FROZEN SHOULDER

You cannot reach behind your back to fasten a bra or tuck in a shirt. Reaching for your seatbelt sends a sharp pain through the shoulder. At night, rolling onto that side wakes you. The shoulder has not just become painful, it has stopped moving.

The capsule is a sleeve of connective tissue wrapping the whole ball-and-socket joint. In frozen shoulder it becomes inflamed and then thickens and contracts, so the joint physically cannot travel through its normal range. That is what separates it from a rotator cuff problem: here the restriction is mechanical, and it applies in every direction, including when someone else moves your arm for you.

It progresses through three overlapping phases. A painful freezing phase where pain dominates and movement starts to reduce, a stiff frozen phase where the pain may ease but the shoulder locks up and a thawing phase where movement gradually returns. Understanding which phase you are in matters, because it changes what treatment should be doing.

The idea that you should simply wait it out deserves challenging. Long-term follow-up suggests only around 60% of untreated patients regain normal or near-normal function, and up to half retain some lasting restriction. A 2025 study found that with conservative treatment, night pain settled in roughly a month and meaningful range of motion returned within the year, regardless of how severe things were at the start (Kanokvaleewong et al., 2025). Waiting costs you months of avoidable pain and stiffness.

This is one of the conditions where shockwave therapy earns its place. A meta-analysis of 20 randomised trials found that adding shockwave to standard treatment produced significantly better pain relief and a strong improvement in shoulder function compared with the same treatment given without it (Zhang et al., 2022). It works as an addition to hands-on care rather than a replacement for it, and in practice it lets us bring the pain down faster and start moving the joint sooner, which is what compresses the overall timeline.

Alongside that, a Cochrane review supports manual therapy combined with exercise for adhesive capsulitis (Page et al., 2014). Our approach pairs joint mobilisation and soft tissue work with a graded rehabilitation programme matched to your phase, and we will also look at the neck and upper back, which almost always stiffen up in compensation.

It is worth knowing why this happened. Frozen shoulder is far less random than it was once thought. Hormonal changes around perimenopause are now understood to play a real role, which is why it is so common in women in their late 40s and 50s. Diabetes is a well-established risk factor (Dyer et al., 2023), and an underactive thyroid turns up in a significant proportion of cases. Where something systemic is driving it, that is worth identifying rather than treating the shoulder in isolation.