Is Your Shoulder Getting Stiff and Sore? What You Need to Know About Frozen Shoulder

By Ben Renshaw | Hills Performance Sports Physio

---

Has your shoulder been getting progressively stiffer over the past few months? Are you waking at night unable to find a comfortable position, or struggling to reach overhead for things that used to feel effortless? If so, you may be dealing with a frozen shoulder, and the sooner it's properly assessed, the better.

Frozen shoulder, or adhesive capsulitis, is one of the more common shoulder conditions we see in the clinic. It's also one of the most frequently mismanaged, either pushed through too aggressively in the early stages, or left too long before anything is done about it.

What is it?

Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed and scarred, reducing joint volume and progressively restricting movement. The key feature is that the restriction is global - movement is limited in all directions, and not just when you try to move your arm yourself, but also when someone else moves it for you. That distinction alone separates it from most other shoulder problems.

It most commonly affects adults between 40 and 65, more so in women than men, as well as being more prevalent in people with diabetes, thyroid disorders, or other hormonal conditions. Those with diabetes are nearly four times more likely to develop frozen shoulder - and tend to have a more difficult course.

The three stages

Frozen shoulder progresses through three distinct stages, and knowing which stage you're in is central to getting the right treatment at the right time. The condition is self-limiting for most people, however untreated, it can take one to three years to resolve. The right physiotherapy at each stage significantly changes that trajectory.

The freezing stage

Pain is the primary problem in this phase - a persistent, dull ache that sharpens with movement, often with significant night pain. This phase can last weeks to several months, and it's the stage where management decisions matter most.

Aggressive stretching can be counterproductive here and may worsen inflammation. The priority is pain management: hands-on treatment, gentle mobilisation within a comfortable range, and education about what's happening. That last part matters more than people expect - research has linked anxiety and poor understanding of the condition to greater symptom severity and a more prolonged course (Dyer et al., 2023). Corticosteroid injections are most effective during this stage, reducing pain and making physiotherapy more tolerable - but they work best in combination with it, not as a replacement (Hanchard et al., 2020).

The frozen stage

Shoulder joint stiffness becomes the most dominant and reported problem. Pain may ease slightly, but movement becomes severely restricted. External rotation is typically the first and most affected direction, followed by limitation in elevation and internal rotation. Most people present at this point, having waited months hoping it would settle.

Joint mobilisation and capsule stretching have been shown to produce meaningful improvements in range of motion (Duzgun et al., 2019), and exercise-based physiotherapy is considered best practice. Hydrodilatation is a doctor referred procedure used to stretch joint capsule with injection of saline and local anaesthetic which has shown strong outcomes for both pain and function, and is most effective when followed by structured physiotherapy (Hanchard et al., 2020). The rotator cuff also begins to weaken significantly during this phase; early gentle strengthening sets the foundation for recovery.

The thawing stage

This is where physiotherapy is at its most effective. Movement gradually returns, and a progressive approach,  increasing the intensity of mobility work and strengthening as tolerated supports full recovery. Evidence supports progressive stretching and mobilisation, with range of motion improving significantly when physiotherapy is structured and consistent (Sun et al., 2016; Zhang et al., 2020).

Restoring strength is equally important. The rotator cuff, scapular stabilisers, and posterior shoulder musculature are frequently significantly weakened by the time patients reach this stage, and without targeted strengthening, full functional recovery is rarely achieved even once range of motion returns (Kelley et al., 2009, cited in Achilova et al., 2026). Progress is guided by pain relief and functional gains, not range of motion alone, with full resolution achievable for the majority within three to six months of structured rehabilitation (Hamed-Hamed et al., 2026).

Why early assessment matters

Without treatment, frozen shoulder can take one to three years to fully resolve. Early assessment means confirming the diagnosis, identifying your stage, and starting the right treatment, rather than inadvertently prolonging the process.

Assessment doesn't always involve imaging, frozen shoulder is a clinical diagnosis, made from your history and how the shoulder moves. What a thorough assessment gives you is clarity: whether this is genuinely frozen shoulder, which stage you're in, whether an MRI referral or multidisciplinary care, including referral for injection is appropriate alongside physiotherapy, and a realistic timeline for recovery. For most people, that clarity alone changes how they engage with treatment, and that matters. At Hills Performance Sports Physio in Rouse Hill, your first appointment will give you a clear picture of where you're at and a structured plan from day one. 

Frequently Asked Questions

Is a frozen shoulder the same as a rotator cuff tear? No, and the distinction matters. A rotator cuff tear typically involves a specific mechanism and produces weakness alongside pain. Frozen shoulder is gradual in onset and restricts movement in all directions, including when someone else moves your arm. Both can cause significant shoulder pain, which is why a proper assessment is important.

Will it go away on its own? Often, eventually, however untreated frozen shoulder is measured in years, not months. Physiotherapy, particularly when combined with appropriate injection therapy, significantly reduces the duration and severity of the condition.

I have diabetes, does that change things? Yes. People with diabetes tend to respond more slowly to treatment and may need longer, more individualised rehabilitation. Corticosteroid injections also require more caution in this group, making early physiotherapy even more important.

When should I see a physiotherapist?

 As soon as you notice progressive stiffness developing, don't wait for it to fully freeze. Frozen shoulder that's caught early is far more manageable than one that's been left for months. The earlier the intervention, the better the outcome.

References

·       Dyer et al. (2023). BMJ Open, 13(1). doi:10.1136/bmjopen-2022-062377

·       Hamed-Hamed et al. (2026). Pain Research and Management. doi:10.1155/prm/3820129

·       Duzgun et al. (2019). RCT, n=54.

·       Hanchard et al. (2020). Physiotherapy, 107, 150–160.

·       Kelley et al. (2009), cited in Achilova et al. (2026). The American Journal of Medicine, 139(5).

·       Sun et al. (2016). The American Journal of Sports Medicine, 45(9).

·       Zhang et al. (2020). The American Journal of Sports Medicine, 49(6).