Why It Happens and How To Navigate Recovery

Is your shoulder incredibly painful, seemingly for no reason? Have you noticed it getting progressively stiffer, making simple tasks like reaching into a cupboard, brushing your hair, or fastening a bra almost impossible? If this sounds familiar, you might be experiencing the frustrating condition commonly known as Frozen Shoulder. The medical term often used is Adhesive Capsulitis, but as we’ll explore, even that label might not tell the whole story.

What IS This Stiff, Painful Shoulder Condition?

Frozen Shoulder typically follows a distinct, albeit highly variable, pattern:

1. The Freezing Stage: This initial phase is often marked by significant, sometimes severe, shoulder pain, particularly at night. Gradually, you start losing range of motion. This stage can last anywhere from a few months to many months.
2. The Frozen Stage: Pain might begin to lessen somewhat, but stiffness becomes the dominant feature. Your shoulder feels profoundly ‘stuck’, especially when trying to lift your arm outwards or rotate it externally (like reaching behind your back). This stage can last for many months.
3. The Thawing Stage: Slowly, gradually, over a period of months to even a year or two, your range of motion starts to improve.

The term ‘Adhesive Capsulitis’ suggests inflammation and the formation of adhesions (sticky scar tissue) within the capsule surrounding the shoulder joint, causing it to thicken and contract. While inflammation and capsular changes are certainly involved, the exact underlying cause and pathology are still debated among experts, and whether ‘adhesions’ are the primary driver is perhaps an oversimplification. What we do know is the clinical picture: significant pain followed by profound stiffness.

Does Knowing the Exact Cause Change How We Manage It?

Often, Frozen Shoulder seems to appear out of the blue (idiopathic), although risk factors like diabetes, thyroid conditions, previous injury, or prolonged immobilization increase the chances. But here’s a key point: trying to pinpoint the precise microscopic reason why your shoulder decided to ‘freeze’ often doesn’t fundamentally change the most effective management approach.

This is where we find simplicity on the far side of complexity. After acknowledging the complex potential inflammatory and fibrotic processes involved, and the frustratingly long natural history, the core principles of good management boil down to some straightforward essentials: patience, clear education, appropriate pain management, and carefully guided, stage-appropriate movement. Getting lost searching for a complex ‘fix’ often distracts from these effective basics.

Management: Patience, Education, and Stage-Appropriate Movement are Key

Given that Frozen Shoulder tends to run a long course but typically resolves eventually, management focuses on controlling symptoms and maintaining as much function as possible:

1. Education & Reassurance (Crucial!): Understanding the typical stages and variable timeframes (often 1-3 years) is vital. Knowing it does get better helps manage the frustration. This is often the most important first step.
2. Pain Management (Especially in the ‘Freezing’ Stage): Finding ways to reduce severe pain is critical early on. This might involve activity modification or advice on pain relief options. Cortisone injections are sometimes considered specifically during this highly painful phase to provide significant pain relief, allowing you to sleep better and tolerate gentle movement – think of it as calming the fire, not curing the condition.
3. Physiotherapy – Tailored to the Stage: This is NOT about aggressively forcing movement, especially early on!
   • Freezing Stage (Pain Dominant): Focus is on pain relief and gentle, pain-free range-of-motion exercises for frozen shoulder. Aggressively stretching a painful, inflamed shoulder can make things worse!
   • Frozen Stage (Stiffness Dominant): As pain settles, the focus shifts to more progressive (but still guided and comfortable) exercises aimed at gradually restoring mobility.
   • Thawing Stage: Continuing mobility work and adding progressive strengthening exercises as range improves.
4. Other Interventions (Considered Later): For persistent stiffness after the painful phase has settled and a good trial of physiotherapy hasn’t yielded sufficient results, options like hydrodilatation (injecting fluid to stretch the capsule) or, rarely, manipulation under anaesthesia or surgical release might be discussed with a specialist. These are generally not first-line treatments.

Did You Know?

• Frozen Shoulder is most common between the ages of 40 and 65, and slightly more common in women.
• While it usually affects one shoulder, about 1 in 5 people may eventually develop it in the other shoulder as well (though usually not at the same time).
• The goal of physiotherapy isn’t necessarily to drastically speed up the natural history (which is hard to do), but to help you manage pain effectively, maintain usable range, prevent excessive muscle guarding, and maximise your functional recovery as the condition resolves.

Navigating Frozen Shoulder with Abound Physio

Dealing with shoulder pain and stiffness from Frozen Shoulder requires patience and expert guidance. Accurate diagnosis (ruling out other causes), clear education, and a stage-appropriate management plan are essential.

Struggling with a stiff, painful shoulder that fits this description?

Let us help you understand and navigate this challenging condition with an evidence-based, supportive approach.