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Quick Summary
At J&J Therapy in New Malden, our HCPC-registered physiotherapists combine hands-on manual therapy, radial shockwave therapy (Swiss Storz Medical MASTERPULS), and a tailored exercise programme to help ease pain, restore range of motion, and shorten recovery from frozen shoulder. Most patients notice meaningful improvement within 4–8 sessions, with a typical course of 6–12 sessions depending on stage and severity. Every plan is individualised and evidence-based, and both Bupa and AXA insurance are accepted.
What Is Frozen Shoulder?
Frozen shoulder — known medically as adhesive capsulitis — is a painful and progressively stiff condition of the glenohumeral joint capsule. The capsule becomes inflamed and then thickens and tightens, particularly around the coracohumeral ligament and rotator interval, reducing the normal joint volume from approximately 28–35 mL to under 10 mL. Histologically it resembles a Dupuytren-like fibroproliferative process, with increased inflammatory cytokines, myofibroblast proliferation, and dense collagen deposition (Bunker and Anthony, 1995; Le et al., 2017).
Frozen shoulder characteristically progresses through three overlapping stages:
Stage 1 — Freezing / Painful (2–9 months): gradual onset of diffuse shoulder pain, often worse at night, with stiffness developing progressively.
Stage 2 — Frozen / Stiff (4–12 months): pain often eases but stiffness dominates, with marked global loss of range of motion — particularly external rotation.
Stage 3 — Thawing / Recovery (5–24 months): slow, gradual return of movement and function.
The total natural history is typically 1.5–3 years, although contemporary evidence suggests that up to 40% of people experience persistent symptoms at 4 years of follow-up (Hand et al., 2008). Frozen shoulder can be classified as primary (idiopathic), with no clear trigger, or secondary to systemic conditions (diabetes, thyroid disease, Dupuytren's, Parkinson's disease), intrinsic shoulder pathology, or extrinsic causes. It affects approximately 2–5% of the general population, most commonly women aged 40–60, and occurs in 10–20% of people living with diabetes.
Research supports a combined approach of manual therapy, exercise, and radial extracorporeal shockwave therapy, with randomised controlled trials showing significant improvements in pain, range of motion, and SPADI scores compared with sham treatment or conventional physiotherapy alone (Hussein and Donatelli, European Journal of Physiotherapy, 2016; Vahdatpour et al., 2014).
Do You Experience These Symptoms?
✓ Severe shoulder pain, especially at night — often the earliest and most distressing symptom, making it difficult to sleep on the affected side
✓ Progressive stiffness limiting movement in all directions — both active and passive range of motion become restricted
✓ Marked loss of external rotation — the hallmark clinical sign that distinguishes frozen shoulder from most other shoulder conditions
✓ Difficulty reaching overhead, behind your back, or across your body — affecting everyday tasks such as washing hair or putting on a coat
✓ Trouble with dressing, fastening a bra, or reaching a back pocket — reflecting the characteristic capsular pattern of restriction
✓ Aching pain referred down the upper arm — pain can radiate towards the deltoid insertion and mid-arm
✓ Persistent dull ache at rest that worsens with any sudden or unguarded movement
These symptoms are treatable. Specialist physiotherapy can help.
What Causes Frozen Shoulder?
• Primary (idiopathic) frozen shoulder
In many patients, no clear cause can be identified — this is termed primary or idiopathic frozen shoulder. Although the trigger is unclear, it is strongly associated with systemic metabolic conditions and a genetic predisposition, with familial clustering observed in some cohorts.
• Diabetes mellitus
People with diabetes have up to a fivefold increased risk of developing frozen shoulder, and around 10–20% of diabetics are affected (Zreik et al., 2016). The mechanism is thought to involve non-enzymatic glycation of capsular collagen, which stiffens connective tissue.
Risk is higher with longer diabetes duration, type 1 diabetes, and poorer glycaemic control.
• Thyroid disorders
Both hypothyroidism and hyperthyroidism are independently associated with an elevated risk of frozen shoulder. Altered thyroid hormone levels appear to influence connective-tissue metabolism and fibroblast behaviour, predisposing the capsule to contracture.
• Post-immobilisation, trauma, or surgery
Prolonged immobilisation after a shoulder fracture, dislocation, stroke, or cardiac event can trigger secondary frozen shoulder. It is also a well-recognised complication of rotator cuff repair and breast surgery with axillary dissection.
• Age, sex, and other associations
Frozen shoulder most commonly affects adults aged 40–60, with women affected more often than men (ratio approximately 1.4–2:1). Associated conditions include Dupuytren's contracture, Parkinson's disease, and hyperlipidaemia, all of which share a fibroproliferative tendency.
How We Treat Frozen Shoulder at J&J Therapy
We go beyond exercise sheets. Your first session is a full 45-minute assessment AND treatment - so you leave feeling the difference.
Hands-On Manual Therapy
Targeted glenohumeral joint mobilisation, graded Maitland techniques, and capsular stretching — progressed from gentle Grade I–II mobilisations during the painful stage to Grade III–IV end-range mobilisations in the stiffness-predominant phase to restore movement and ease pain.
Shockwave Therapy*
Swiss Storz Medical MASTERPULS
to promote tissue healing, disrupt capsular adhesions, and modulate pain in the glenohumeral joint capsule.
Non-invasive, evidence-based. Typically 4–6 sessions.
Targeted Exercise Programme
Stage-specific programme: pendulum (Codman's) exercises and passive range-of-motion in the painful phase; pulley work, wand-assisted external rotation, and end-range capsular stretches in the stiff phase; rotator cuff and scapular strengthening in the thawing phase — with consistent daily home practice as the cornerstone of long-term recovery.
Shockwave Therapy
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Chronic neck tension and trigger points in the upper trapezius and surrounding muscles can be difficult to resolve with exercise alone. Our Swiss-manufactured Storz Medical MASTERPULS shockwave system delivers precise acoustic waves to break down muscle knots, improve blood flow, and support the body's natural healing response.
Swiss Storz Medical MASTERPULS - clinical-grade precision
Non-invasive — no needles, no medication
Stimulates natural tissue repair and blood flow
Typically 3-6 sessions for lasting improvement
Results may vary. Your physiotherapist will recommend the best plan for your specific condition.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Sudden, severe shoulder pain following a fall, collision, or trauma — may indicate a fracture, rotator cuff tear, or dislocation
Signs of infection — fever, redness, warmth, rapid swelling, or a hot, exquisitely tender shoulder (possible septic arthritis)
Numbness, tingling, or new weakness extending into the arm or hand — may indicate cervical radiculopathy or nerve compression
History of cancer with new, persistent shoulder pain, or unexplained weight loss, night sweats, or a palpable mass — requires prompt medical review
FAQs About Frozen Shoulder
How long does frozen shoulder last?
Frozen shoulder is often described as self-limiting, with most people improving over 1.5 to 3 years. However, contemporary follow-up studies show that up to 40% of patients retain some residual stiffness or discomfort at four years without active treatment (Hand et al., 2008). Structured physiotherapy — including manual therapy, shockwave therapy, and a guided exercise programme — can meaningfully shorten this timeline and improve long-term outcomes.
Is shockwave therapy effective for frozen shoulder?
Yes — research strongly supports radial shockwave therapy as a valuable component of frozen shoulder treatment. A double-blind, placebo-controlled randomised trial by Hussein and Donatelli (2016) showed that rESWT combined with physiotherapy produced significantly greater improvements in pain, range of motion, and SPADI scores than sham plus physiotherapy. Further RCTs (Vahdatpour et al., 2014; Santoboni et al., 2017) confirm that shockwave therapy outperforms conventional physiotherapy alone and may be particularly helpful in diabetic frozen shoulder. It is not a stand-alone cure, but it is an effective, non-invasive option that may shorten recovery and reduce the need for injections or surgery.
Can I prevent frozen shoulder?
There is no proven way to prevent primary (idiopathic) frozen shoulder. However, you can reduce your risk of secondary frozen shoulder by maintaining good glycaemic control if you have diabetes, following early mobilisation protocols after shoulder surgery or immobilisation, and seeking timely physiotherapy after any shoulder injury rather than resting the arm for prolonged periods.
Should I exercise through the pain?
No — pushing hard through sharp pain can worsen inflammation and prolong the painful phase. We recommend working within a tolerable discomfort range, typically no more than 3–4 out of 10 on a pain scale. Your physiotherapist will guide you on the correct intensity for your stage, progressing stretches and mobilisations as the capsule becomes less reactive.
When should I consider a corticosteroid injection or surgery?
Per NICE CKS and BESS guidance, an intra-articular corticosteroid injection may be considered during the painful (freezing) stage for short-term pain relief, ideally image-guided. Specialist review is appropriate if symptoms have not meaningfully improved after approximately three months of structured conservative care, at which point options such as hydrodistension, manipulation under anaesthesia (MUA), or arthroscopic capsular release may be discussed. The UK FROST trial (Rangan et al., Lancet, 2020) found all three secondary-care options effective, with early structured physiotherapy plus injection being the most cost-effective first-line pathway.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
Last reviewed:
17 April 2026