Physiotherapy Treatment for Frozen Shoulder (adhesive capsulitis) | Comprehensive Guide 2025

Frozen shoulder, medically known as adhesive capsulitis, is a painful condition characterized by stiffness and limited movement in the shoulder joint. This condition can hinder your ability to perform daily tasks such as lifting, reaching overhead, or even simple actions like getting dressed. In this detailed guide, we will explore frozen shoulder physiotherapy treatment and offer in-depth insights into how physiotherapy can help alleviate the pain, improve mobility, and restore functions of the shoulder joint.

Table of Contents

1. What is Frozen Shoulder?
2. Symptoms and Causes of Frozen Shoulder
3. Understanding the Phases of Frozen Shoulder
4. The Role of Physiotherapy in Frozen Shoulder Treatment
5. Key Physiotherapy Techniques for Frozen Shoulder
6. Exercise and Stretching for Frozen Shoulder
7. Advanced Physiotherapy Techniques for Severe Cases
8. Home Remedies and Self-Care Tips for Frozen Shoulder
9. Prevention Tips to Avoid Frozen Shoulder Recurrence
10. Conclusion

What is Frozen Shoulder?

Frozen shoulder, or adhesive capsulitis, is a condition where the shoulder joint becomes stiff and painful, severely limiting its range of motion. The shoulder’s connective tissue, known as the capsule, thickens and tightens, causing the space within the joint to shrink. This results in pain, restricted movement, and difficulty performing routine tasks that require the use of the shoulder.

This condition typically progresses in three phases—each phase being marked by different symptoms and recovery timelines. While the exact cause of frozen shoulder is not fully understood, it is believed to occur due to prolonged immobility, injury, or inflammation of the shoulder joint.

Frozen shoulder can develop without any clear cause but is more common in individuals aged between 40 and 60, with women being more affected than men. It’s also seen more frequently in people with certain medical conditions, such as diabetes, thyroid issues, and heart disease.

Adhesive Capsulitis (Frozen Shoulder) — Special Tests

Adhesive capsulitis (frozen shoulder) can be assessed through several special tests during a physical examination. These tests help differentiate it from other shoulder pathologies. Here are the key special tests used:

1. Apley’s Scratch Test

Purpose: To assess shoulder range of motion (ROM) in internal and external rotation.

How to Perform:

• Ask the patient to reach one hand over the shoulder and touch the opposite scapula (External Rotation).

• Then reach behind the back to touch the opposite scapula from below (Internal Rotation).

Positive Sign: If the patient feels pain or cannot reach the scapula — it may indicate limited ROM due to frozen shoulder.

2. Passive Range of Motion (PROM) Test

Purpose: To assess how much movement is possible at the shoulder when moved by the therapist (not the patient).

How to Perform:

• Therapist passively moves the patient’s shoulder in all directions:

  • Flexion

  • Abduction

  • External Rotation

  • Internal Rotation

Positive Sign: All movements are restricted — especially External Rotation, which is the most affected in adhesive capsulitis.

3. Capsular Pattern Recognition

This is a classic diagnostic feature of frozen shoulder.

The pattern of movement limitation is:

• External Rotation – most limited

• Abduction – moderately limited

• Internal Rotation – least limited

This “Capsular Pattern” helps differentiate adhesive capsulitis from other shoulder conditions.

4. Painful Arc Test

Purpose: To differentiate between frozen shoulder and rotator cuff problems.

How to Perform:

• Ask the patient to actively raise the arm sideways (abduction).

In Frozen Shoulder:

• The full arc of motion is often not possible due to stiffness.

In Rotator Cuff Impingement:

• Pain occurs only in the middle range (60°–120°) of abduction.

5. Neer’s and Hawkins-Kennedy Tests

Purpose: To assess for impingement or rotator cuff tendonitis.

In Frozen Shoulder:

• These tests are usually negative, because the primary problem is joint stiffness, not tendon impingement.

6. Sulcus Sign

Purpose: To check for shoulder instability.

In Frozen Shoulder:

• The test is negative, because the shoulder is stiff, not unstable.

Summary for Easy Recall:

Symptoms and Causes of Frozen Shoulder?

Symptoms of Frozen Shoulder

The symptoms of frozen shoulder vary depending on the phase the condition is in. Common signs include:

• Pain: The pain typically begins gradually, with a dull ache in the shoulder that worsens with movement. During the freezing phase, the pain intensifies and may become constant, affecting daily activities.
• Stiffness: One of the most obvious symptoms of frozen shoulder is stiffness, especially when reaching behind the back or attempting overhead movements. The range of motion in the shoulder joint is severely reduced.
• Limited Movement: As the condition progresses, the shoulder joint becomes more immobile. Patients may struggle with basic tasks, such as reaching up to a shelf or even putting on a coat.
• Night Pain: The pain often worsens at night, which can interfere with sleep and significantly impact overall quality of life.

Causes of Frozen Shoulder

The exact cause of frozen shoulder remains unclear, but it’s often associated with one or more of the following factors:

• Injury or Surgery: After shoulder surgery or an injury, the shoulder may become immobilized for a period. This prolonged lack of movement can trigger the onset of frozen shoulder. Conditions like rotator cuff tears or fractures may also lead to a higher risk of frozen shoulder.
• Health Conditions: Frozen shoulder is more common in people with diabetes, thyroid problems, and heart disease. Diabetes increases the risk due to associated inflammation and slowed tissue healing. Thyroid dysfunction may also play a role in the development of frozen shoulder.
• Age and Gender: Frozen shoulder typically affects people between the ages of 40 and 60. Women, especially those in this age range, are more likely to develop frozen shoulder compared to men.
• Immobilization: Prolonged lack of shoulder movement, either due to a lack of activity or resting for an extended period after an injury, can cause the shoulder capsule to thicken and tighten, leading to the development of frozen shoulder.

Understanding the Phases of Frozen Shoulder

Frozen shoulder progresses through three distinct stages:

1. Freezing Phase (Pain Phase)

The freezing phase is characterized by inflammation in the shoulder joint and pain, especially during movement. The pain gradually increases and can become more intense, particularly during the night. The stiffness begins to set in during this phase, and the range of motion starts to decrease. This phase can last anywhere from 6 weeks to 9 months.

2. Frozen Phase (Stiffness Phase)

During the frozen phase, the pain may subside but the shoulder becomes progressively more stiff. This phase can last anywhere from 4 to 6 months. While the pain is reduced, the stiffness becomes much more noticeable. Simple tasks like reaching for objects or turning the arm become very difficult.

3. Thawing Phase (Recovery Phase)

The thawing phase is the recovery period. This phase is characterized by a slow improvement in range of motion and a reduction in pain. It can last anywhere from 6 months to 2 years. The mobility of the shoulder joint gradually improves, but it may take time for individuals to regain their full range of motion.

The Role of Physiotherapy in Frozen Shoulder Treatment?

Physiotherapy plays a crucial role in frozen shoulder physiotherapy treatment. It aims to reduce pain, improve the range of motion, and restore shoulder function. Treatment plans are tailored to the individual’s stage of frozen shoulder and may evolve as the condition progresses.

Key goals of frozen shoulder physiotherapy treatment include:

• Pain Reduction: Various physiotherapy techniques are used to reduce pain, including manual therapy, modalities like heat and cold packs, and electrical stimulation.
• Restoring Range of Motion: One of the primary aims of physiotherapy is to restore the shoulder’s full range of motion. Physiotherapists use stretching exercises, joint mobilizations, and other techniques to improve flexibility.
• Strengthening the Shoulder: Once the pain subsides and movement improves, physiotherapists help to strengthen the shoulder muscles to support the joint and prevent re-injury.
• Education: Physiotherapists educate patients about posture, movement techniques, and self-care practices to minimize the risk of recurrence.

Frozen Shoulder Physiotherapy Treatment Techniques

Physiotherapists employ a combination of techniques to address frozen shoulder effectively. These include:

1. Manual Therapy

Manual therapy involves the physiotherapist using their hands to manipulate the shoulder joint, increasing the range of motion and reducing stiffness. Techniques include:

• Joint Mobilization: Gentle movements of the shoulder joint are performed to increase mobility and alleviate pain.
• Soft Tissue Manipulation: The physiotherapist applies pressure to muscles and soft tissues around the shoulder to reduce tightness and promote healing.

2. Stretching and Range of Motion Exercises

Stretching exercises are essential to improving shoulder mobility. Key exercises include:

• Pendulum Swings: The patient bends forward and lets the affected arm hang freely. Gentle swings in a circular motion help to loosen up the joint.
• Wall Crawls: Standing against a wall, the patient uses their fingers to “crawl” up the wall, gradually increasing the reach to stretch the shoulder.

3. Strengthening Exercises

Once the pain subsides, strengthening the muscles around the shoulder joint is vital. Strengthening exercises include:

• Resistance Band Exercises: Resistance bands are used to strengthen the muscles of the shoulder and arm, promoting better stability and function.
• Isometric Exercises: These exercises involve contracting the muscles around the shoulder without actually moving the joint, helping to build strength while minimizing stress on the joint.

4. Ultrasound Therapy

Ultrasound therapy uses sound waves to penetrate deep into the shoulder tissues. It helps reduce inflammation, promotes healing, and increases blood circulation to the area, accelerating recovery.

Exercise and Stretching for Frozen Shoulder

In addition to professional physiotherapy, daily exercises and stretches can significantly improve the condition of frozen shoulder. These exercises aim to restore flexibility, reduce stiffness, and strengthen the shoulder muscles. Here are some recommended exercises:

1. Pendulum Swings

Stand beside a chair or table and lean forward slightly, letting your arm hang freely. Slowly swing your arm in small circles, first clockwise and then counterclockwise. Gradually increase the size of the circles as the joint loosens.

2. Towel Stretch

Hold a towel behind your back with both hands. Use your unaffected arm to pull the towel upwards gently, stretching the shoulder. Hold the stretch for 20-30 seconds and repeat the process several times throughout the day.

3. Shoulder Rolls

Sit or stand with a straight posture. Slowly raise your shoulders towards your ears, roll them back, and then relax them. This exercise helps to release tension in the shoulders and improve overall mobility.

4. Wall Climb

Face a wall, and slowly “walk” your fingers up the wall as high as you can reach. Gradually increase the height as your range of motion improves. This exercise helps to stretch the shoulder joint without putting excessive strain on it.

If you want to learn more about exercises for frozen shoulder click here

Advanced Physiotherapy Techniques for Severe Cases

In cases where frozen shoulder physiotherapy treatment does not work, more advanced interventions may be required:

1. Shockwave Therapy

Shockwave therapy uses high-frequency sound waves to promote tissue healing and reduce chronic pain in the shoulder. It helps break down scar tissue, stimulates blood flow, and accelerates recovery.

2. Corticosteroid Injections

Corticosteroid injections can help control inflammation and reduce pain. While not a long-term solution, they provide relief during the more painful phases of frozen shoulder.

3. Hydrodilatation

Hydrodilatation is a procedure that involves injecting sterile fluid into the shoulder joint to stretch the capsule and improve mobility. It’s particularly useful in severe cases where other treatments haven’t been successful.

Home Remedies and Self-Care Tips for Frozen Shoulder Management

Along with physiotherapy, there are several self-care practices that can alleviate symptoms and improve shoulder function:

• Ice and Heat Therapy: Applying ice can help reduce inflammation, while heat therapy can relax muscles and improve circulation.
• Massage: Gentle massage around the shoulder can help reduce muscle tension and promote healing.
• Gentle Movement: Even during the painful stages, it’s important to engage in light movement. Avoid prolonged immobility to prevent the shoulder from becoming stiffer.
• Over-the-Counter Pain Relief: Medications like ibuprofen can be used to manage pain and reduce inflammation.

Prevention Tips to Avoid Frozen Shoulder Recurrence

Once frozen shoulder has been treated and mobility has returned, there are several ways to prevent the condition from recurring:

• Regular Exercise: Keep performing shoulder exercises to maintain strength and flexibility.
• Good Posture: Avoid slumping or poor posture that could put strain on the shoulder joint.
• Avoid Inactivity: Prolonged inactivity can contribute to stiffness. Ensure the shoulder remains active and moves regularly.

How Physio at Home Can Help with Frozen Shoulder Physiotherapy Treatment?

1. Personalized Care in the Comfort of Your Home
   One of the main advantages of choosing Physio at Home is that you receive personalized care without the need to visit a clinic. Our physiotherapists come to your home, ensuring that you can follow your treatment plan in a familiar and comfortable environment, which can help reduce stress and improve your recovery process.

2. Tailored Treatment Plans
   Our physiotherapists will assess the severity of your frozen shoulder and create a customized treatment plan to address your specific needs. Whether you’re in the freezing, frozen, or thawing phase, we ensure that the exercises and techniques are suited to your current condition.

3. Techniques We Use at Physio at Home
   Our physiotherapists will utilize a variety of techniques, including:

   • Manual Therapy: Gentle manipulation and joint mobilizations to increase range of motion and alleviate pain.

   • Stretching and Range of Motion Exercises: Exercises designed to improve shoulder flexibility, such as pendulum swings, wall climbs, and towel stretches.

   • Strengthening Exercises: As pain reduces, strengthening exercises help stabilize the shoulder joint and prevent future injuries.

   • Ultrasound Therapy: For deeper tissue healing and pain reduction.

   • Education: Our physiotherapists will also guide you on posture, self-care practices, and preventative measures to avoid recurrence.

4. Convenient Scheduling
   With Physio at Home, you can schedule your physiotherapy sessions at times that are most convenient for you, without worrying about travel or clinic hours. This flexibility allows for better consistency in treatment, which is vital for recovery from frozen shoulder.

5. Ongoing Support
   Our physiotherapists will provide continuous support throughout your recovery journey. They will monitor your progress, adjust the treatment plan as needed, and ensure that you’re comfortable with your rehabilitation exercises. Additionally, we can provide you with exercises to perform between sessions to maintain progress and improve mobility.

6. Affordable and Accessible
   Physio at Home offers competitive pricing for high-quality physiotherapy services, ensuring that you have access to effective treatment without the burden of expensive clinic visits. With our home-based care, you get the same professional physiotherapy expertise but with the added benefit of convenience and comfort.

How to Get Started with Physio at Home

To begin your frozen shoulder physiotherapy treatment with Physio at Home, simply follow these steps:

1. Contact Us: Call us at 03124090036 or visit physioathome.pk to schedule your initial consultation.

2. Initial Assessment: Our physiotherapists will assess your condition, evaluate your symptoms, and discuss your medical history to determine the best approach for treatment.

3. Begin Treatment: Based on the assessment, we’ll develop a personalized treatment plan that includes in-home physiotherapy sessions tailored to your needs.

4. Ongoing Support: We offer continued support and adjustments to your treatment plan to ensure the best possible recovery outcomes.

Conclusion

Frozen shoulder is a challenging condition that can severely affect your daily life. However, with the right plan for frozen shoulder physiotherapy treatment, the symptoms can be managed effectively, and full mobility can be restored. If you’re suffering from frozen shoulder pain, with Physio at Home, you have access to high-quality, convenient physiotherapy treatment that helps you regain mobility and reduce pain. Our expert physiotherapists will guide you through the recovery process, helping you achieve long-term results from the comfort of your home. Don’t let frozen shoulder hold you back—contact Physio at Home today to start your journey to recovery.