Understanding Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is a painful condition that limits motion in the shoulder joint. It occurs when the capsule of connective tissue surrounding the shoulder thickens and becomes tight. This reduces the smooth gliding movement of the joint and makes even simple daily activities difficult, such as reaching overhead or behind the back.

This condition affects an estimated two to five percent of the general population. It is more common in adults between the ages of forty and sixty and is seen more often in women than in men. People with diabetes are at a much higher risk. Research shows that as many as twenty percent of people with diabetes will develop frozen shoulder at some point.

Frozen shoulder usually develops in stages and may take many months to improve.

How Long Does Frozen Shoulder Last

Frozen shoulder is temporary. The process usually lasts from one to three years, though many people begin feeling better much sooner once motion improves and the irritation settles. With consistent therapy and proper pacing, the shoulder often regains strength and mobility far earlier than the complete timeline suggests.

Common symptoms include:

• Deep aching pain in the shoulder

• Stiffness and loss of motion

• Difficulty sleeping because of shoulder discomfort

• Weakness due to pain and guarding

The pain is often constant and can worsen at night. Over time, the joint becomes more restricted which limits normal movement during daily tasks. These symptoms are frustrating, but they are reversible and can respond well to guided care.

The Three Phases of Frozen Shoulder

Frozen shoulder develops in a predictable pattern. Understanding the stages helps patients stay encouraged during treatment.

Freezing Phase: Pain begins gradually and motion becomes limited. The shoulder feels stiff and irritated. This is when calming the joint is most important.

Frozen Phase: Pain often begins to lessen, while stiffness remains the main concern. Many people begin to feel small gains in comfort during this period.

Thawing Phase: Movement steadily improves and the shoulder becomes more flexible. This is the stage where patients often feel major progress and return to confident use of the arm.

Why Hyperirritability Matters in Physical Therapy:

Many patients with frozen shoulder experience what therapists call a hyperirritable shoulder. This means the tissues react strongly even to gentle stretching or light pressure. Because of this, pushing too hard can increase pain and slow progress.

A thoughtful approach to physical therapy is important. Treatment often focuses first on calming the irritated tissues through gentle movement, soft tissue work, and pain control strategies. Only after the irritation settles can more aggressive stretching be introduced. Physical therapy that accounts for tissue irritability of the shoulder responds better and recovery tends to move forward more smoothly.

It is very important to not just push through pain. If you are noticing that your shoulder pain and stiffness is worse that night or the next day following stretching/exercises, than you need to go lighter with your program. 

Non Surgical Treatment Options:

Most people improve with non surgical care. These treatments include

• Physical therapy to restore motion, strength, and joint mobility

• Targeted stretching taught in a gradual and safe manner

• Heat or cold for pain relief

• Joint mobilization performed gently by a licensed therapist

• Anti inflammatory medication when recommended by a medical provider

• Corticosteroid injections in some cases to calm inflammation

With committed participation many patients see significant improvement in function over time without the need for an operation.

Surgical Treatment Options:

If pain and stiffness remain severe and do not improve after several months of therapy, a physician may recommend a surgical option. The two most common procedures are

• Manipulation under anesthesia, where the doctor gently moves the shoulder to loosen the tight capsule

• Arthroscopic capsular release, where tight tissue is carefully trimmed to restore motion

Even after surgery, physical therapy remains an important part of recovery to maintain the gains in mobility and to retrain healthy shoulder movement.

The Outlook:

The outlook for frozen shoulder is encouraging. The body is built to heal this condition and the great majority of people regain comfortable function. With patience, proper pacing, and skilled therapy, daily activities become easier and confidence in the shoulder steadily returns. Progress sometimes feels slow early on, but it builds momentum as the shoulder moves from stiffness toward freedom of motion.