Frozen shoulder: what it is and what soft tissue therapy can offer

Adhesive capsulitis, frozen shoulder, is a condition involving progressive fibrosis of the glenohumeral joint capsule. The capsule thickens, contracts, and adheres to the humeral head, limiting range in a predictable pattern: external rotation is lost first, then abduction, then internal rotation.

The cause is not fully understood. Associations include diabetes, thyroid conditions, prior shoulder surgery, and prolonged immobilisation. Idiopathic frozen shoulder, no identifiable cause, is common in women between 40 and 65.

Phase 1 (Freezing, 2–9 months): Pain is the dominant symptom, range is reducing. This phase is the most painful and the most difficult to treat. Manual therapy that pushes into range is contraindicated, it aggravates the inflammatory process.

Phase 2 (Frozen, 4–12 months): Pain reduces but range is significantly limited. This is when manual therapy is most useful, gentle range restoration, MFR to the capsular tissue, and progressive loading within comfortable range.

Phase 3 (Thawing, 12–24 months): Spontaneous recovery of range. Most people recover fully, though the timeline is longer than most expect. Manual therapy accelerates the thawing phase.

In the frozen and thawing phases, MFR to the anterior and posterior shoulder capsule, soft tissue work to the rotator cuff and scapular stabilisers, and progressive range-loading exercises can meaningfully reduce the duration and severity of each phase.

In the freezing phase, the role is pain management and maintaining range in the directions that are still available, not forcing movement into restriction.

Soft tissue therapy cannot replace corticosteroid injection in the freezing phase (injection is the most effective pain management intervention in Phase 1), and it cannot replace hydrodilatation or surgical release in severe cases that do not resolve with conservative management.

A clear diagnosis and clinical staging are essential before any treatment begins. If shoulder pain has been present for more than 3 months with progressive range loss, a clinical assessment is the appropriate first step.