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Shoulder stiff no matter what you do? You may need treatment for a frozen shoulder.

Shoulder Stiffness and Pain

A frozen shoulder doesn’t have a thing to do with temperature.

Often referred to as a stiff or “frozen” shoulder, adhesive capsulitis develops in about 5% of Americans and is a painful condition in which shoulder movement becomes limited. Affecting more women than men and adults 40-60 years old according to Harvard Medical School, patients with frozen shoulder in one shoulder, 20% to 30% are at risk of developing it in the other shoulder too. 

Physical therapists help adults with adhesive capsulitis reduce frozen shoulder pain and stiffness and restore movement safely and effectively.

The condition was nicknamed “frozen” shoulder because the more pain you feel, the less likely it is that the shoulder will be actively used. Reduction of use causes the shoulder capsule to become tight and thicken, making the shoulder even more challenging to move; it has become “frozen” in position.

What is a frozen shoulder (adhesive capsulitis)?

Adhesive capsulitis is a condition of shoulder stiffening because of scar tissue, resulting in shoulder pain upon movement and loss of mobility. The actual origin of frozen shoulder is a matter of debate. Research indicates that it is caused by autoimmune reactions and inflammation, where the body’s immune response launches attacks against its own tissues. 

FROZEN SHOULDER GRAPHIC

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The shoulder has a broader and more varied range of motion than any other area of the body.

The shoulder joint contains ligaments that attach the top of the upper arm bone to the shoulder socket, securely holding the joint in place. Frozen shoulder forms when the durable connective tissue surrounding the shoulder joint becomes thick, stiff, and inflamed. The frozen shoulder risk increases when you don’t receive exercise therapy after experiencing tendinitis or an injury.

Other possible causes include:

  • Response after surgery or an injury
  • Shoulder pain from various conditions such as joint arthritis, a rotator cuff injury, bursitis, or tendinitis that has caused a person to move their shoulder less or not at all
  • Immobilization of the arm after surgery or fracture, such as in a sling

At times, however, there is no apparent reason why frozen shoulder develops.

The causes of frozen shoulder are a bit of a medical mystery.

What does frozen shoulder feel like?

Many people suffering from frozen shoulder have increasing pain and a loss of shoulder movement. Frozen shoulder is typically broken down into four stages. Your physical therapist will help determine what stage you are in. A patient once described the feeling as having been “struck by lightning in the shoulder for 20-30 seconds.”

Stage One: Pre-“freezing”

During stage one of development, it may be challenging to identify your problem as frozen shoulder. You’ve noticed symptoms that are getting worse for one to three months. Moving your shoulder causes pain – it regularly aches even when you’re not reaching or using your arm, but the pain increases and becomes sharp with movement. You might curb shoulder activity during this period to safeguard your shoulder by using it to a lesser extent. It’s easiest to notice the loss of movement when you rotate your arm away from the body, but many patients that we see noticed that their motion was limited when they attempted to raise an arm or they reached behind their back. Shoulder pain is the trademark feature of this stage; you may experience pain during the day and at night.

Stage Two: “freezing”

By the time you’ve progressed to stage two, you’ve likely noticed symptoms for 6 or more months, likely with a progressive loss of shoulder movement and increased pain (especially at night). The shoulder still has some range of movement, but both pain and stiffness limit it.

Stage Three: the shoulder is “frozen”

Your symptoms and shoulder pain have persisted for about a year, and your range of shoulder movement has significantly decreased. During the early part of stage three, there is usually still substantial pain. Towards the end of this stage, however, pain tends to decrease, with shoulder pain occurring primarily when you move your arm as far as you can.

Stage Four: “thawing” the shoulder

You’ve had progressive symptoms for more than a year, and there is a considerable decrease in pain- especially nighttime pain. There is still a limited range of shoulder movement, but completing daily tasks and activities involving overhead motion is improving.

Don’t try to function normally through frozen shoulder pain.

Frozen shoulder

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How is frozen shoulder diagnosed?

Often, physical therapists do not see patients with adhesive capsulitis until well into the freezing or frozen phases. Frequently, people are working with a PT to treat other issues when their physical therapist notices the signs and symptoms of frozen shoulder.

  • A physical therapist will complete a thorough evaluation to rule out other diagnoses, including your health history. 
  • Your physical therapist can identify specific patterns in your limited range of motion typical of adhesive capsulitis.
  • In addition, your physical therapist will analyze other conditions you may have, like diabetes, thyroid dysfunction, and autoimmune disorders associated with adhesive capsulitis.

How can physical therapy help you with frozen shoulder pain?

A physical therapist’s overall goal is to restore movement and mobility, getting you back to being able to perform daily life activities. As the evaluation process determines the stage of your shoulder condition, your PT will create a comprehensive movement and exercise program tailored to your individual needs. Exercise is most effective for those in stages two through 4.  

Your physical therapy treatment may incorporate:

  • Manual therapy and exercises: Your physical therapist will work with you to regain as much range of motion as possible and help reduce your pain. They will likely use a combination of range-of-motion exercises and hands-on manual therapy techniques to improve shoulder movement.
  • Thermal treatment: PTs often use heat and cold therapies to help relax the muscles before other forms of treatment.
  • Home exercise program: Your physical therapist will create a gentle home exercise program to help reduce your shoulder pain and loss of motion. Your therapist will teach you ways to avoid being overly aggressive with stretching, so that shoulder pain doesn’t worsen.
  • Education: PTs match treatment activities and intensity levels to your abilities and limitations and educate you on the appropriate use of your shoulders and arms. Your therapist will consistently monitor your progress to ensure your safety. 
  • Pain medication:  There are times when conservative care does not reduce or eliminate frozen shoulder pain. In these cases, physical therapists may refer you for further medical testing to discuss prescription pain medication or even an injection of a safe anti-inflammatory and pain-relieving medication. Research demonstrates that although these types of pain relief don’t provide benefits for range of motion and won’t shorten the duration of the condition, they offer short-term pain reduction.

Simple activities like fastening a bra or reaching an item on an overhead shelf may be impossible when you have a frozen shoulder.

Suppose you diligently follow your regimen of frozen shoulder exercises. In that case, you’ll likely be able to resume your normal activity levels (90% of people improve with physical therapy and non-surgical measures). Full recovery from a frozen shoulder takes time- possibly several months to years. Your physical therapist will show you how far to push yourself and will teach you the appropriate exercises. Once you’ve established your limitations, you can practice and maintain most of the movements on your own at home.  

There is no known method of preventing frozen shoulder. This condition’s onset is often gradual, and the inflammation process will want to run its course. Notwithstanding, the sooner you contact an experienced physical therapist, the more quickly you will receive appropriate information and treatment to address your shoulder pain and symptoms most effectively.


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Shoulder stiff no matter what you do? You may need treatment for a frozen shoulder.
Chris S
AUTHOR

Dr. Chris Sovey

Healthy Consumer PT

"We Help Adults 40+ Living With Pain, Stiffness, Or Loose Joints Get Healthy, Age Stronger, And Get Back To The Activities They Love, Even If Past Treatments Have Failed"

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