Frozen Shoulder: Causes, Stages, and How Physiotherapy Helps

Frozen shoulder — medically known as adhesive capsulitis — is a painful and debilitating condition characterised by stiffness and loss of movement in the shoulder joint. It affects approximately 2–5% of the general UK population and is more common in women, people aged 40–60, and those with diabetes or thyroid conditions.

The three stages of frozen shoulder

Stage 1 — Freezing (2–9 months): Pain gradually develops, often worse at night. Range of movement begins to reduce. This is the most painful phase.

Stage 2 — Frozen (4–12 months): Pain levels may reduce, but stiffness reaches its maximum. Significant restriction in all shoulder movements, particularly external rotation.

Stage 3 — Thawing (12–24 months): Gradual return of movement. Pain continues to reduce. Full recovery is the norm, though it can take up to three years without treatment.

Does physiotherapy speed recovery?

Evidence-based physiotherapy can significantly accelerate recovery through all three stages. In the freezing phase, treatment focuses on pain management and maintaining what movement remains. In the frozen and thawing phases, progressive stretching, joint mobilisation, and strengthening exercises restore range of movement more rapidly than natural resolution alone.

When is surgery considered?

The vast majority of frozen shoulders resolve with physiotherapy and time. Surgery (manipulation under anaesthetic or arthroscopic capsular release) is reserved for cases that have not responded to 6–12 months of conservative management.