Adhesive capsulitis, or as it is more commonly referred to, frozen shoulder, is a severe and long-term problem. It affects 3-5% of the general population, women slightly more than men, typically between 40-60 years old, and is 4x more likely in people with diabetes. The cause of primary adhesive capsulitis is unknown, but secondary adhesive capsulitis occurs when there is already known primary injury to the shoulder. However, the recovery process can be faster with physical therapy, and you can return to your previous full function. There are three phases of frozen shoulder: freezing, frozen, and thawing.
The freezing period can last 3-9 months and is characterized by a loss of movement and increasing pain.2 If diagnosed in this stage, physical therapy can help with pain management and minimizing loss of movement. This is done with stretching, manual therapy, and modalities such as heat, or ice as needed.3
The second phase, the frozen phase, typically is during months 4-12 after symptoms start and is characterized by a significant decrease in pain but significant motion limitations.2 In this stage, you are most likely to be limited with rotating your arm to the side, raising it to the side over your head like a snow angel, and raising it over your head in front of you. In this stage, physical therapy helps the most with limiting the loss of movement, maximizing your function in your available range of motion, and improving your motion. This is also completed with stretching and manual therapy, with exercises tailored specifically to each patient’s individual needs and limitations. Strengthening can also be initiated in this stage based on patient tolerance.3
The final phase is the thawing phase and is typically during months 12-24, post the start of symptoms.2 During this phase, patients begin to experience sharp increases in range of motion, and in the end, return to full function in the shoulder and arm. Physical therapy during this phase helps to expedite the improvement in range of motion with continued manual therapy and stretching, with an increased focus on end range motion vs. maintaining pain-free motion as it was in the earlier stages. Strengthening, if not already initiated, begins in the stage and is also of extreme importance to return strength and stability in the new ranges of motion and improve endurance with the patient’s return to prior activities.
If you have been diagnosed with a frozen shoulder, have been experiencing the symptoms of a frozen shoulder, or have been experiencing another injury of the shoulder, reach out to your local Athletico clinic to get started with an individualized physical therapy program.
*Per federal guidelines, beneficiaries of plans such as Medicare, Medicaid, Tricare, VHA and other federally funded plans are not eligible for free assessments.
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
1. Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World J Orthop. 2015;6(2):263-268. Published 2015 Mar 18. doi:10.5312/wjo.v6.i2.263
2. Rangan A, Goodchild L, Gibson J, et al. Frozen Shoulder [published correction appears in Shoulder Elbow. 2016 Jul;8(3):215].Shoulder Elbow. 2015;7(4):299-307. doi:10.1177/1758573215601779
3. van de Laar, S. M., & van der Zwaal, P. (2014). Management of the frozen shoulder.Orthopedic Research and Reviews,6, 81-90.