Frozen Shoulder Syndrome: Understanding the Stages, Treatment, and Recovery

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

If you've noticed increasing shoulder pain and difficulty reaching overhead, behind your back, or even getting dressed, you may be experiencing frozen shoulder syndrome. Also known as adhesive capsulitis, frozen shoulder is a common condition that causes pain and progressive stiffness in the shoulder joint.  

What Is Frozen Shoulder? 

Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed, thickened, and tight, leading to pain and significant loss of shoulder movement (Kraal et al., 2019). Unlike many other shoulder conditions, frozen shoulder affects both active and passive range of motion, meaning the shoulder remains stiff even when someone else attempts to move it. 

The condition affects approximately 2–5% of the general population and is most common in adults between 40 and 60 years of age (Kraal et al., 2019). It is also more common in women than men. 

Common Symptoms 

Symptoms may include: 

• Deep aching shoulder pain 

• Pain that worsens at night 

• Difficulty reaching overhead 

• Difficulty reaching behind the back 

• Stiffness when dressing or grooming 

• Reduced ability to lift objects 

• Loss of shoulder mobility in multiple directions 

  
  

What Causes Frozen Shoulder? 

The exact cause is not always known. Frozen shoulder is classified as either: 

• Primary (idiopathic): Develops without a clear cause. 

• Secondary: Occurs following injury, surgery, immobilization, or another medical condition. 

  
  

Common contributing factors include: 

• Prolonged shoulder immobilization 

• Rotator cuff injuries 

• Shoulder surgery 

• Previous shoulder trauma 

• Diabetes 

• Thyroid disorders 

• Cardiovascular disease 

  
  

Individuals with diabetes have a significantly higher risk of developing frozen shoulder than the general population (Chan et al., 2017). 

Stages of Frozen Shoulder 

Frozen shoulder typically progresses through three stages: 

1. Freezing Stage (2–9 months) 

• Gradual onset of shoulder pain 

• Increasing stiffness 

• Difficulty with daily activities 

• Symptoms may worsen over several months 

2. Frozen Stage (4–12 months) 

• Pain often decreases somewhat 

• Significant stiffness remains 

• Shoulder movement becomes severely restricted 

3. Thawing Stage (5–24 months) 

• Gradual improvement in mobility 

• Functional activities become easier 

• Range of motion slowly returns 

Can frozen shoulder be fully healed?  

Frozen shoulder improves significantly in most people over time, and while recovery is gradual—often taking 12 to 36 months—many patients regain near-normal shoulder movement and function with a combination of physiotherapy, education, and activity modification. Most patients experience substantial to near-complete recovery in pain and function over time, though some people have lingering symptoms/stiffness.  

How Physiotherapy Can Help 

Physiotherapy is one of the primary treatments for frozen shoulder and can help reduce pain, improve mobility, and restore function. 

Your physiotherapy treatment may include: 

• Comprehensive shoulder assessment 

• Education regarding activity modification 

• Gentle range-of-motion exercises 

• Joint mobilization techniques 

• Stretching programs 

• Progressive strengthening exercises 

• Home exercise prescription 

• Modalities (Infrared red-light therapy, Electrotherapy, Heat, Dry needling, Acupuncture)

When Should You See a Physiotherapist? 

Consider booking a physiotherapy assessment if you experience: 

• Progressive shoulder stiffness 

• Shoulder pain lasting more than a few weeks 

• Difficulty reaching overhead or behind your back 

• Night pain affecting sleep 

• Reduced ability to perform work, sports, or daily activities 

If shoulder pain and stiffness are limiting your daily activities, the physiotherapy team at Waterloo Sports Medicine Centre can help guide your recovery with an individualized treatment plan tailored to your needs.