Frozen shoulder: causes, timeline, and how physiotherapy helps

Frozen shoulder (adhesive capsulitis) is one of the most frustrating conditions we treat, mostly because it genuinely does get worse before it gets better, and patients are rarely warned about that. Understanding the stages makes the whole process far less alarming.

What's actually happening

The capsule of connective tissue surrounding the shoulder joint thickens and tightens, restricting movement in every direction — not just one. It's more common after a period of immobility (an arm in a sling, a shoulder injury, even prolonged desk work), and more common in people with diabetes.

The three stages

1. Freezing (2–9 months). Pain gradually increases and range of motion starts to reduce, often worse at night.
2. Frozen (4–12 months). Pain may ease somewhat, but stiffness is now severe — reaching overhead, behind the back, or out to the side becomes genuinely difficult.
3. Thawing (5–24 months). Movement gradually returns, with or without treatment, though the total timeline without any intervention can run past a year.

What treatment actually looks like

• In the freezing stage: pain management, gentle range-of-motion work that respects the irritability of the joint, and activity modification so you aren't constantly aggravating it.
• In the frozen stage: more assertive stretching and joint mobilisation to push gently against the stiffness, alongside strengthening of the muscles around the shoulder blade that tend to weaken from disuse.
• In the thawing stage: progressive strengthening and functional retraining to fully restore overhead and behind-the-back movement, not just "enough" movement to get by.

What we saw with one patient

A recent patient came to us after more than a year of a limiting frozen shoulder that was affecting her work as an architect. After ten sessions combining manual therapy and a structured home programme, she had her full range of motion back — a result she credited as much to the consistency of the home exercises as to the in-clinic work.