Known as “frozen shoulder,” adhesive capsulitis is a complex condition that can affect one or both shoulder joints. As with other conditions, physical therapy is recommended to help with pain and mobility loss that comes with frozen shoulder. However, this article will share why it is treated differently than other shoulder problems. 

Before we discuss why, it helps to understand the causes of frozen shoulder, how it progresses, and symptoms at each stage. Read along as we delve into each topic, as well as do’s and don’ts for treatment of frozen shoulder. 

What is Frozen Shoulder (Adhesive Capsulitis)?

Adhesive capsulitis occurs when the capsule surrounding the shoulder joint is irritated or inflamed. As a result, you lose range of motion, but not necessarily strength, in the affected shoulder joint.

While many people are familiar with the anatomy of the shoulder, most have never heard of the joint capsule. 

x ray image of a shoulder joint capsule which tightens with a frozen shoulder or adhesive capsulitis

Think of the joint capsule as a supportive ball that surrounds the shoulder joint. The role of the capsule is to hold the shoulder together in a fluid-like substance that lubricates the joint to help it move. 

Adhesive capsulitis causes the joint capsule to tighten, which makes it difficult to move the arm. You will notice difficulty lifting your arm to the front and out to the side, as well as reaching across your body. Also, adhesive capsulitis makes passive arm motions difficult.  

Interestingly, adhesive capsulitis does not typically affect muscle strength. This means that, while you may experience difficulty reaching shelves in the kitchen, you will still be able to grip utensils or carry grocery bags. 

3 Stages of a Frozen Shoulder

Frozen shoulder is characterized by different pain patterns depending on the stage of condition. 

There are three stages to a frozen shoulder:

  • Stage 1: Freezing
  • Stage 2: Frozen
  • Stage 3: Thawing

During Stage 1, the “Freezing” phase, the shoulder feels achy and irritable. You also may be experiencing pain that remains even after you stopped moving, known as lingering pain.

You should realize that the joint is extremely vulnerable during the “Freezing” phase. Because the joint is easily irritated, too much movement or activity may prolong your recovery in this stage. 

Stage 2 is often referred to as the “Frozen” phase. 

During this stage, the shoulder joint is less painful but extremely stiff. Many people notice a significant difference between Stages 1 and 2 due to the fact that the pain no longer lingers with activity. They also may experience difficulty sleeping through the night. 

Lastly, Stage 3 occurs when the shoulder joint begins to “thaw.” There will be improvements in range of motion, pain levels, and sleeping patterns. Your ability to get dressed, bathe, and do housework will begin to improve. 

Learning the stage of your condition is important. Each stage has different characteristics which could affect your recovery and prognosis. 

What are the Common Causes?

The actual cause of frozen shoulder is widely debated.

Some experts claim that frozen shoulder is caused by faulty ligaments, and others argue that it is an autoimmune response. Yet, it’s interesting to consider why the shoulder is the only joint that is affected if it is an autoimmune response, especially since it is linked to systemic diseases as risk factors. 

Regardless of its cause, there is no quick fix for recovery from frozen shoulder. Be wary of providers who claim to know the exact cause of your condition and promise fast results. 

What are the Risk Factors?

While the causes are unknown, some risk factors for frozen shoulder have been identified. These characteristics make you more susceptible to developing frozen shoulder in one or both joints. 

These characteristics include: 

  • Diabetes mellitus 
  • Women over the age of 50 years
  • Thyroid disease
  • Parkinson’s Disease
  • Cardiovascular disease
  • Recent surgery with a period of immobility 
  • History of frozen shoulder 

People with recent shoulder surgery may be at risk for frozen shoulder due to immobilization in a sling or trauma from the procedure. Also, the non-dominant extremity tends to be affected more frequently than the dominant side.

How Long Will Recovery From Frozen Shoulder (Adhesive Capsulitis) Last?   

Recovery from frozen shoulder can vary. To understand why, let’s take a look at the expected recovery for each stage. 

During the “Freezing” phase, the shoulder joint is acutely inflamed and painful. This can last anywhere from six weeks to nine months. Once the inflammation goes away and you transition into the “Frozen” phase, expect recovery to take an additional four to six months. Remember, this is the stage when the shoulder is less painful but severely lacking in range of motion.

Finally, the “Thawing” phase can take a total of six months (or more) to recover. 

Overall, recovery from frozen shoulder is lengthy and frustrating because it does not resolve quickly. But, receiving proper management, especially in the early phases, can make recovery as short as possible.

How is Adhesive Capsulitis Diagnosed?

physical therapist diagnosing a patient with frozen shoulder or adhesive capsulitis

Your physical therapist will take you through an evaluation to examine both shoulder joints. This may include checking your range of motion, both actively and passively, strength, and areas of pain. 

One of the telltale signs of frozen shoulder is a limitation in range of motion in many directions. Another common characteristic is good muscle strength in contrast to weakness that is typically seen in other shoulder conditions, like a rotator cuff tear or a labral tear

Differentiating frozen shoulder from other shoulder problems is extremely important. Because of this, your therapist will make sure that your neck, collarbone, and shoulder blades are functioning properly. Although frozen shoulder is not seen as often as other injuries, it needs to be properly diagnosed in order to receive the right treatment. You may be asked to get imaging to rule out any serious medical conditions, however, this is not always necessary.

Treating Frozen Shoulder Mobility Loss

Earlier in the article, we discussed the importance of identifying the stages of frozen shoulder. Not only is it critical to your prognosis, but staging can also determine which frozen shoulder treatments are right for you. 

During the “Freezing” phase, the shoulder joint capsule is inflamed, painful, and vulnerable to injury. Treatment at this stage can target pain relief and introduce gentle motion to maintain movement. Individuals in the “Freezing” phase will most likely see their physical therapist 1-2 times per week for a few weeks. 

Once you enter the “Frozen” phase, or Stage 2 of frozen shoulder, you may only see your physical therapist a few times per month to check in. Because each person will progress differently, it is important for you to discuss expectations for recovery with your physical therapist. 

The Do’s and Don’ts for Treatment of Frozen Shoulder

In this section, we will review general do’s and don’ts for treatment of adhesive capsulitis. 

  1. DO talk to your physical therapist about your condition. Why? He or she can discuss risk factors that may be specific to your case. You should also talk about your current stage of frozen shoulder, prognosis, and timeline for recovery.  
  2. DO consider a steroid injection if offered during the “Freezing” phase. Why? Research supports the use of steroid injections during the acute/inflammatory phase of frozen shoulder. A steroid injection can reduce swelling, pain, and inflammation and may shorten the duration of the “Freezing” phase. Injections given during the other stages of frozen shoulder have not been shown to be as effective.
  3. DON’T ignore your condition. Why? Doing nothing will not make frozen shoulder go away faster. This condition can resolve on its own, but you should see a professional to confirm the diagnosis and receive proper treatment.
  4. DO practice frozen shoulder exercises from your physical therapist. Why? Being consistent with your physical therapy exercises will ensure that your shoulder remains as mobile as possible. Even though the exercises may seem basic, they are necessary to protect your range of motion. Be sure to clarify reps, sets, and frequency of exercises with your physical therapist.
  5. DON’T perform your daily activities like you usually do. Why? Activity modification is a great way to protect the joint, especially during the “Freezing” phase. If you can’t sleep, then ask your physical therapist about different positions that can help you sleep through the night.
  6. DO consider alternative treatments with your physical therapist. Why? Alternative treatments for frozen shoulder can reduce pain and stiffness as well as maintain range of motion. Your physical therapist may suggest joint mobilizations, manual therapy, or dry needling depending on your stage of frozen shoulder.
  7. DON’T spend tons money on cupping or massages to get rid of frozen shoulder. Why? Cupping, electrical stimulation, or massages are not effective in getting rid of frozen shoulder. While these techniques may reduce pain associated with the “Freezing” phase, they do not have any effect on the condition itself.

Physical Therapy Management of Adhesive Capsulitis

physical therapy exercises for treating frozen shoulder or adhesive capsulitis

Physical therapists specialize in conditions that affect your ability to move. Since frozen shoulder affects your arm movements, physical therapists can help with your recovery.

Your physical therapist will coach you on ways to reduce pain during each stage of frozen shoulder. You will also learn how to increase your range of motion and improve your overall movement patterns. He or she will be a great source of information while helping you to understand your diagnosis and recovery. 

It is important for you to realize that physical therapy will not shorten your recovery from frozen shoulder. However, it will improve your quality of life as your body eventually heals itself.

Takeaway points

  • Adhesive capsulitis affects one or both shoulder joint capsules and causes varying degrees of dysfunction. 
  • It is imperative that adhesive capsulitis is diagnosed early and staged correctly. 
  • Recovery from adhesive capsulitis takes many months and will require physical therapy exercises to maintain your range of motion for as long as possible. 
  • Be wary of providers who offer a quick fix or surgery to get rid of your adhesive capsulitis. 
  • Find a physical therapist who is skilled in musculoskeletal conditions in order to receive the most effective treatments according to your adhesive capsulitis stage.

If you reside in the Columbus, Ohio area, then consider seeking help from Dr. Andrew Junak at Peak Physiotherapy & Performance. He is a board-certified orthopedic specialist in physical therapy with extensive experience in managing various shoulder conditions, including frozen shoulder. 

Short on time? Contact him today for a free 15-minute phone consultation to discuss your aches and pains. Take the first step and call today.

About the Author

Dr. Andrew Junak is a Doctor of Physical Therapy and Board-Certified Orthopedic Specialist. Dr. Junak received his Doctorate of Physical Therapy from Walsh University and completed his Orthopedic Specialist training at the Cleveland Clinic Orthopaedic Residency Program. He is the owner of Peak Physiotherapy and Performance, a physical therapy clinic in Canal Winchester, Ohio where he serves the local communities of Lancaster, Reynoldsburg, Grove City, Pickerington, and Columbus. In his practice, Dr. Junak helps clients with jaw pain, neck pain, and headaches find relief without resorting to medications, injections, or surgery.


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