Adhesive capsulitis or “frozen shoulder” is a common condition characterized by significant pain and restriction of shoulder motion, in the absence of a known intrinsic shoulder disorder. The underlying cause of adhesive capsulitis is poorly understood, however, recent evidence suggests progressive inflammation and fibrosis, producing thickening and contracture of the shoulder capsule. Resulting is substantial restriction in shoulder function. It affects 3-5% of the population, mainly middle-aged and commonly those with comorbid conditions such as diabetes.

The course of disease typically follows 3 phases and can take up to 2 years to fully resolve.

  1. “Freezing” phase (10-36 weeks): characterized by significant pain and increasing involuntary stiffness.
  2. “Frozen” phase (4-12 months): characterized by significant increase in stiffness however with subsiding pain
  3. “Thawing” phase (5-26 months): characterized by gradual spontaneous improvement in shoulder mobility and function.

Fortunately, the prognosis for frozen shoulder is in most cases a complete resolution of symptoms.

Unfortunately the term “frozen shoulder’ has been overused and misapplied to patients with stiff and painful shoulders. Conditions such as calcific tendonitis, arthritis, and rotator cuff tears can also lead to a stiff and painful shoulder. However, these conditions lack true capsular contracture and restriction in passive range of motion and therefore should not be labelled as frozen shoulder. Accurate diagnosis is essential because of dissimilar treatment approaches for these separate entities.


Treatment regimens for adhesive capsulitis routinely involves conservative management using physiotherapy. Our qualified physiotherapists can help with the diagnosis and management of such shoulder impairments with a combination of manual therapy approaches to help provide pain relief and restore normal shoulder range of motion and function.

Physiotherapy treatment techniques to effectively treat frozen shoulder include:

  • Manual therapy techniques including mobilizations and manipulations
  • Modalities such as TENS, IFC, ultrasound, hot and cold therapy to reduce pain and decrease inflammation
  • Soft tissue massage for tight muscles
  • Exercise prescription specific to the problem to increase flexibility, strength, co-ordination and scapula-humeral stability
  • Stretching and strengthening exercises
  • Proprioception and motor control exercises
  • Functional rehabilitation exercises
  • Postural retraining, ergonomic education

Physiotherapy is an essential ingredient in treating shoulder injuries for our patients. Please think of referring to us so that we can assist you in getting the best results possible for your patients.

How can a PPS Physio help?

Your PPS Physiotherapist can help diagnose the problem and establish its severity. From this information an appropriate treatment plan can be made to get you back to full recovery as soon as possible.
This may involve activity modification, massage and mobilizations and other therapeutic agents to make you feel better. They will also tell determine and correct any biomechanical or postural issues that predispose you to injury.
Most importantly, your PPS Physiotherapist will provide you with specific stretches and an exercise program to prevent this issue from reoccurring when you return back sport.