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Understanding Frozen Shoulder

 

Frozen shoulder, medically known as Adhesive Capsulitis, is a condition where the shoulder joint becomes stiff, painful and gradually loses its range of movement. It occurs when the capsule surrounding the shoulder joint thickens and tightens, ultimately restricting movement and causing pain. Although it can be a frustrating and lengthy condition, with the right management, most people make a full recovery.

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Who Does It Affect?

Frozen shoulder most commonly affects adults between 40 and 65 years old and it’s more frequent in women. It can occur following an injury, surgery, or period of immobilisation, but often develops without any obvious cause. People with diabetes, thyroid issues, or previous shoulder injuries are at higher risk.

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Stages of Frozen Shoulder

Frozen shoulder develops gradually and typically progresses through three stages:

1. Freezing Stage (Painful Phase) – The shoulder becomes increasingly painful, especially with movement. Range of motion begins to reduce.

2. Frozen Stage (Stiffness Phase) – Pain may reduce slightly, but stiffness becomes the main issue. Daily tasks such as dressing or reaching overhead can be difficult.

3. Thawing Stage (Recovery Phase) – Gradual improvement in movement and a return to normal function as the capsule loosens.

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​​Each stage can last several months, and full recovery may take anywhere from 12 to 24 months. However, with effective Physiotherapy, this timeframe can be significantly reduced, helping to restore movement and function much sooner.​

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Symptoms to Look Out For

• Dull, aching pain in the shoulder and upper arm

• Pain worse at night or when lying on the affected side

• Gradual stiffness and loss of movement

• Difficulty performing everyday activities (e.g., reaching and lifting)

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Physiotherapy Management

Physiotherapy plays a vital role in both pain relief and restoring movement throughout every stage of frozen shoulder. A well-structured treatment plan can not only make daily life more comfortable but also dramatically shorten the overall recovery time, which can otherwise last 12–24 months.

 

At Prime Performance Physio, we use a combination of hands-on therapy, tailored exercise, and advanced technology to support recovery at every stage.

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• Education & Reassurance: Understanding what’s happening inside the shoulder is key to progress. We explain the natural course of frozen shoulder, from the painful “freezing” stage to the final “thawing” phase, helping you understand that recovery is possible. Education has been shown to reduce anxiety and improve adherence to rehabilitation (Babatunde et al., 2017).

• Manual Therapy: Gentle mobilisation and soft tissue techniques help maintain joint mobility, reduce stiffness and relieve pain. Evidence suggests that manual therapy combined with exercise is more effective than exercise alone for improving pain and function in frozen shoulder (Page et al., 2014).

• Exercise Prescription: Exercise is central to recovery from frozen shoulder. In the early phase, gentle, pain-free movements help maintain mobility and ease stiffness. As symptoms improve, stretching and strengthening exercises are gradually introduced to restore shoulder stability and function.

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A key principle in rehabilitation is “creep”, the gradual lengthening of tight soft tissue through slow, sustained movement. This controlled approach allows the shoulder capsule to adapt over time, improving flexibility and range of motion without triggering pain or inflammation.

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Advanced Pain Relief Modalities:
 

We use evidence-based technology to enhance recovery and reduce pain:

• Shockwave Therapy: At Prime Performance Physio, we use Focused Shockwave Therapy, a precise treatment that helps reduce pain, improve movement and support natural healing in frozen shoulder (Vahdatpour et al., 2014). There are two main types of shockwave therapy: Radial and Focused. While radial devices treat surface-level muscle or tendon pain, Focused Shockwave Therapy reaches deeper tissues and can be directed accurately to the shoulder joint. As one of the few clinics in the region offering FSWT, we’re able to provide a more advanced, evidence-based treatment to help you recover faster and move with confidence.

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• Compex EMS Muscle Stimulator: During the early, more painful stages of frozen shoulder, electrical stimulation can be a useful way to manage discomfort and support gentle muscle activation when movement is limited. The Compex system delivers controlled electrical impulses that help to reduce pain, improve circulation and prevent muscle deconditioning while the shoulder is too sore for normal exercise. Electrical stimulation can assist in pain modulation by influencing sensory nerves and encouraging the release of natural endorphins (Gondin et al., 2011). At Prime Performance Physio, we often use Compex alongside manual therapy and gentle movement work to make the early stages of recovery more comfortable and effective.

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• Corticosteroid (Steroid) Injections: In some cases, a corticosteroid injection may be recommended to help manage pain during the early or “freezing” stage of frozen shoulder, when inflammation and discomfort are at their peak. The injection helps to reduce irritation within the shoulder capsule, easing pain and stiffness so you can participate more comfortably in physiotherapy and begin gentle movement sooner. Research shows that combining steroid injections with physiotherapy can improve short-term pain relief and range of motion compared to physiotherapy alone (Blanchard et al., 2010). While not a cure on their own, injections can provide an important window of relief that allows for more effective hands-on treatment and exercise.

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Recovery and Outlook

 

Although frozen shoulder can be a long and frustrating condition, recovery is the rule, not the exception. With early intervention, the right combination of manual therapy, structured exercise and, where appropriate, advanced modalities Focused Shockwave Therapy, most people regain full and pain-free movement.

At Prime Performance Physiotherapy, we tailor every rehabilitation plan to your stage of recovery and personal goals. If you think you may have frozen shoulder, or you’re unsure what’s causing your shoulder pain, book a consultation or free chat with one of our therapists. We’ll assess your symptoms, help explain what’s going on and together, decide the best path forward, so you can get back to moving freely and living without pain.

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References 

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​If you would like to know more about Frozen Shoulder and it's treatment, please contact us on 01949 485084