Adhesive Capsulitis or Frozen Shoulder: Causes, the stages, prognosis and treatment options

Frozen shoulder, or adhesive capsulitis, is a frustrating condition that can significantly affect your shoulder movement and cause persistent pain. If you are dealing with this issue you are not alone, as it is more common than you might think. At our clinic, we see many patients struggling with frozen shoulders, and we’re here to help guide you through understanding why it happens, its natural progression and the best ways to manage it, including the role of physiotherapy and potential surgical options. 

What causes frozen shoulders?

The exact cause isn’t always clear, but it involves inflammation, thickening and tightening of the capsule surrounding the shoulder joint, which leads to stiffness and reduced mobility. There are certain risk factors that increase your chances of developing a frozen shoulder. For example, thyroid disorders like hypothyroidism or hyperthyroidism, Parkinson’s disease, cardiac disease, diabetes, prolonged immobilisation of the shoulder after surgery, a fracture or another injury of the arm. 

It is most commonly seen in women aged between 40-60. Targeting 1.4:1 ratio of women to men. It will affect approximately 4% of the general population across their lifespan, that’s 1 in every 25 people.

Most often it develops without a specific trigger or “idiopathically”. But if you have had a recent surgery and are developing or have developed a frozen shoulder, this is likely the lead contributing factor. 

The stages of frozen shoulder

Frozen shoulders can be broken down into 3 different stages of the condition. It develops slowly but with proper supervision and ongoing intervention, the prognosis is often good with the majority of people making either a full or near full recovery. 

Freezing Stage (Painful Phase) 

This is the initial phase where pain gradually gets worse, especially at night or with movement. Your shoulder’s range of motion will decrease. This usually lasts 6 weeks to 9 months. Daily activities like reaching overhead or behind your back become increasingly difficult.

People’s activities they struggle with most is doing their hair, getting dressed or reaching above their head for activities. 

Frozen stage (Adhesive Phase)

Here, the pain eases up. But the stiffness peaks, making it hard to perform even simple tasks. This stage spans 4 to 6 months. The good news is that the pain from the first stage often is significantly reduced.

Thawing Stage (Resolution phase)

Motion slowly begins to return, and strength improves. This recovery phase can take anywhere from 6 months to 2 years, with gradual progress toward normal or near-normal movement. Patience is a must, progress will likely be slow but you are in the home stretch. 

Frozen shoulder will recover on its own as long as it’s actively managed with ongoing exercise and proper supervision to reduce discomfort and speed recovery. 

The Stages of Frozen Shoulder and Estimated Time

Frames

Frozen shoulder typically progresses through three distinct stages, each with its own symptoms and duration. While the timeline can vary from person to person, the entire process often takes 12 to 18 months for most people to see significant improvement, though full recovery can extend up to 3 years in some cases. Understanding these stages can help set realistic expectations and motivate you to stick with treatment.

1. Freezing Stage (Painful Phase): This is the initial phase where pain gradually increases, especially at night or with movement, and your shoulder’s range of motion starts to decrease. It usually lasts from 6 weeks to 9 months. Daily activities like reaching overhead or behind your back become increasingly difficult.
2. Frozen Stage (Adhesive Phase): Here, the pain may start to ease up, but the stiffness peaks, making it hard to perform even simple tasks. This stage typically spans 4 to 6 months. The good news is that the intense pain from the first stage often diminishes.
3. Thawing Stage (Resolution Phase): Motion slowly begins to return, and strength improves. This recovery phase can take anywhere from 6 months to 2 years, with gradual progress toward normal or near-normal function. Patience is key here, as pushing too hard too soon can set you back.

Keep in mind that while frozen shoulder often resolves on its own, active management can speed up the process and reduce discomfort.

Adhesive capsulitis or Frozen Shoulder Exercises

Chest Openers

Single Arm Row

Row with scaption

Band exercises

The Role of Physiotherapy in Managing Frozen Shoulder

Physiotherapy plays an important role in resolving frozen shoulders. Helping to control pain, restore range of motion, and rebuild strength at every stage. At Physio and Fitness Clinic here in Seaford, our physiotherapists tailor programs to your specific needs, emphasising education, home exercises and hands on techniques to ensure the best outcomes for you.

In the Freezing stage

We focus on gentle pain relief methods like low-intensity stretches, mobilisations, and other treatment techniques to reduce the range of motion loss and assist with pain management. 

In the Frozen Stage

Treatment shifts to regaining motion through joint mobilisations, shoulder joint range of motion based stretches and end range mobilisations. We might incorporate massage, dry needling, pressure point release work and other techniques to help improve the pain profile of the joint. 

In the Thawing Stage

This is where the best gains can be made. Targeting strength deficits dependent on your profile, proprioceptive neuromuscular awareness and progressive stretching to get you back to your best and prevent recurrence. 

Consistency is vital, simple daily routines can make a massive difference and often will address the potential root issues to your stiffness and muscle tension. 

Surgical Intervention: Intra-articular Steroids and Other Options 

Recent peer-reviewed trials found that Intra-Articular Steroids were the best treatment option for people in the Frozen stage of Frozen shoulder, requiring less analgesic pain relief after the procedure whilst achieving the same long-term results to similar procedures such as Hydrodilatation which has steroids within the fluid injected into the joint capsule to balloon and joint into some more range of motion. Ultimately, the choice is up to you as to which you see more appropriate, you can discuss with your physio or doctor which option would be best for you.

Other surgical options include manipulation under general anesthesia. For those stubborn shoulders that aren’t resolving. This is where you are put to sleep and your arm is moved around by a surgeon to help break up the scar tissue. Arthroscopic surgery can also be utilised to release the capsule. These are rare interventions but effective with recovery taking 6 weeks to 3 months, again supported by physiotherapy. 

Final thoughts

Frozen shoulders can be a challenging and long journey, but with the right approach, most people regain full function. If you’re experiencing pain or stiffness, don’t wait – early intervention through physiotherapy can make all the difference. At Physio and Fitness clinic, we’re committed to personalised care to get you moving comfortably again. Schedule an appointment today to discuss your symptoms and create a tailored plan.