Frozen shoulder (adhesive capsulitis) is one of the most misunderstood conditions in physiotherapy. Aggressive stretching when the shoulder is irritable makes the pain worse. Gentle range-of-motion work when the shoulder needs strengthening leaves you weak and stiff. The right physiotherapy depends entirely on which phase you are in. The four-phase model used below draws on the original Reeves (1975) description, the AAOS 2011 clinical review, and Lewis’ more recent reframing of “non-specific shoulder pain” — clinicians do not agree on every detail, but the staged approach is well-supported.
Phase 1: Freezing (painful)
Typically lasts roughly 2 to 9 months. Pain is the dominant feature, often at night, often worse than the stiffness. What we do: pain modulation (gentle manual therapy, controlled range work into pain-free ranges only), clear education on what not to do (no aggressive stretching, no painful end-range work), sleep-position advice. Pushing through pain in this phase is one of the fastest ways to extend the freezing period.
Phase 2: Frozen (stiff)
Pain begins to settle but range is now severely limited — typically external rotation drops first, then abduction. Lasts roughly 4 to 12 months. What we do: graded mobility work, joint mobilisation, scapulothoracic strengthening, and a structured home programme. Hydrodilatation injection — saline plus corticosteroid under ultrasound guidance — can be considered with your physician at this stage; the UK FROST trial (Rangan et al., Lancet 2020) found it broadly comparable to manipulation under anaesthesia for shoulder pain and function, with lower invasiveness.
Phase 3: Thawing (recovery)
Range begins to return and strength deficits become obvious — particularly in the rotator cuff and scapular stabilisers. Lasts roughly 5 to 24 months. What we do: progressive strengthening, return-to-function work (overhead lifting, daily tasks, sport-specific patterns where relevant).
Phase 4: Full recovery
Most people regain near-full range and full function, though a small percentage have some residual stiffness — typically in end-range external rotation — that does not noticeably affect daily life.
What frozen shoulder is not
Frozen shoulder clinically resembles other shoulder pathology — rotator-cuff tears, calcific tendinopathy, sub-acromial pain syndrome — and is often mis-diagnosed in either direction. The hallmark is a global loss of both passive and active range, particularly external rotation in the neutral position. Imaging is occasionally helpful but is rarely diagnostic on its own.
For phase-appropriate care, see our shoulder physiotherapy page.
Disclaimer: Frozen shoulder can mimic — and coexist with — other shoulder pathology. Clinical assessment is essential before starting any exercise programme.