Frozen Shoulder: What You Need to Know

Understanding, Treating, and Managing Adhesive Capsulitis.

Being a Licensed Medical Massage Therapist (specializing in Orthopedic Massage), this is a condition I’ve seen and presently working with my clients to overcome. If you’re experiencing shoulder pain that came out of nowhere and your range of motion is getting worse, you are not alone!

You might be dealing with a condition called Adhesive Capsulitis, but generally known as Frozen Shoulder, a common but often misunderstood problem that can seriously affect your daily life.

What Is Frozen Shoulder & What you need to know

What makes this condition most challenging is the term Frozen Shoulder. It is used so loosely. Often just to define when a person has limited ROM in shoulder, with no indication or specifics. But adhesive capsulitis is specific and referring to inflammation in the Glenohumeral joint capsule itself (that's the ball and socket part of your shoulder).

Many muscles can limit your shoulder movement, and these limitations can be from other conditions, but not be true capsulitis. Seeing a doctor to have your condition diagnosed will make a real difference in getting the appropriate treatment plan and protocols in place. Frozen shoulder is not an umbrella term for “any time there is limited movement and pain in the shoulder”. Understanding your symptoms and how this condition started will be relevant for both diagnosis and management of your condition.

Frozen shoulder is a condition where the shoulder becomes painful, stiff, and difficult to move. It tends to happen gradually and can last for months or even years. The misdiagnosis or general use of the term “Frozen Shoulder” happens because of the many connecting/ neighboring muscles and ligaments in the area. And what makes this condition even more difficult the cause can honestly just be unknown, just appears out of nowhere. Even though it can be difficult to identify, there are a few characteristics, orthopedic assessment test and client history, that can help you to receive the proper treatment.

There are two types of Frozen Shoulder

1. Primary - Unknown cause. It developed seemingly with no reason.

2. Secondary- you can usually attribute it to a certain cause or condition like Trauma (e.g. fall or injury), Surgery, Hyper/Hypo Thyroid, High Cholesterol, Diabetes, Stroke

And this condition goes through three phases:

1. Freezing: Pain develops and movement becomes limited (2–9 months).

2. Frozen: Pain may ease, but shoulder joint stiffness increases (4–12 months).

3. Thawing: Movement begins to return slowly and range of motion increases (12–24+ months).

It’s most common in adults over 40 and women. But more studies are showing that metabolic disorders are still key risk factors: Diabetes (especially poorly controlled) and thyroid issues remain top contributors.

Why Does It Happen?

Recent studies show frozen shoulder (adhesive capsulitis) is the interplay (the way multiple things have an effect on each other) of chronic inflammation, fibroblast proliferation, and capsular fibrosis as the driving factors. In other words, it’s the inflammation in the joint capsule (the connective tissue surrounding your shoulder). And over time, this causes the connective tissue to become thickened and tight. It’s almost like shrink-wrap around your joint, making movement painful and very difficult.

Treatment: What Works (and What’s New)

The good news? You don’t have to just “live with it.” While frozen shoulder often improves with time (depending on the type and phase), there are effective treatments that can ease pain and speed up your recovery. 

The American Academy of Orthopedic Surgeons (AAOS) consensus guidelines still recommend corticosteroids + gentle mobility exercises early, then manual therapy + strengthening in the later stages.

Recommended treatments include:

-Cortisone Injections

• A tried-and-true option for early pain relief.

• Research still supports injections directly into the joint work better than anti-inflammatory pills or other types of injections.

• Best results are seen in the early (freezing) phase.

-Physical Therapy & Gentle Movement

• Stretching and movement exercises are essential, but too much too soon can make things worse.

• The most recent recommendations is gentle, pain-free mobilization, especially in the early stages.

• Techniques like joint mobilizations are proven to help restore movement.

-Patience & Personalized Care

• It truly depends on the individual case. It’s important that the treatment is tailored to client’s comfort, pain level, and stage of healing

-Platelet-Rich Plasma (PRP) *New Trial Study

• A newer option involving an injection of your body’s own platelets.

• Promising trial found PRP significantly improved range of motion after 8 weeks when compared to placebo, though not yet widely available or covered by insurance, so it’s more costly.

• I can’t stress this enough. PRP is still in trial research phase but it’s definitely something to keep on your radar for the future.

What You Can Do Now

If you think you might have frozen shoulder, talk to your doctor or licensed physical therapist for proper diagnosis and referrals. The earlier you catch it, the more options you have.

In the meantime here are some self-care tips:

• Avoid painful overhead movements

• Apply heat to help with tightness

• Start gentle range-of-motion exercises (like shoulder circles) if it’s comfortable

• Don’t “push through” the pain - less is more in the early stages. 

Final Thoughts

My key takeaway is when it comes to frozen shoulder, gentle is better. Research supports gentle, pain-free mobilization over aggressive manipulation, especially early in the condition, helps with restoring movement.

Frozen shoulder can feel frustrating—but with early diagnosis, education, and the right support, relief and recovery are possible.

Article written by Diana Gordon, LMT, OMMT

As a professional Licensed Massage Therapist for 23 years, I have had the privilege of learning, growing, and sharing with my clients. I am grateful to now share what I’ve learned with you. I’m not a doctor or pretend to be one, so if you have pre-existing conditions or any medical concerns, it is always best to first consult your medical physician before starting any treatment.