Frozen shoulder (also known as adhesive capsulitis) is an ‘idiopathic’ condition, which means that it has no known cause. It usually occurs between the ages of 40-60 and is more common in women than in men. Those with diabetes, thyroid disease, and/or who have experienced a previous shoulder injury are at an increased risk. Frozen shoulder typically occurs in 3 stages. In total, these stages can last upwards of approximately 2 years. Additionally, each stage is characterized by the associated symptoms combined with the time since onset. To figure out what stage you are in, consider the time that has passed since you first noticed any changes in your shoulder pain or function.

Stage 1 – “Freezing Stage”

0-9 months since onset. Gradual pain onset, including night pain and pain at rest; gradually increased restriction in movement. Stiffness increases and functional movements decline. This stage is characterized by symptoms slowly getting worse.

Common Functional Changes: Waking up in the night with shoulder pain, and inability to find a comfortable sleeping position. Increased difficulty in common movements, including reaching behind your head, putting your arm into clothing, reaching overhead, putting something in your back pocket, reaching for your bra strap, and putting on your seatbelt. These are just a few of the many tasks people begin to struggle with when dealing with Frozen Shoulder.

 Treatment Goals:

1. Pain Management: Depending on the severity of pain, your shoulder may need to be in a sling for brief periods. Treatment focus will be on pain management techniques.
2. Passive Range of Motion: Very light passive shoulder movement with your physiotherapist in the pain-free range.
3. Light passive exercises: This will help to passively get your shoulder moving and preserve as much range as possible. An example of this is a “pendulum”

Stage 2 – “Frozen Stage”

9-15 months since onset. You may have little to no pain at rest, but still have pain with movement. Your movement is most restricted at this point. Additionally you may notice a decrease in muscle size in the shoulder and upper arm due to lack of use. This stage is characterized by a decrease in pain, but persistent stiffness.

Functional Changes: You have an easier time falling asleep and decreased pain at rest. All of the movements mentioned in the freezing stage feel extremely stiff and remain painful.

Treatment Goals:

1. Progress Passive Range of Motion: Due decreased pain, your joint more comfortable while it is relaxed
2. Active-Assisted Range of Motion: Using your other arm to help move in the pain-free range to increase range of movement.
3. Joint Mobilization: Passive joint mobility done with your physiotherapist to help encourage proper movement and increase range of motion. This can also be done with some active movement.
4. Stretching and Strengthening: Progressing your light exercise program to strengthen and stretch supporting muscles in your shoulder.

Stage 3 – “Thawing Phase”

15-24 months since onset. You have minimal amounts of pain, and experience gradual reduction in stiffness. The amount of recovery varies from person to person. For this reason, some people re-gain function, while others do not regain full mobility. Most people see some improvement but may never reach complete range of movement compared to their other arm. This stage is characterized by no pain and a gradual improvement in your movements.

Functional Changes: Any movement that involves reaching the arm above the head, behind the head, out to the side, or behind the back will feel stiff, but non-painful. All of these movements may begin to get easier over time. The amount of stiffness will depend on the person, as well as how long they’ve been in the “Thawing Phase”.

Treatment Goals:

1. Stretching and Strengthening: Progressing strength and length of muscles depending on specific functional needs. This can be done independently and with your physiotherapist. Due to pain reduction, load and range of motion can both be progressed as tolerated.
2. Manual Mobilization: Due to pain reduction, manual mobilization can be performed by the physiotherapist more aggressively. This will help with mobility of your joint capsule, assisting with increased movement.
3. Function, Function, Function: Up until this point, pain has likely stopped you from doing things that you want/need to do. At this stage, you and your therapist to work together to restore those functions. As needed certain tasks may still need modification.

Main Takeaway

The most important task consistent for you in all three stages is movement in the pain free range to preserve and improve mobility. Even though the stages come with all different pain levels, and amount of movement, treatment focus is on preserving function. Regular movement and structured exercise will give you the best chance at making a great recovery and getting back to the thing you love.

If any of these symptoms sound familiar, and you think you might have Frozen Shoulder, contact your physiotherapist to ask questions. These are some common symptoms, functional changes, and treatment goals, but Frozen Shoulder looks different for everyone. Before attempting any exercises, or acting on any information, you find online, it is best to speak with one of your trusted health professionals.

Stay safe and take care,

Daniel Sedran

Registered Physiotherapist
Owner of First Line Physiotherapy