Frozen shoulder, or adhesive capsulitis, is a condition in which the capsule surrounding the shoulder joint thickens and tightens. The shoulder becomes painful first and stiff afterwards, and the stiffness is mechanical — the joint will not move further even when someone else moves the arm for you.

What it feels like

• A deep ache in the shoulder, often worst at night and difficult to sleep on
• Reaching behind your back, overhead or across your body becomes hard, then impossible
• Stiffness that does not ease once you have warmed up
• Range of motion is limited whether you move the arm yourself or someone else moves it
• Usually one shoulder, and more often the non-dominant one

Common causes

• No clear trigger at all — this is called primary frozen shoulder and it is the most common form
• A period of immobility after injury, fracture or shoulder surgery
• Diabetes, which raises the risk substantially
• Thyroid disorders
• Most common between the ages of 40 and 60, and more common in women

How physiotherapy helps

Frozen shoulder moves through three stages — painful, stiff, then gradually recovering — and the right treatment is different in each. The first job of an assessment is to work out which stage you are in, because stretching hard into range during the painful stage usually makes things worse. Treatment commonly includes:

• Pain management and gentle movement during the painful stage, rather than aggressive stretching
• Manual therapy to restore glide at the joint as the painful stage settles
• A graded range-of-motion programme you continue at home between visits
• Strengthening for the rotator cuff and the muscles around the shoulder blade as movement returns
• Laser therapy or electrotherapy for pain where they suit your presentation
• Advice on sleeping positions, and on which daily activities to modify and which to keep doing

What to expect at your first visit

Your physiotherapist takes a history, measures how far the shoulder moves both actively and passively, and checks whether the pattern fits frozen shoulder or one of the other problems that cause a stiff, painful shoulder. They will explain which stage you appear to be in and what that means for how treatment is paced. Most people begin treatment in the same appointment.

When to see a doctor instead

See your physician if the shoulder became stiff after a fall or a direct injury, if you cannot lift the arm at all following trauma, or if the shoulder is hot, red and swollen with fever. A frozen shoulder that is not improving at all after several months of treatment is also worth reviewing medically, as some people benefit from an injection or a specialist opinion alongside physiotherapy.

Booking an appointment

You do not need a doctor’s referral to see a physiotherapist in Ontario. Some extended health plans ask for one before they will reimburse you, so it is worth checking your policy.

We are at 2600 Skymark Avenue, Building 3, Unit 102, Mississauga, open Monday to Friday 9:00 AM – 10:00 PM and Saturday and Sunday 9:00 AM – 7:00 PM, with free parking. See our fees or call 647-998-4727.

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This page is general information, not medical advice. An assessment with a registered physiotherapist is the way to find out what is causing your symptoms and what will help.