder on its own, so physiotherapy carries on alongside it. We time the range work for when the pain has settled, whether that comes from the injection or from the shoulder moving on. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*