What is frozen shoulder?
Frozen shoulder, also known as adhesive capsulitis, is a painful condition characterized by gradual loss of mobility in the shoulder. This condition occurs when the shoulder capsule – the connective tissue surrounding the joint – thickens and becomes stiff, leading to pain and stiffness. Over time, the shoulder can become so immobile that everyday activities such as dressing, combing hair, or raising the arm become extremely difficult or even impossible.
Frozen shoulder develops gradually and usually progresses through three stages: the freezing stage (painful phase), the frozen stage (complete stiffness), and the thawing stage (recovery). Although symptoms can last for months or even years, proper physical therapy can significantly speed up the recovery process and help restore full shoulder function.
Who is most commonly affected by this condition?
Frozen shoulder can occur in anyone, but certain groups of people are at higher risk:
People between 40 and 60 years old – statistics show that frozen shoulder most commonly occurs in middle-aged and older individuals, while it is less common in younger populations.
Women more often than men – research has shown that women are more prone to developing this condition, especially during menopause, which may indicate a connection to hormonal changes.
People with previous shoulder injuries – if the shoulder has been injured (e.g., after a fracture, surgery, or sprain), there is a higher chance of developing frozen shoulder due to limited mobility during the recovery period.
Diabetics – people with diabetes have up to five times higher risk of developing this condition compared to those without blood sugar problems. Although the exact reason is not fully understood, it is believed that elevated blood glucose levels affect the elasticity of the connective tissue in the shoulder.
People with certain medical conditions – frozen shoulder is more common in individuals suffering from thyroid diseases, Parkinson’s disease, heart conditions, or autoimmune diseases, as these conditions can affect connective tissue and joint mobility.
People with prolonged periods of arm inactivity – if someone does not use their shoulder for a long time due to injury, surgery, or immobilization (e.g., after a stroke or surgical intervention), the risk of developing frozen shoulder increases due to gradual tightening of the joint capsule.
Symptoms and Stages of Frozen Shoulder
Frozen shoulder does not appear suddenly – it develops gradually through three clearly defined stages, each with its specific symptoms and duration. Overall, the process can last from several months to a few years, but with appropriate treatments and physical therapy, recovery can be significantly accelerated and discomfort reduced.
Stage 1: Freezing Stage (Initial Pain and Stiffness)
Duration: 6 to 9 months
Main symptom: Gradually increasing shoulder pain
In this early stage, patients initially feel mild pain and discomfort in the shoulder, which intensifies over time. The pain can be present even at rest, but is usually more pronounced during movement, especially when lifting the arm above the head or moving it backward.
As the condition progresses, stiffness develops – patients notice increasing difficulty performing daily activities such as dressing, combing hair, or reaching for objects at height. Pain often worsens at night, which can disrupt sleep.
How can we help?
Gentle stretching and mobilization exercises to prevent further movement restriction
Pain relief therapies such as electrotherapy, ultrasound therapy, magnetotherapy, laser therapy, and shockwave therapy
Advice on proper posture and avoiding sudden movements
Phase 2: Frozen Stage (Reduced Mobility)
Duration: 4 to 12 months
Main symptom: Pronounced stiffness, while pain may be somewhat reduced
This is the most severe phase when patients experience significant movement limitation, seriously affecting quality of life. Although pain may decrease somewhat, the shoulder becomes extremely stiff, making even simple movements like raising the arm forward or to the side difficult.
Patients often describe a feeling of a “block” in the shoulder, as if the joint simply cannot move any further despite effort. This phase can be frustrating because shoulder functionality is drastically reduced.
➡ How can we help?
Individualized physical therapy to improve mobility
Manual techniques and mobilizations to loosen connective tissue
Kinesiotherapy and muscle-strengthening exercises to prevent loss of strength
Phase 3: Thawing Phase (Gradual Recovery)
Duration: 6 to 24 months
Main symptom: Gradual improvement in mobility and reduction of pain
This is the phase of spontaneous recovery – shoulder mobility gradually returns, and pain almost completely disappears. The muscles around the shoulder begin to regain their function, and daily activities become easier.
However, if the patient has not undergone therapy during the previous phases, there is a possibility that the shoulder may never fully regain its function. Therefore, continuous physical therapy is crucial to release the joint from stiffness and restore it to an optimal state.
➡ How can we help?
Rehabilitation programs to speed up functional recovery
Advanced stretching and muscle strengthening exercises
Massage and myofascial release techniques to improve circulation and tissue relaxation
Causes and Risk Factors
Frozen shoulder (adhesive capsulitis) occurs when the shoulder joint capsule thickens, tightens, and forms scar tissue, which limits mobility. Although the exact cause is not always known, there are several factors that can contribute to the development of this condition. Below, we will explain in detail the most common causes and risk factors that increase the likelihood of developing frozen shoulder.
Injuries and shoulder surgeries
How do injuries lead to frozen shoulder?
Any shoulder injury—such as a sprain, strain, fracture, or dislocation—can cause prolonged immobilization of the arm, which increases the risk of developing frozen shoulder. When the shoulder remains immobile for an extended period, the joint capsule thickens and tightens, leading to stiffness and pain.
Surgery as a trigger for frozen shoulder
Patients who have undergone shoulder surgeries—such as rotator cuff reconstruction, joint replacement, or clavicle surgery—are also at increased risk. After surgery, a period of rest is often necessary for tissue healing, but if rehabilitation is delayed or insufficient, permanent movement restrictions may develop.
➡ How can we help?
Timely physical therapy after injury or surgery is crucial to prevent the formation of scar tissue.
Gentle mobilization exercises help maintain mobility even during the recovery phase.
Pain reduction therapies, such as electrotherapy, can ease the early stages of rehabilitation.
Diabetes and Other Medical Conditions
Diabetes – one of the main risk factors
Statistics show that people with diabetes have a 2 to 4 times higher risk of developing frozen shoulder compared to healthy individuals. The exact reason is not fully understood, but it is believed that elevated blood sugar levels may contribute to thickening and reduced elasticity of the joint capsule, leading to movement restrictions.
Other medical conditions that increase risk
Besides diabetes, other chronic conditions may be associated with frozen shoulder, including:
Thyroid diseases (hypothyroidism and hyperthyroidism) – Hormonal changes can affect the quality of connective tissue.
Parkinson’s disease – Nervous system damage can cause increased stiffness in muscles and joints.
Cardiovascular diseases – Circulatory problems may contribute to degenerative changes in the joints.
How can we help?
A therapeutic approach tailored for diabetic patients – gentle mobilization exercises and techniques to improve circulation.
A combination of manual therapy and active exercises to increase tissue flexibility.
Patient education on the importance of early physical activity to reduce the risk of stiffness.
Prolonged inactivity of the arm
Why does inactivity contribute to frozen shoulder?
One of the most common causes of this condition is prolonged inactivity or immobilization of the arm. When the shoulder is not used for an extended period, the synovial fluid (which lubricates the joint) decreases its function, connective tissue thickens, and shoulder mobility becomes limited.
Inactivity of the arm can result from:
✔ Prolonged rest due to injury or surgery
✔ Sitting in a poor posture and avoiding movement due to pain
✔ Sedentary lifestyle and lack of physical activity
Who is most at risk?
People who spend long hours sitting (e.g., office workers) and do not engage their shoulders in regular movement may notice a gradual decrease in flexibility. Also, older adults who use their arms less due to general muscle weakness are more likely to develop frozen shoulder.
➡ How can we help?
Functional exercises to maintain shoulder mobility, even for people who spend a lot of time sitting.
Movement therapy (active and passive) to prevent further joint deterioration.
Advice on proper posture and workplace ergonomics to reduce the risk of shoulder stiffness.
How is frozen shoulder treated?
Treatment of frozen shoulder is a lengthy process that requires patience, persistence, and appropriate therapy. Although the condition can resolve spontaneously over several years, proper treatments can significantly speed up recovery, reduce pain, and restore shoulder function in a shorter time.
Physical therapy as the key to recovery
Physical therapy is the foundation of treating frozen shoulder because it helps gradually restore movement and prevent further worsening of the condition. The goal of therapy is to reduce pain, improve flexibility, and strengthen the shoulder muscles.
Electrotherapy: Used to relieve pain and improve shoulder mobility. Electrical impulses stimulate muscles and nerves, reducing tension, pain, and inflammation while helping relax muscles that have become shortened and stiff due to frozen shoulder.
Magnetotherapy: The application of a magnetic field helps improve circulation, reduce inflammation, and accelerate tissue regeneration. In frozen shoulder, magnetotherapy aids muscle relaxation, decreases pain, and speeds up the recovery process of joints and surrounding structures.
Laser therapy: Low-intensity laser helps reduce pain and inflammation in the shoulder, accelerates tissue regeneration, and stimulates circulation. This therapy alleviates shoulder pain, improves mobility, and speeds up the healing of tissues damaged by restricted movement.
Ultrasound therapy: Sound waves penetrating deep into tissues help reduce inflammation, swelling, and pain, as well as stimulate circulation. It effectively relaxes muscles and decreases tightness in the shoulder, enabling better mobility and less discomfort.
Shockwave therapy: Shockwave therapy uses acoustic waves to reduce pain, stimulate circulation, and accelerate tissue regeneration. It helps decrease muscle tension and stiffness, improving shoulder mobility and reducing inflammation caused by frozen shoulder.
Exercises to Improve Mobility
One of the most important aspects of treating frozen shoulder is performing exercises that increase joint mobility. Exercises should be done gradually and according to the current condition of the shoulder to avoid overexertion or injury.
Types of exercises applied:
Stretching exercises – Help increase the range of motion and reduce shoulder stiffness. For example, exercises where the patient gently raises the arm or rotates the shoulder help gradually open up the joint.
Resistance exercises – In phases when pain decreases, adding resistance can help strengthen the muscles around the shoulder, which further contributes to stability and mobility.
Rotator cuff strengthening exercises – These exercises are crucial for restoring shoulder function because the rotator cuff stabilizes the joint and allows for easier movements.
Massages and Manual Therapy
Massages and manual therapy can significantly help reduce muscle tension and improve blood flow in the joint. These therapies assist in releasing the stiffness-related tension and reducing pain.
How do massages help?
Increase circulation – Massages enhance blood flow in the affected area, allowing better delivery of nutrients and oxygen, which speeds up recovery.
Pain reduction – They reduce muscle tension, which directly contributes to lessening shoulder pain.
Manual therapy
Manual therapy involves gentle manipulation of the joint and surrounding structures to increase the range of motion. This can include joint mobilizations, which improve the flow of synovial fluid through the joint and reduce tissue thickening.
At the In Locco Physio and Aesthetic Center, we offer individualized rehabilitation programs designed to help patients restore shoulder function and reduce pain in the most effective way.
If you notice early signs of stiffness or shoulder pain, don’t wait — take timely action and protect the health of your shoulder!
Prevention and Tips for Maintaining Shoulder Health
The shoulder is one of the most flexible and mobile joints in the human body, but it is also prone to injuries and conditions such as frozen shoulder. While some risk factors, like aging or certain medical conditions, are beyond our control, there are many ways to maintain shoulder health and prevent pain and stiffness.
Exercises for Strengthening and Flexibility
One of the most effective ways to maintain shoulder health is to regularly perform exercises that strengthen the muscles around the shoulder and increase its flexibility. These exercises not only improve mobility but also reduce the risk of injuries.
Strengthening exercises for the shoulder
Lateral and front raises with dumbbells: These exercises strengthen the deltoid muscles and help maintain shoulder stability. Start with lighter weights and gradually increase them to build muscle strength.
Push-ups: This exercise strengthens the chest, shoulder, and triceps muscles, improving shoulder stability. You can perform push-ups on your knees or with your full body, depending on your strength level.
Rotations with elastic bands: This exercise targets the rotator cuff, which is crucial for shoulder stability. Use elastic bands that provide resistance during the movement.
Exercises to increase flexibility
Overhead shoulder stretch: Hold your arm above your head and gently lean to the opposite side to stretch the lateral shoulder muscles. This stretch helps maintain flexibility and prevents stiffness.
Chest muscle stretch: Since poor posture can cause tightness in the muscles around the shoulder, it’s important to stretch the chest muscles and bring the shoulders back into proper alignment. You can do this by placing your hands behind your back and pulling your shoulders backward.
Shoulder rotations: This simple stretch can be done while sitting or standing. Rotate your shoulders forward and backward to help release tension.
Tips to Prevent Shoulder Stiffness
In addition to regular exercises, there are several other preventive measures you can take to maintain shoulder health and prevent conditions like frozen shoulder.
Maintain proper posture
Proper posture, both while sitting and standing, is essential for shoulder health. If you spend a lot of time at a desk during the day, pay attention to keeping your back straight and your shoulders relaxed. Avoid overloading one shoulder, as this can cause pain and stiffness.
Take breaks during repetitive activities
If you perform activities that require repeating the same movements (such as working on a computer, driving, or physically demanding work), take regular breaks to relax your shoulders and prevent overstrain. This is especially important when performing activities involving lifting or moving heavy objects.
Maintain good physical fitness
Your overall body health plays a key role in shoulder health. Regular exercise, including aerobic activities, muscle strengthening, and focusing on flexibility, can significantly reduce the risk of injuries and shoulder stiffness. Additionally, increasing the strength of muscles around the shoulder can improve its stability and mobility.
Lift and carry heavy objects properly
When lifting or carrying heavy objects, make sure to use proper technique. Bending your knees and holding the weight close to your body can help reduce stress on the shoulder. Also, when carrying bags or other items on one shoulder, try to switch sides occasionally to avoid uneven loading.
Maintain a normal body weight
Excess weight can increase pressure on joints, including the shoulders. Maintaining a healthy body weight reduces stress on the shoulder and can help prevent joint problems. A balanced diet and regular exercise are key to preserving optimal body weight.