Frozen Shoulder- Vale Chiropractic
What Is Frozen Shoulder?
Frozen shoulder, medically known as adhesive capsulitis, is a condition characterised by persistent shoulder pain and stiffness that can last many months and, in some cases, several years. It occurs when the capsule of connective tissue surrounding the shoulder joint becomes inflamed, thickened, and tight, leading to the formation of adhesions that restrict movement.
People typically notice a gradual onset of pain, often worse at night, followed by a progressive loss of shoulder mobility. Movements such as flexion, abduction, and external rotation are most commonly affected. This can significantly interfere with daily activities, sleep, and quality of life.
The Three Stages of Frozen Shoulder
Frozen shoulder progresses through three well‑recognised stages:
1. Freezing Stage (Painful Stage)
Gradual onset of shoulder pain
Increasing stiffness toward the end of this phase
Typically lasts 3-9 months
Pain is often the dominant symptom
2. Frozen Stage (Stiffness Stage)
Pain may lessen, but stiffness becomes more pronounced
Daily activities become more difficult
Typically lasts 4–12 months
3. Thawing Stage (Recovery Stage)
Gradual improvement in range of motion
Full recovery is common but not guaranteed
Can last 12–42 months
Recent studies suggest that although many people recover well, some degree of long‑term stiffness may persist, especially in individuals with underlying health conditions.
Causes and Risk Factors
The exact cause of frozen shoulder remains unclear, but it affects approximately 2–5% of the general population and is most common in adults aged 40–60. It occurs slightly more often in women.
Diagnosis is usually made clinically through history and physical examination. Imaging such as ultrasound or MRI can help rule out other conditions but is not always required.
Types of Frozen Shoulder
1. Primary (Idiopathic) Adhesive Capsulitis
Develops gradually with no identifiable cause
Most common form
2. Secondary Adhesive Capsulitis
Occurs following:
Shoulder injury or surgery
Prolonged immobilisation
Rotator cuff pathology
It is also associated with systemic conditions such as:
Diabetes (strongest known risk factor)
Thyroid disorders
Cardiovascular disease
Stroke
Autoimmune conditions
People with diabetes often experience more severe symptoms and slower recovery.
Treatment Options
Treatment aims to reduce pain, restore movement, and support functional recovery. The best approach depends on the stage of the condition and individual factors. Always consult a healthcare professional for personalised advice.
Common Treatment Approaches
Manual therapy (mobilisation, soft tissue techniques)
Joint mobilisation to improve capsule flexibility
Exercise therapy, including:
Pendulum exercises
Wall‑walk exercises
Stretching and strengthening programmes
Kinesiotaping (adjunctive support)
Trigger point therapy
Corticosteroid injections — particularly effective in the early painful stage
Hydrodilatation (saline distension of the joint capsule) — evidence has grown in recent years
Manipulation under anaesthesia (MUA) — used selectively
Analgesics and NSAIDs for pain relief
Recent guidelines emphasise exercise therapy combined with education as the foundation of treatment, with injections used strategically depending on the stage.
Pendulum Exercise- https://www.youtube.com/watch?v=dYQsTDnnCdQ
Wall Walk Exercise- https://www.youtube.com/watch?v=63KfVbybLo8
Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta‑analysis of prevalence. Shoulder & Elbow. 2020.
Challoumas D, et al. Management of frozen shoulder: a systematic review and cost‑effectiveness analysis. British Journal of Sports Medicine. 2020.
Page MJ, et al. Manual therapy and exercise for adhesive capsulitis: updated evidence. Journal of Orthopaedic & Sports Physical Therapy. 2021.
Sun Y, et al. Efficacy of corticosteroid injections for adhesive capsulitis: a meta‑analysis. American Journal of Sports Medicine. 2021.
Lewis J. Frozen shoulder: what does current evidence tell us? Musculoskeletal Science & Practice. 2023.
NHS UK. Frozen Shoulder Overview (updated 2024).