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Thawing The Frozen Shoulder - Pain Management and Physiotherapy Exercises

Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterised by stiffness and reduced mobility in the shoulder joint, posing significant challenges in daily activities. This article, "Thawing The Frozen Shoulder - Pain Management and Physiotherapy Exercises," aims to elucidate the crucial role of pain management and physiotherapy exercises in mitigating these symptoms. By providing an overview of the condition, detailing targeted mobility and strengthening exercises, and examining the efficacy of injection treatments for pain management.

woman holding shoulder in pain

Understanding Frozen Shoulder

Frozen shoulder is a debilitating condition characterised by pain and limited movement in the shoulder joint. It predominantly affects individuals aged between 40 and 60 and is more common in women and those with certain health conditions, such as diabetes or thyroid disorders. The progression of a frozen shoulder can be divided into three distinct stages, each with its own set of symptoms and expected duration.

The Stages of Frozen Shoulder

  1. Freezing Stage: This initial phase is marked by a gradual onset of pain and a noticeable decrease in the range of motion. Movement of the shoulder causes discomfort, and pain often worsens at night. This stage can last from 2 to 9 months.

  2. Frozen Stage: During this period, the pain may begin to diminish; however, the shoulder becomes stiffer, and using it becomes more difficult. The frozen stage typically lasts from 4 to 12 months.

  3. Thawing Stage: This final phase is characterized by a gradual improvement in mobility. Pain decreases, and the ability to move the shoulder slowly returns. The thawing stage can last from 5 to 24 months.

man holding shoulder in pain


The underlying cause of frozen shoulder involves the thickening and shrinkage of the joint capsule that surrounds the shoulder joint, leading to a reduction in the joint's volume and a consequent decrease in its range of motion. This condition may follow an injury, surgery, or prolonged immobility, though it sometimes develops without a clear cause.

Symptoms and Diagnosis

The hallmark symptoms of frozen shoulder are persistent pain, stiffness, and limited range of motion. These symptoms significantly disrupt daily activities and quality of life. Diagnosis is primarily based on a physical examination, with imaging tests such as MRI or ultrasound employed to exclude other conditions.

Risk Factors

Risk factors for developing frozen shoulder include age, gender, and a history of diabetes, thyroid disorders, cardiovascular disease, or previous shoulder injuries. Early treatment is vital for those at increased risk.


With proper management, including physiotherapy exercises, pain management techniques, and sometimes surgical intervention, most individuals can expect to regain shoulder function within 1 to 3 years, depending on the stage at diagnosis and the treatment efficacy.

Understanding these stages and timelines helps patients and healthcare providers create a more targeted approach to treatment, focusing on the specific challenges presented by each phase of the condition.

Frozen Shoulder Physiotherapy Exercises for Mobility

Physiotherapy is key in enhancing mobility for those suffering from frozen shoulder, offering a series of exercises aimed at expanding the shoulder's range of motion, easing pain, and reinstating normal function. It's crucial to consult a healthcare provider before embarking on any exercise regimen to confirm its suitability for one's specific health condition.

Exercises such as the pendulum stretch, where one swings the affected arm in gentle circles while leaning forward, and the towel stretch, involving pulling the affected arm upward using a towel with the other hand, are beneficial. The crossover arm stretch, which involves pulling the arm across the chest, and the finger walk, where fingers 'walk' up a wall to elevate the arm, alongside the armpit stretch, where the affected arm is gently lifted to stretch the armpit, are also recommended.

These exercises aim at enhancing the shoulder's flexibility and strength gradually.

Undertaking them regularly is imperative for improving mobility and alleviating shoulder pain in individuals with frozen shoulder. It's important to perform these exercises gently and refrain from pushing through pain to avoid exacerbating the condition.

male physiotherapist with female shoulder patient

Strengthening Exercises for Stability

For individuals recovering from a frozen shoulder, strengthening the shoulder is just as important as regaining mobility. These exercises aim to stabilise the shoulder joint, support the recovery process, and prevent future stiffness and pain. It's essential to begin these exercises when the pain has decreased and mobility begins to improve, and always under the guidance of a healthcare professional.

Exercises include isometric shoulder exercises, where muscles contract without moving the joint, and shoulder blade squeezes, which involve pulling the shoulder blades together as if holding a pencil between them.

Further exercises to enhance shoulder stability and strength encompass resistance band pull-aparts, where a band is stretched by moving the arms outward, and dumbbell side lateral raises, involving lifting weights to the side up to shoulder height. The prone horizontal abduction, performed by lifting a dumbbell out to the side while lying face down, also contributes to strengthening the shoulder.

These exercises, performed with appropriate repetitions and frequency, are integral to a comprehensive recovery strategy for individuals with frozen shoulder.

Monitoring progress and adjusting exercises based on pain levels and improvements in strength and mobility are vital to ensure effective recovery and shoulder health maintenance.

male physiotherapist with male shoulder patient

The Role of Injections in Frozen Shoulder Pain and Stiffness Management

In the management of frozen shoulder, injections can help to change the course of the condition, especially for individuals experiencing severe pain and restricted mobility that limit their ability to participate in physiotherapy exercises. These treatments can provide significant pain relief and improve the range of motion, facilitating a more active engagement in physical therapy and hastening recovery.

Ultrasound-Guided Shoulder Joint Steroid Injections

Steroid injections directly into the shoulder joint can reduce inflammation and pain. The use of ultrasound guidance allows for precise placement of the steroid, ensuring maximum efficacy and minimizing risks. Typically, patients may experience relief within a few days, and the effects can last several weeks to months. This window of reduced pain is crucial for actively participating in physiotherapy exercises to restore mobility and strength.

ultrasound guided shoulder injection

Ultrasound-Guided Hydrodilatation

For cases of persistent stiffness, ultrasound-guided hydrodilatation is another effective intervention. This procedure involves injecting a large volume of saline mixed with a steroid and sometimes a local anesthetic into the shoulder joint capsule. The fluid volume helps stretch the capsule, breaking down adhesions and improving range of motion. Hydrodilatation is particularly beneficial for the "frozen" stage of adhesive capsulitis, offering an opportunity to accelerate the "thawing" process.

Considerations and Aftercare

While injections offer substantial benefits, there are potential side effects including a small risk of infection and possible weakening or rupture of the joint capsule. Therefore, these treatments should be considered after a thorough evaluation by a healthcare professional and typically recommended when conservative measures have not provided adequate relief.

After receiving an injection, patients are advised to rest the affected shoulder for a short period before gradually resuming exercises. Close follow-up with a healthcare provider is essential to monitor progress and adjust treatment plans as needed.

Injections, when used judiciously, can be a valuable component of a comprehensive treatment strategy for frozen shoulder, providing relief and facilitating rehabilitation through physiotherapy.

female physiotherapist with male shoulder patient

Maintaining Shoulder Health Post-Recovery

Recovering from a frozen shoulder is a significant milestone, but maintaining shoulder health to prevent recurrence is equally important. Here are key strategies to ensure long-term shoulder wellness:

Regular Exercise

Incorporate shoulder mobility and strengthening exercises into your regular fitness routine. Consistency is crucial for maintaining the range of motion and strength achieved during recovery. Choose low-impact exercises that promote flexibility and muscular endurance without overstraining the shoulder.

Posture Awareness

Poor posture can contribute to shoulder tension and impair mobility. Practice good posture, especially if your work involves long periods of sitting or repetitive shoulder movements. Ergonomic adjustments to your workspace can also help reduce strain on your shoulder.

Warm-Up and Cool Down

Always warm up before engaging in physical activity and cool down afterward. Gentle stretching before and after exercise prepares the muscles and joints for movement, reducing the risk of injury.

Listen to Your Body

Pay attention to signs of discomfort or fatigue in your shoulder. If you experience pain or stiffness, don't ignore it. Adjusting your activity level and consulting a healthcare professional can help address minor issues before they become more significant.

gym weight lifting


In navigating the challenges of a frozen shoulder, understanding your condition and engaging in targeted physiotherapy exercises are key steps towards recovery. However, the journey doesn’t end here. Personalised care from professionals who understand the intricacies of musculoskeletal conditions can significantly enhance your path to regaining full shoulder mobility and strength. At ACTIVATE Musculoskeletal Clinic, located in Kent and London Harley Street, we’re dedicated to providing expert guidance and treatment to help you move beyond the limitations of frozen shoulder, providing a one-stop-clinic for shoulder management.

Take the next step towards optimal shoulder health. Book an appointment with us today and experience a tailored approach to recovery.

About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.


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