Quick Answer
What is the best treatment for frozen shoulder?
There is no single best treatment for frozen shoulder (adhesive capsulitis) — effective management depends on which stage the condition is in and the individual's pain levels and functional needs. Research supports a combination of manual therapy, progressive exercise, and in some cases corticosteroid injection in the early painful phase. Physiotherapy, chiropractic care, and shockwave therapy each address different aspects of the condition and can be used in combination. Most cases resolve, but without appropriate management this can take two to four years — treatment can significantly shorten that timeline.
Frozen shoulder is one of the more miserable musculoskeletal conditions. It is painful, it is slow, and it has a habit of being significantly more disabling than people expect when it first begins. It also tends to be poorly explained — patients are often told to simply wait it out, without being given an accurate picture of what drives recovery or what can be done to accelerate it.
The clinical name is adhesive capsulitis. It describes a condition in which the joint capsule of the glenohumeral (shoulder) joint becomes inflamed and progressively thickened and contracted, dramatically reducing the joint's range of motion and producing significant pain, particularly at night and at end range.
Who Gets Frozen Shoulder?
Frozen shoulder affects approximately 2–5% of the general population. Certain groups are at higher risk:
- Age 40–60: the overwhelming majority of cases occur in this window
- Women: more commonly affected than men, for reasons not fully understood
- Diabetes: people with diabetes are four to five times more likely to develop frozen shoulder, and their presentations tend to be more severe and longer-lasting
- Thyroid conditions: both hypo- and hyperthyroidism are associated with increased risk
- Prolonged immobilisation: frozen shoulder can develop secondary to shoulder surgery, fracture, or any period of reduced shoulder use
- Cardiovascular disease and Dupuytren's contracture: both associated with elevated risk
In many cases, no clear cause is identified — this is called idiopathic adhesive capsulitis. It may begin after a minor injury, or seemingly from nothing at all.
Frozen shoulder is distinct from rotator cuff pathology, subacromial pain, and cervical referred pain — and treating the wrong diagnosis is why many shoulder presentations fail to improve. Accurate assessment at the outset saves months.
The Three Phases
Frozen shoulder classically progresses through three overlapping phases, each with distinct characteristics and management priorities.
Phase 1 — Freezing (Painful Phase): 2–9 Months
The condition typically begins with increasing shoulder pain, often worst at night and with specific movements (particularly reaching behind the back or overhead). Range of motion begins to reduce but may not yet be dramatically restricted. This phase is primarily inflammatory. Pain management and early, gentle movement are the priorities. Corticosteroid injection in this phase has the strongest evidence for short-term pain and function improvement.
Phase 2 — Frozen (Stiff Phase): 4–12 Months
Pain may begin to ease, but the shoulder becomes progressively stiffer. All planes of movement are restricted — external rotation is typically the most limited, followed by abduction and internal rotation. Capsular contracture is the dominant process. Manual therapy directed at restoring joint mobility becomes the most relevant intervention during this phase. Daily life is significantly affected: reaching overhead, putting on a jacket, fastening clothing at the back, and sleeping on the affected side all become difficult or impossible.
Phase 3 — Thawing (Recovery Phase): 5–26 Months
Range of motion gradually returns. Pain is generally lower than in the freezing phase. Progressive exercise to restore full strength and movement pattern is the priority. Most people recover full or near-full function, though complete recovery can take years without treatment — and a meaningful proportion are left with permanent reduction in range of motion and residual discomfort.
2–4 years
Typical untreated timeline for frozen shoulder to resolve — appropriate management may reduce this to 6–12 months
How Physiotherapy Can Help
Physiotherapy
Staged manual therapy, mobilisation, and progressive exercise
Physiotherapy is the primary conservative treatment for frozen shoulder across all three phases, though the approach differs significantly by stage. In the freezing phase, gentle range of motion work, pain science education, and load management are prioritised — aggressive joint stretching in the early painful phase can worsen inflammation and delay recovery. In the frozen phase, manual therapy including glenohumeral joint mobilisation and capsular stretching techniques directly targets the contracted capsule, and progressive exercise addresses the motor control deficits that develop during the period of restriction. In the thawing phase, functional rehabilitation restores full movement and strength. Research supports physiotherapy as effective for improving range of motion and function, with greater effect when combined with corticosteroid injection in the painful phase.
How Chiropractic Care Can Help
Chiropractic Care
Cervicothoracic contribution and shoulder joint assessment
Frozen shoulder does not occur in isolation. The cervical spine (particularly C5 and C6 nerve root levels) frequently refers pain to the shoulder and upper arm, and reduced cervicothoracic mobility is associated with compensatory loading at the glenohumeral joint. A chiropractic assessment evaluates these contributing factors — restricted thoracic extension and rotation, cervical segment restriction, and altered scapular mechanics — and addresses them through manipulation, mobilisation, and soft tissue therapy. This is particularly relevant in the frozen phase, where the shoulder's restricted movement creates load redistribution through the neck and upper back that may itself become a source of pain. Peripheral shoulder joint mobilisation techniques are also within chiropractic scope and may complement physiotherapy-directed capsular work.
How Shockwave Therapy Can Help
Shockwave Therapy
Targeting calcific deposits and stimulating capsular tissue remodelling
Shockwave therapy has its clearest evidence in frozen shoulder when calcific deposits are present alongside the capsular contracture — a combination called calcific tendinitis with secondary frozen shoulder. Focused shockwave directed at calcific deposits can accelerate their resorption, removing a significant source of pain and facilitating better response to manual therapy and exercise. Research also suggests that radial shockwave applied to the shoulder capsule and surrounding soft tissues may support tissue remodelling and improve blood flow to poorly vascularised areas of the capsule. At Velca, shockwave for frozen shoulder is typically integrated alongside physiotherapy rather than used in isolation.
When Other Interventions Are Needed
Conservative care does not work for everyone, and knowing when to escalate is as important as the treatment itself. Options beyond physiotherapy, chiropractic, and shockwave include:
- Corticosteroid injection: most effective in the freezing (painful) phase; produces meaningful short-term improvement and may make the shoulder more responsive to manual therapy. Less effective in the frozen phase once the inflammatory process has given way to contracture.
- Hydrodilatation (distension arthrography): injection of fluid and steroid under pressure into the shoulder joint to stretch the contracted capsule; evidence is moderate, though some patients respond well.
- Manipulation under anaesthesia (MUA): physical mobilisation of the joint while the patient is anaesthetised; appropriate for refractory cases where conservative care has not produced adequate progress after six or more months.
- Arthroscopic capsular release: surgical release of the capsule; reserved for cases that have failed all other interventions.
Your physiotherapist or chiropractor at Velca will advise on referral pathways if conservative care reaches a reasonable trial without adequate progress.
Kelley et al. (2013) — Journal of Orthopaedic & Sports Physical Therapy, 43(5)
Clinical practice guidelines for adhesive capsulitis recommending manual therapy and exercise as first-line conservative treatment, noting that the combination produces better outcomes than either alone. The guidelines also identify stage-specific differences in treatment approach, with early-stage presentations benefiting from corticosteroid injection combined with physiotherapy.
Frequently Asked Questions
Will frozen shoulder get better on its own?
Most cases do eventually resolve without treatment, but the timeline is long — commonly two to four years — and a meaningful proportion of people are left with permanent stiffness or residual pain. Treatment does not guarantee faster recovery in every case, but the balance of evidence suggests that appropriate physiotherapy and manual therapy reduce disability and may shorten overall recovery time compared to watchful waiting alone.
Can I do exercises at home for frozen shoulder?
Yes, and home exercise is an important part of management. The type of exercise matters significantly — aggressive self-stretching in the painful freezing phase can provoke flares and delay recovery, whereas gentle pendulum exercises and pain-free range of motion work are generally appropriate. Your physiotherapist will prescribe exercises matched to your specific stage and pain levels rather than a generic programme.
Is it safe to use my shoulder through the pain?
Gentle, pain-free or low-pain movement is encouraged throughout all phases of frozen shoulder. Loading the shoulder into significant pain, however, is counterproductive — it does not speed recovery and may worsen inflammation in the early phase. The guiding principle is to keep the shoulder as mobile as possible within a tolerable pain range, rather than either avoiding all movement or forcing through pain.
How do I know if it's frozen shoulder or a rotator cuff problem?
The key clinical distinction is pattern of restriction. Frozen shoulder restricts movement in all directions — external rotation, abduction, and internal rotation are all limited, and the restriction is consistent whether the examiner or the patient moves the arm (both passive and active restriction). Rotator cuff pathology typically shows greater restriction in active movement than passive, with a different pattern of which movements are most affected. These distinctions require clinical assessment to confirm — imaging can be helpful but is often normal in early frozen shoulder.
Does Velca treat frozen shoulder?
Yes. Our physiotherapy, chiropractic, and shockwave teams each have a role in frozen shoulder management and can work in a coordinated way where that is appropriate for your presentation. Stage assessment at your first appointment guides which approach is prioritised.
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This article is intended for general information purposes only and does not constitute medical advice. Please consult a qualified health professional for assessment, diagnosis, and treatment tailored to your individual circumstances. Velca Allied Health, 10 Wellington Street, Howick, Auckland 2014.
