Physiotherapy for Frozen Shoulder in Surbiton

What Is Frozen Shoulder?

Frozen shoulder is a condition in which the capsule — the tough outer lining of the shoulder joint — becomes inflamed, thickened and progressively tighter. Over time, adhesions (bands of scar-like tissue) form inside the capsule, physically reducing the space available for movement. The result is a shoulder that is both painful and stiff in every direction, particularly when lifting the arm or reaching behind the back.

It affects around 2–5% of the general population, most commonly between the ages of 40 and 60, and is slightly more common in women. People with diabetes are three to five times more likely to develop frozen shoulder than the general population, and the condition is often more severe and slower to resolve in this group. A previous shoulder injury, thyroid conditions and prolonged immobility (such as after a fracture or surgery) also increase risk.

The cause is not fully understood, but the process is well characterised. It is not simply a matter of "inflammation" — the capsule undergoes fibrotic changes driven by specific inflammatory cytokines, which is why it progresses through distinct stages regardless of treatment.

The Three Stages

Stage 1 — Freezing (2–9 months)

The shoulder becomes progressively more painful, particularly at night and at the extremes of movement. Pain is often described as a dull ache at rest with sharp catches during movement. Range of motion begins to reduce, though this may not be obvious early on. This is the most painful stage.

Stage 2 — Frozen (4–12 months)

Pain may ease slightly, but stiffness becomes the dominant problem. The shoulder is severely restricted in all planes. Activities like fastening a bra, tucking in a shirt or reaching overhead become difficult or impossible. Sleep disturbance remains common due to inability to lie on the affected side.

Stage 3 — Thawing (5–24 months)

Movement gradually returns. Pain reduces progressively. With physiotherapy, this phase is considerably shorter than natural resolution alone. Without treatment, the thawing phase can last two years or more, and not all patients fully recover their movement.

How Physiotherapy Helps Frozen Shoulder

Physiotherapy cannot instantly dissolve the adhesions inside the shoulder capsule, but it achieves several things that significantly accelerate recovery and reduce suffering:

• Pain management: Manual therapy techniques — including joint mobilisation, soft tissue release and nerve mobilisation — reduce pain and muscle guarding around the shoulder.
• Preventing secondary stiffness: Without movement, the muscles around the shoulder weaken and shorten, adding a second layer of restriction on top of the capsular tightness. Targeted stretching and strengthening prevents this.
• Improving range of motion: Gentle, specific mobilisation exercises progressively challenge the capsule within tolerable limits. Research shows this accelerates the thawing phase.
• Addressing compensatory patterns: People with frozen shoulder instinctively adapt — using their neck, opposite shoulder or upper back to compensate for lost movement. These compensations cause secondary problems and should be corrected early.
• Education and reassurance: Understanding the condition — that it will get better, that the stages are predictable — reduces catastrophising, which itself is a significant driver of pain experience and disability.

What to Expect at Your Appointment

Your first appointment is a full assessment, typically lasting 45–60 minutes. Your physiotherapist will take a detailed history to confirm the diagnosis, rule out other causes of shoulder pain (rotator cuff tears, osteoarthritis and AC joint problems can all mimic frozen shoulder) and identify which stage you're in.

The physical examination assesses your active and passive range of motion in multiple directions, strength, muscle tone around the shoulder girdle and any impingement signs. We also assess your neck, as cervical spine problems commonly refer pain to the shoulder and can coexist with frozen shoulder.

Treatment typically begins in the first session. In the freezing stage, the focus is on pain management, gentle mobilisation and education. In the frozen stage, we progress to more assertive stretching and manual therapy. In the thawing stage, the priority shifts to strengthening and restoring normal movement quality.

Between sessions, you will receive a home exercise programme — typically 10–15 minutes of specific stretches and exercises twice daily. Adherence to the home programme is one of the strongest predictors of recovery speed. We review and progress the programme at each appointment.

Corticosteroid Injections and Other Treatments

Physiotherapy is rarely used in isolation for frozen shoulder. Corticosteroid (steroid) injections are often recommended alongside physiotherapy, particularly in the freezing stage when pain is most severe. Evidence shows that injections reduce pain in the short term, and — crucially — when combined with physiotherapy, they produce better outcomes than either treatment alone. The injection reduces inflammation enough to allow more effective physiotherapy to take place.

If you have had an injection elsewhere, bring the details to your appointment. We often time physiotherapy sessions to maximise the injection's anti-inflammatory window (typically days 3–14 post-injection) by scheduling more intensive mobilisation during this period.

In cases of severe, prolonged frozen shoulder that has not responded to conservative treatment, hydrodilatation (injecting fluid under pressure to stretch the capsule) or manipulation under anaesthetic may be considered by your orthopaedic surgeon. Physiotherapy is always required after these procedures to maintain the gains achieved.

Frequently Asked Questions