It often starts with a coat. October arrives, the jacket comes out of the wardrobe, and reaching back for the second sleeve produces a sharp, catching pain that was not there in the summer. A few weeks later, fastening a bra, pulling a seatbelt across or lying on that side at night has become a problem, and the arm simply will not go where it used to.
Pain first, then a stubborn loss of movement: that sequence is the signature of frozen shoulder. It is one of the most misunderstood conditions we treat. It is slow, frustrating and properly painful, but it also behaves in a consistent way, and it is far easier to live with once you know where you are in it.
What frozen shoulder actually is
The medical name is adhesive capsulitis. The shoulder is a ball-and-socket joint wrapped in a loose, flexible envelope of connective tissue called the capsule. That looseness is what gives the shoulder more range than any other joint in the body.
In frozen shoulder the capsule becomes inflamed, then thickens and tightens around the joint. The inflammation is what hurts. The tightening is what takes the movement away, usually in every direction, and most of all when you try to turn the arm outwards.
One feature separates it from most other shoulder problems: the movement is blocked, not just painful. The arm will not go further even if somebody else lifts it for you.
Who gets it
Somewhere between two and five in every hundred people will have a frozen shoulder at some point. It is not caused by cold weather, despite the name, and often there is no trigger at all. But some groups are clearly more at risk:
- People aged 40 to 60, and women more often than men.
- People with diabetes. They are several times more likely to develop it, and it tends to last longer. If you want the background, we have a plain-English guide to Type I and Type II diabetes.
- People with thyroid conditions.
- Anyone whose shoulder has been kept still, after surgery, a fracture, a spell in a sling or a stroke.
- People who have had it on the other side. It rarely returns in the same shoulder, but the opposite one is affected in a fair number of cases.
The three stages
- Freezing, the painful stage. Roughly two to nine months. Pain dominates, often a deep ache in the shoulder and upper arm that is at its worst at night. Movement shrinks week by week.
- Frozen, the stiff stage. Roughly four to twelve months. The pain settles, particularly at rest, but stiffness is at its peak. This is when people say the shoulder no longer hurts much, it just does not work.
- Thawing, the recovery stage. Anything from six months to two years. Movement gradually comes back, usually without drama.
End to end, the whole process typically takes one to three years. Most people get back to good function. A minority are left with some lasting stiffness, which is why "it goes away on its own" is true but not the whole story.
How to recognise it
- A deep, aching pain in the shoulder and the outside of the upper arm
- Night pain, and not being able to lie on that side
- A sharp jolt of pain with any sudden or reaching movement
- Trouble reaching behind your back or out to the side: sleeves, bra straps, back pockets, seatbelts
- A hard stop to the movement, the same whether you lift the arm yourself or someone lifts it for you
Not every stiff, sore shoulder is frozen. Rotator cuff problems, arthritis in the joint and pain referred from the neck can all look similar at first, and they are treated differently. Frozen shoulder is diagnosed by examination. An X-ray is sometimes used, not to see the frozen shoulder, which does not show up, but to rule out arthritis.
What helps, stage by stage
The most useful thing to understand is that the right approach changes as the condition moves on.
- In the freezing stage, calm it down. Pain relief, heat, and gentle movement inside the comfortable range: pendulum swings, sliding the hand along a table, supported lifts. Stretching hard into pain at this point irritates an already inflamed capsule. This is also the stage where a steroid injection, arranged through your GP, has the best evidence: it reduces pain and often frees up some movement for a few weeks or months. That is a different picture from tennis elbow, where we are much more cautious about injections.
- In the frozen stage, start to stretch. Once the pain has eased, regular, gentle, sustained stretching into the stiffness becomes useful, and so does hands-on mobilisation of the joint. The neck, shoulder blade and upper back have usually been compensating for months by now and need work too.
- In the thawing stage, rebuild. As range returns, progressive strengthening of the rotator cuff and the muscles around the shoulder blade gets the arm ready for the gym, the pool or the tennis court again.
- All the way through, keep using the arm. Everyday tasks within comfort are good for it. Resting it completely, or keeping it in a sling, makes the stiffness worse.
- Sort out the nights. Lie on the good side and hug a pillow, or lie on your back with a pillow under the affected arm. Sleep is usually the first thing people want back.
If a shoulder is not progressing, there are hospital options: hydrodilatation, where fluid is injected to stretch the capsule, manipulation under anaesthetic, and keyhole surgery to release the capsule. A large UK trial compared structured physiotherapy plus a steroid injection with the two surgical routes. All three groups improved substantially, and none was clearly better a year later. In practice that means good hands-on care and exercise is a sensible place to start, with surgery kept for the stubborn cases.
What does not help
- Forcing it. Aggressive stretching in the painful stage tends to make the pain worse and lengthen the process.
- Complete rest. A shoulder that is not moved stiffens faster.
- Waiting with no plan. It may well resolve by itself, but two years of poor sleep and a weak arm is a high price, and the lasting stiffness some people are left with is more likely when nothing is done.
- Assuming it is frozen shoulder. Plenty of people are told they have one when the problem is the rotator cuff or the neck, and they spend months waiting for a thaw that is never going to come.
When to get it looked at
Book in if:
- Shoulder pain has been disturbing your sleep for more than a couple of weeks
- You are losing movement, and can no longer reach behind your back or overhead as you could
- You have diabetes or a thyroid condition and a shoulder is starting to stiffen
- You have been told it is a frozen shoulder, but not which stage you are in or what to do about it
- A shoulder is not recovering after an injury, an operation or time in a sling
Some things need prompt medical attention rather than an osteopath: being unable to lift the arm after a fall or injury, a hot, red, swollen joint or feeling feverish and unwell, and shoulder or arm pain that comes with chest tightness or breathlessness.
We start by working out whether it really is a frozen shoulder, examining the neck and the whole shoulder, not just the sore spot. Then we treat for the stage you are in, with hands-on work and a short exercise plan that changes as you move from one stage to the next, and we will tell you when it is worth asking your GP about an injection. There is more on how we approach it on our frozen shoulder page. If a shoulder has been getting stiffer and keeping you awake, book in and we'll take a proper look.