Frozen Shoulder: Causes, Stages and How Physiotherapy Helps

What Is Frozen Shoulder?

Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed and thickened, leading to the formation of scar tissue. As the capsule tightens, movement becomes increasingly restricted and painful. The exact cause is not fully understood, but certain factors increase the risk significantly.

Frozen shoulder is more common in women than men and most frequently affects people between the ages of 40 and 60. It is strongly associated with diabetes — a 2023 systematic review and meta-analysis found that people with diabetes have approximately 3.7 times the odds of developing frozen shoulder compared with people without diabetes (Dyer et al., PMC9815013, 2023). Other risk factors include thyroid disorders, prolonged immobility of the shoulder following injury or surgery, and cardiovascular disease.

The Three Stages of Frozen Shoulder

Frozen shoulder progresses through three recognised stages — freezing, frozen and thawing — each with a distinct pattern of pain and stiffness and a typical (though variable) duration (Li, Angelo & Taqi, StatPearls, 2025).

Stage 1 — The Freezing Stage (2 to 9 months)

The freezing stage is characterised by gradually worsening pain, often worse at night and at rest. Movement begins to become restricted but pain is the dominant symptom at this stage. Many patients describe an aching, throbbing pain that is difficult to position away from. This stage typically lasts between two and nine months and is often the most painful phase of the condition.

Stage 2 — The Frozen Stage (4 to 12 months)

In the frozen stage, pain often begins to reduce but stiffness becomes the dominant problem. Movement is significantly restricted in multiple directions — particularly external rotation and elevation of the arm. Daily tasks such as reaching overhead, fastening clothing and sleeping comfortably become difficult or impossible. This stage typically lasts between four and twelve months.

Stage 3 — The Thawing Stage (5 to 24 months)

The thawing stage sees a gradual return of movement as the capsule loosens. Pain continues to reduce and function slowly improves. With appropriate physiotherapy, the thawing stage can be accelerated and movement restored more completely than without treatment. Full recovery is achievable for most patients, though the timeline varies considerably between individuals.

How Physiotherapy Helps Frozen Shoulder

Physiotherapy is recommended as a first-line, evidence-based treatment for frozen shoulder at all three stages. The UK's largest randomised trial of frozen shoulder treatments — comparing early structured physiotherapy with steroid injection, manipulation under anaesthesia and arthroscopic capsular release — found that all three approaches produced meaningful improvement at 12 months, with no single treatment proving clearly superior on pain and function, while physiotherapy offered the fastest access and lowest cost (Rangan et al., UK FROST, The Lancet, 2020). The approach varies depending on which stage you are in and what your dominant symptoms are.

During the freezing stage, physiotherapy focuses on pain management, gentle movement to prevent further restriction and education about the condition and its natural progression. Manual therapy techniques including joint mobilisation and soft tissue treatment can help manage pain and maintain range of movement.

During the frozen stage, the focus shifts to maintaining and gradually improving range of movement through targeted stretching, manual therapy and exercise prescription. Your physiotherapist will work within your pain tolerance, progressively loading the shoulder to encourage capsule remodelling.

During the thawing stage, physiotherapy becomes more active, focusing on restoring full range of movement, rebuilding shoulder strength and retraining movement patterns that may have been compensated during the painful stages. A structured home exercise programme is central to recovery at this stage.

What Does Frozen Shoulder Treatment at Iris Physio Involve?

At Iris Physio we assess and treat frozen shoulder at our clinics in Warrington, Leeds and Nottingham. Your initial assessment will establish which stage you are in, the degree of restriction in each movement direction and any contributing factors such as diabetes or previous shoulder injury.

From there your physiotherapist will design a personalised treatment plan combining hands-on manual therapy, targeted exercise prescription and education. Sessions are one-to-one with your dedicated physiotherapist at every appointment — the same clinician who knows your history, monitors your progress and adapts your programme as you move through each stage.

No GP referral is needed. We aim to see patients within three to five days of enquiry.

Frequently Asked Questions About Frozen Shoulder