Frozen Shoulder: What It Is and How Long It Lasts

Frozen shoulder - adhesive capsulitis - is one of the more frustrating conditions we treat. Not because it's dangerous, but because it takes a long time, causes significant pain and limitation, and often comes on for no obvious reason. Understanding the stages helps manage expectations and keeps people engaged with treatment.

Stage 1: The freezing phase (2-9 months)

Pain is the dominant feature. It develops gradually, often waking people at night, and is characterised by an aching quality that is hard to position away from. Movement starts to become restricted but pain is the bigger problem. This is the most frustrating phase because it can feel like nothing is working.

Stage 2: The frozen phase (4-12 months)

Pain typically reduces but movement restriction is at its worst. The shoulder is stiff in all planes - especially external rotation and abduction. Daily activities like reaching into the back seat of a car, doing up a bra, or combing hair become difficult. Function is significantly impacted but the pain is more manageable.

Stage 3: The thawing phase (5-24 months)

Range of motion gradually returns. This phase can be slow and non-linear - there are periods of improvement followed by plateaus. Most people recover full or near-full movement, though a small percentage retain some permanent restriction.

How treatment differs at each stage

One of the most common mistakes we see is applying the same treatment approach across all three stages. Aggressive stretching during the freezing phase, for example, tends to flare pain without improving range - the tissue simply isn't ready for it yet.

• Freezing phase: pain management is the priority - anti-inflammatories, heat, and gentle movement within comfort only. A corticosteroid injection into the glenohumeral joint in this stage can significantly reduce the severity and duration of the freezing phase and is often worth discussing with your GP or specialist.
• Frozen phase: progressive, graded stretching and range-of-motion work becomes appropriate as pain settles. Hydrodilatation - an injection that stretches the joint capsule with fluid - is a more aggressive option that can speed recovery for patients whose stiffness is limiting daily function.
• Thawing phase: strengthening work becomes the focus once range of motion is returning, to rebuild the rotator cuff and scapular control that weakened while the shoulder was protected during the stiffer phases.

Physiotherapy remains valuable throughout, but its role changes at each stage - guiding pacing during the painful freezing phase, progressing movement during the frozen phase, and rebuilding strength during thawing. Getting the sequencing wrong is a common reason people feel like months of treatment made no difference.

A typical case

A recent patient - a 54-year-old who'd had no shoulder injury but noticed gradually worsening night pain over about six weeks - is a fairly representative presentation. She was in the freezing phase when she was assessed, still able to work but waking most nights. Treatment focused on pain settling strategies, a referral back to her GP to discuss a corticosteroid injection, and gentle pendular movement - deliberately not aggressive stretching. By month four she'd moved into the frozen phase, pain settled but stiffness marked, and treatment shifted to progressive range-of-motion work. This kind of staged approach is standard for adhesive capsulitis and is why timelines are given in ranges rather than fixed weeks.

FAQs

Is frozen shoulder linked to diabetes?

Yes - people with diabetes are two to four times more likely to develop frozen shoulder, and it can take longer to resolve and sometimes affects both shoulders. If you have diabetes and develop shoulder stiffness, it's worth flagging this to your physio and GP early.

Can frozen shoulder come back once it resolves?

It's uncommon for frozen shoulder to recur in the same shoulder once it has fully resolved, but around 5-15% of people go on to develop it in the other shoulder within a few years.

Should I keep using my arm or rest it?

Keep using it within your pain limits rather than immobilising it completely - a sling or complete rest tends to make stiffness worse. The goal in the freezing phase specifically is gentle, pain-guided movement, not pushing through pain.