Quick Summary
Frozen shoulder (adhesive capsulitis) is a condition where the capsule surrounding your shoulder joint becomes inflamed, thickened and tight — causing progressive pain and stiffness. It affects an estimated 2–5% of people, most commonly between ages 40 and 60. Evidence shows that guided physiotherapy, manual mobilisation and targeted exercise can ease pain and restore movement, and research suggests shockwave therapy may provide additional benefit — typically over 3–6 sessions alongside your programme.
What Is Frozen Shoulder?
Frozen shoulder — known medically as adhesive capsulitis — is a condition where the flexible tissue surrounding your shoulder joint (the joint capsule) becomes inflamed, thickened and contracted, causing pain and progressive loss of movement.
The capsule normally allows your shoulder to move freely in all directions. In frozen shoulder, the capsule tightens and dense bands of scar-like tissue form, dramatically reducing how far your shoulder can move — turning the arm outwards is characteristically the most restricted movement (Ramirez, American Family Physician, 2019).
The condition typically progresses through three overlapping stages:
Stage 1 — Freezing (around 2–9 months): Gradual onset of increasing pain, often worse at night, with progressive loss of movement.
Stage 2 — Frozen (around 4–12 months): Pain begins to ease but marked stiffness dominates, limiting everyday tasks.
Stage 3 — Thawing (12 months or longer): Movement gradually returns, often over a year or more.
Although often described as self-limiting, research suggests this is optimistic: persistent symptoms of some degree have been reported in up to 40% of people left untreated, which is why we encourage active, guided management rather than simply waiting. Studies of affected capsule tissue show an inflammatory process progressing to fibrosis — the biological target of treatments that aim to restore flexibility and settle pain (Akbar et al., PLOS One, 2019).
Do You Experience These Symptoms?
✓ A deep, aching pain in your shoulder, often worse at night and when lying on the affected side
✓ Gradual, progressive stiffness limiting movement in all directions
✓ Difficulty reaching overhead, out to the side, or behind your back
✓ Particular loss of external rotation — turning your arm outwards
✓ Trouble with everyday tasks such as dressing, washing your hair or fastening a seatbelt
✓ Pain that came on gradually rather than after a single obvious injury
✓ A tendency to guard the shoulder, with reduced natural arm swing when walking
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Frozen Shoulder?
• Idiopathic onset — no clear trigger
In many people frozen shoulder develops spontaneously with no obvious cause; this is termed primary frozen shoulder.
The underlying process involves inflammation of the joint capsule followed by fibrosis, but why it begins is still not fully understood.
• Diabetes and thyroid disease
Diabetes is the strongest known risk factor — research suggests people with diabetes are around five times more likely to develop frozen shoulder (Zreik et al., Muscles, Ligaments and Tendons Journal, 2016).
Thyroid disease and raised cholesterol are also associated, and outcomes tend to be slower in longstanding diabetes.
• Age and sex
Frozen shoulder most commonly affects people aged 40–60 and is somewhat more common in women.
It rarely occurs before 40, and while recurrence in the same shoulder is uncommon, the opposite shoulder is later affected in a minority of people.
• Immobilisation, surgery or injury
Secondary frozen shoulder can follow a period of the shoulder being kept still — for example after surgery, a fracture, a rotator cuff injury or a stroke.
Keeping the shoulder gently moving after injury, under guidance, may reduce this risk.
How We Treat Frozen Shoulder at J&J Therapy
Hands-On Manual Therapy
Our HCPC-registered physiotherapists use hands-on manual therapy — graded joint mobilisation and soft-tissue techniques — to ease pain and gradually restore movement. We match treatment intensity to your stage: gentler, pain-relieving techniques during the painful freezing phase, progressing to firmer mobilisation as stiffness becomes the main problem. Evidence shows mobilisation combined with exercise can improve range of movement and function, and we always work within your comfort, as research suggests overly aggressive stretching can slow recovery.
Shockwave Therapy*
Swiss Storz Medical MASTERPULS
to stimulate blood flow, support the healing response and improve the flexibility of the thickened, contracted shoulder capsule and surrounding soft tissue.
Non-invasive, evidence-based. Typically 3–6 sessions.
Targeted Exercise Programme
We design a targeted, progressive exercise programme to rebuild movement and strength — typically pendulum exercises, gentle range-of-movement work and stretching kept within a comfortable range, progressing to strengthening as symptoms allow. Evidence shows exercise therapy improves movement, function and pain in frozen shoulder. We also coach you through a simple home programme, because consistent, pain-limited daily movement is central to recovery.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
A hot, red, swollen shoulder with fever or feeling unwell (possible joint infection)
A history of cancer, an unexplained lump, unexplained weight loss, or severe unremitting night pain
Shoulder pain after significant trauma, an abnormally shaped shoulder, or sudden new weakness in your arm
Significant pain and disability persisting beyond six months despite appropriate treatment
FAQs About Frozen Shoulder
How long does frozen shoulder take to get better?
Frozen shoulder usually improves over one to three years, moving through freezing, frozen and thawing stages. Recovery varies a great deal between people, and evidence shows some are left with mild residual stiffness. Guided physiotherapy and exercise aim to reduce pain and speed the return of movement.
Will I need surgery?
Most people are managed without an operation. The largest UK trial (UK FROST, The Lancet, 2020) found early structured physiotherapy with a steroid injection gave broadly similar outcomes at 12 months to surgical options. Surgery is generally reserved for cases that do not improve after several months of conservative care.
Should I just rest it until it settles?
No — prolonged immobilisation can make stiffness worse. The aim is gentle, pain-limited movement. We guide you on how much to do so you keep the shoulder moving without overstressing the irritated capsule.
Does shockwave therapy help frozen shoulder?
Research suggests extracorporeal shockwave therapy may help reduce pain and improve movement when used alongside exercise — a meta-analysis of 20 randomised trials concluded it can be a beneficial adjunct to routine treatment (Zhang et al., Orthopaedic Journal of Sports Medicine, 2022). We use Swiss Storz Medical MASTERPULS radial shockwave as a non-invasive option, typically over 3–6 sessions, combined with manual therapy and exercise.
Could my pain be something other than frozen shoulder?
Possibly. Conditions such as rotator cuff problems, shoulder osteoarthritis, biceps tendinopathy or referred neck pain can mimic it. Our physiotherapists assess you carefully to reach the right diagnosis and will refer you on if anything suggests another cause.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
Last reviewed:
20 August 2026