Cannot Move Your Shoulder? Here Is What Frozen Shoulder Really Is
Frozen Shoulder: The Complete Guide to Adhesive Capsulitis
One day you notice your shoulder is sore. A few weeks later you cannot reach into the back seat of your car, do your bra up, or comb your hair without wincing. Frozen shoulder is one of the most misunderstood and mismanaged shoulder conditions we see. Here is exactly what it is, why it happens, and how our physio team at PHYZFIT Bexley North and Marrickville actually treats it.
Short Answer
Frozen shoulder (adhesive capsulitis) is inflammation and progressive tightening of the shoulder capsule that causes severe pain and dramatic loss of movement in all directions. It moves through three stages (freezing, frozen, thawing) and typically lasts 12 to 24 months if left alone. Physiotherapy, targeted loading, and a hydrodilatation or cortisone injection into the joint can shorten the timeline significantly. It affects around 3 to 5 percent of adults, most commonly women aged 40 to 60, and is more common in people with diabetes or thyroid conditions.
Below we walk you through what frozen shoulder actually is, the three stages, how to tell it apart from a rotator cuff issue, and how our team at PHYZFIT treats it.
What exactly is frozen shoulder?
Frozen shoulder, medically called adhesive capsulitis, is a condition where the connective tissue capsule that surrounds the shoulder joint becomes inflamed, thickens and progressively tightens. As the capsule contracts, it physically restricts how far the shoulder can move, and the process is painful.
Unlike a rotator cuff tear or subacromial impingement, the loss of movement in frozen shoulder is not muscular or from pinching. The shoulder is genuinely stuck at the capsular level. This is why passive movement (someone else moving your arm) is just as restricted as active movement (you moving it yourself). That difference is one of the key diagnostic signs our physios use.
Frozen shoulder affects around 3 to 5 percent of the general population and up to 20 percent of people with diabetes. The typical age range is 40 to 60, and it is slightly more common in women.
The three stages of frozen shoulder
Frozen shoulder is a predictable condition. It moves through three stages, and knowing which stage you are in shapes the entire treatment plan.
Freezing (2 to 9 months)
Severe pain including at rest and at night. Progressive loss of movement. This is the most painful stage. The goal is pain relief, not aggressive stretching, which usually makes it worse.
Frozen (4 to 12 months)
Pain starts to ease but the shoulder is now very stiff. Loss of external rotation is a classic sign. This is the stage where targeted loading, capsular work and gradual range exercises help most.
Thawing (5 to 24 months)
Gradual return of movement. Pain continues to settle. Rehab focus shifts to restoring full range, strength and functional shoulder use for work, sport and daily life.
The total course from onset to full recovery is typically 12 to 24 months if left completely alone. Good physiotherapy plus an appropriate injection can shorten this to 6 to 12 months in many cases.
What causes frozen shoulder?
In many cases we do not identify a single trigger. What we do know is a set of strong risk factors:
- Age 40 to 60
- Female sex (slightly higher risk)
- Diabetes (up to 4 times the risk, often more severe and slower to resolve)
- Thyroid conditions (both under and overactive)
- Recent shoulder immobilisation after a fracture, dislocation or surgery
- Recent shoulder or breast surgery
- Cardiovascular disease and Parkinson's disease
- Previous frozen shoulder in the other shoulder (roughly 20 percent chance in the second shoulder within 5 years)
Sometimes frozen shoulder develops after a period of favouring the shoulder because of a minor injury, subacromial impingement or a course of overhead work. The reduced movement itself can trigger the capsular process in a susceptible person.
How do I know if it is frozen shoulder or rotator cuff?
These two often get confused because both cause shoulder pain and both are worse lying on the affected side. The key distinguishing features:
- Loss of external rotation: the hallmark of frozen shoulder. Try to rotate your affected arm outward with your elbow tucked in at your side. If that movement is significantly reduced compared to the other side, frozen shoulder becomes very likely.
- Passive movement is just as restricted as active: if someone gently moves your arm for you and it still cannot go past a certain point without severe pain or a hard stop, it is capsular. Rotator cuff issues usually allow more passive range than active.
- Reaching behind your back is difficult: struggling to do your bra up, tuck a shirt in or reach into a back pocket is a strong sign of frozen shoulder.
- Global loss of movement: frozen shoulder restricts lifting to the front, out to the side, rotating outward and reaching behind the back. Rotator cuff usually restricts one or two directions selectively.
- Onset pattern: frozen shoulder often starts as a mild ache and progressively worsens over weeks to months. Rotator cuff pain often has a clearer trigger (a lift, a fall, an overhead session).
Losing shoulder movement and not sure why?
A 30 minute physio assessment can pinpoint frozen shoulder vs rotator cuff in one visit.
How does PHYZFIT treat frozen shoulder?
Our physio team (Julian De Rosa, Ari Moushis and Sam Nunan) treats frozen shoulder every week. Treatment is staged to match the stage of the condition, because what helps in the frozen phase can actually flare things up in the freezing phase.
Stage 1 (freezing, high pain phase)
- Gentle range of motion within a pain free zone only
- Hands on soft tissue release around the shoulder blade, upper trap and pec
- Sleep setup and load management education
- Consideration of a corticosteroid injection or hydrodilatation if pain is severe and impacting sleep, referred through your GP or a specialist
- Avoid aggressive stretching, deep manipulation or heavy loading
Stage 2 (frozen, stiff phase)
- Targeted capsular mobilisation to open up the tight areas
- Progressive range of motion exercises pushing towards but not through the end range
- Rotator cuff and scapular strengthening in the available range
- Dry needling for compensatory muscle tension
- Consideration of hydrodilatation if progress has stalled
Stage 3 (thawing, recovery phase)
- Full range restoration work
- Progressive strengthening in outer ranges
- Functional loading (reaching, lifting, overhead work, gym or sport)
- Maintenance program to reduce risk of stiffness returning
What about hydrodilatation and cortisone?
These are two of the most effective medical adjuncts we work alongside for frozen shoulder:
- Hydrodilatation (also called capsular distension) is an ultrasound guided procedure where a mix of saline, local anaesthetic and cortisone is injected into the shoulder joint under pressure. The volume physically stretches the tight capsule while the cortisone reduces inflammation. Best evidence is in the frozen phase. Often significantly speeds up recovery.
- Corticosteroid injection alone into the shoulder joint can help settle the severe pain of the freezing phase. It does not stretch the capsule, but the pain relief allows physio to progress.
Both procedures require a specialist referral from your GP. We work closely with local sports medicine doctors and radiologists who perform these procedures and can guide you through the referral pathway if it is appropriate for your case.
What can I do at home right now?
- Sleep on your back with a small pillow under the affected shoulder, or on the good side with a firm pillow supporting the sore arm
- Heat on the shoulder for 10 to 15 minutes before bed to reduce muscle guarding
- Gentle pendulum swings for 60 seconds each direction, morning and evening. Let gravity do the work, no forced movement
- Table slides. Sit at a table, rest the affected forearm on the surface, gently slide the hand forward as far as comfortable. 10 slow reps, 2 to 3 times a day
- Avoid aggressive stretching or forcing movement. It will flare up the pain and often delay recovery
- Keep training the rest of the body. Lower body, core and cardio remain important
- Book an assessment early. Frozen shoulder responds much better when treatment matches the stage. Guessing the stage often makes things worse
⚠ Seek prompt medical review if
- Shoulder pain follows a fall, dislocation or significant injury
- Redness, heat, swelling with fever (possible joint infection)
- Sudden inability to lift or hold the arm up (possible large rotator cuff tear)
- Left shoulder pain with chest tightness, sweating, jaw pain or shortness of breath (possible cardiac event, call 000)
How long does frozen shoulder take to recover?
- Natural course, no treatment: 12 to 24 months, sometimes longer in diabetics
- Physiotherapy alone (started early): 6 to 18 months with better pain control throughout
- Physio plus hydrodilatation or cortisone in the right stage: 4 to 12 months for most cases
- Post surgical release (rare, reserved for cases that have not responded to 6 to 12 months of conservative care): depends on the surgery and rehab
The earlier the correct diagnosis and stage matched treatment starts, the faster and more comfortable the recovery.
We support patients across Bexley, Kingsgrove, Beverly Hills, Bardwell Park, Earlwood, Rockdale, Kogarah and Hurstville from Bexley North, and Marrickville, Newtown, Enmore, Dulwich Hill and Petersham from Marrickville.
Frequently asked questions about frozen shoulder
No. Frozen shoulder is a self limiting condition, meaning it does eventually resolve on its own. The problem is the natural timeline can be up to 24 months of pain and stiffness. Physio and appropriate injections can shorten that significantly.
No. Aggressive stretching in the freezing phase almost always makes it worse. Gentle pain free range of motion is fine. In the frozen phase we can push closer to the end range, but never forcing through severe pain.
Not always. Frozen shoulder is diagnosed clinically. Ultrasound or MRI is considered if we suspect a coexisting rotator cuff issue, if the presentation is unusual, or if a hydrodilatation is being planned.
Yes with modifications. Lower body and core work usually fine. Upper body is guided by stage: avoid overhead pressing and heavy pulling early on, focus on scapular and rotator cuff work in the available range.
Around 20 percent of people develop it in the other shoulder within 5 years of the first episode. It rarely returns in the same shoulder twice.
Yes. Medicare covers 5 sessions per year under a Chronic Disease Management plan. Private health Extras rebates through HICAPS on the day. Workers Compensation, CTP and NDIS (plan managed and self managed only) are all accepted.
Ready for Us to Help You With Your Pain?
If your shoulder has stiffened up and you suspect it is frozen shoulder, book a physiotherapy assessment at PHYZFIT Bexley North or Marrickville with Ari Moushis, Sam Nunan or Julian De Rosa. Getting the stage right early is the difference between a 6 month and a 24 month recovery.
📍 20 Shaw Street, Bexley North 2207
📍 4 Carrington Road, Marrickville 2204 (inside World Gym)
✉ admin@phyzfit.com.au
PHYZFIT Health and Rehab | Bexley North and Marrickville, Sydney | Helping you rebuild trust in your body and live a life without limits.