Orthopaedic Physiotherapy for Frozen Shoulder: Simple Stretching and Strengthening Exercises

Frozen shoulder, also known as adhesive capsulitis, causes pain and stiffness in the shoulder joint. It often develops gradually, making everyday tasks such as reaching overhead, putting on clothes, or sleeping on one side really difficult.  At first, many people might dismiss this discomfort until it turns into a daily struggle. But the good news is that with the right frozen shoulder physiotherapy approach, most people can regain strength and mobility without any long-term complications. In this guide, we’ll walk through what frozen shoulder is, why it happens, and how orthopaedic physiotherapy can support effective recovery.

Understanding Frozen Shoulder

Frozen shoulder is a condition where the connective tissue around the shoulder joint thickens and tightens, causing pain, stiffness, and limited movement. It usually develops gradually and often affects just one shoulder, making daily tasks such as reaching, dressing, or turning in bed difficult. Unlike other shoulder problems, frozen shoulder restricts both active and passive motion, meaning even assisted movements become limited. The loss of motion typically follows a predictable pattern, worsening over time before gradually improving, often over several months.  

Frozen shoulder typically develops in three stages, each with distinct symptoms and duration:

• Freezing stage (Painful stage): Gradual onset of shoulder pain that worsens over time, especially at night; movement becomes limited due to pain.
• Frozen stage (Stiffness stage): Pain begins to ease, but the shoulder becomes stiffer with noticeable restriction in movement.
• Thawing stage (Recovery stage): Pain decreases further and shoulder mobility slowly improves over time, though some stiffness may linger.

Types 

Frozen shoulder is broadly classified into two types:

• Primary (Idiopathic) Frozen Shoulder: This type develops without any identifiable cause. It is more common in individuals with conditions such as diabetes or thyroid disorders but can also appear in people with no underlying health issues.
• Secondary Frozen Shoulder: This type occurs as a result of another condition or injury. Common triggers include shoulder surgery, rotator cuff injuries, trauma, or prolonged immobilisation due to fractures or neurological events like a stroke.

Causes

Frozen shoulder can develop for different reasons, and following conditions are more commonly linked to its development:

• Post-injury or post-surgery immobility: Keeping the shoulder still for long periods after a fracture, injury, or surgery can trigger the onset of frozen shoulder.
• Inflammation or irritation in the shoulder joint: Conditions such as bursitis or tendinitis can lead to inflammation, which may progress into frozen shoulder if not managed early.
• Shoulder trauma: Any direct injury to the shoulder, such as a fall or impact, can increase the risk of capsule tightening over time.
• Chronic conditions: Diabetes, thyroid dysfunction (especially hypothyroidism), and cardiovascular disease are known to interfere with joint health and healing, contributing to capsule changes.
• Autoimmune response: In certain situations, an abnormal immune response can cause the body to target the shoulder joint capsule, resulting in inflammation and restricted movement.

Symptoms

These are the typical symptoms people experience with a frozen shoulder:

• Persistent pain in the shoulder, especially during movement or at night
• Increasing stiffness that gradually limits arm mobility
• Difficulty performing routine tasks like reaching overhead or behind the back
• Reduced range of motion in all directions, affecting both active (self-initiated) and passive (assisted) movements
• Shoulder discomfort that may worsen in cold weather or with inactivity
• Pain that may radiate to the upper arm but not past the elbow

Role of Orthopaedic Physiotherapy in Managing Frozen Shoulder

Orthopaedic physiotherapy plays a vital role in managing frozen shoulder by addressing pain, stiffness, and limited movement. The type of physiotherapy varies depending on whether the patient is in the freezing (painful), frozen (stiffness-dominant), or thawing (recovery) stage

In some cases, physiotherapy at home may also be recommended, particularly during early stages when mobility is limited and visiting a hospital/clinic may be difficult. 

Key techniques of orthopaedic physiotherapy include:

• Joint mobilisation: Techniques to gently increase the shoulder’s range of motion and reduce stiffness.
• Soft tissue therapy: Methods such as massage or myofascial release to relieve muscle tightness and improve blood flow.
• Stretching exercises: Targeted stretches to gradually lengthen tightened tissues and improve flexibility.
• Strengthening exercises: Focused on rebuilding muscle strength around the shoulder to support stability and function.
• Posture correction: Education and exercises to improve posture and reduce undue stress on the shoulder joint.
• Prevention role: Encouraging safe movement and activity after injury or surgery to lower the risk of frozen shoulder development.

Stretching Exercises to Improve Shoulder Mobility

Stretching exercises are essential in managing frozen shoulder, especially during the freezing and frozen stages when stiffness and pain limit the movement. It’s important to perform stretches gently and consistently, staying within pain limits to avoid further irritation. Always follow the specific guidance and exercise plan recommended by your physiotherapist to ensure safe and effective progress.

Below are some common and effective stretches often used to support shoulder mobility:

• Pendulum Stretch: Lean forward, letting the affected arm hang freely. Gently swing the arm in small circular motions or back and forth to encourage gentle joint movement without strain.
• Cross-Body Stretch: Gently pull your stiff arm across your chest with the help of your unaffected arm, keeping it at shoulder height. Maintain the stretch for 15 to 30 seconds to loosen the rear shoulder muscles.
• Towel Stretch: Take a towel and hold one end in each hand behind your back. Using the stronger arm, slowly pull upward to stretch the affected shoulder and engage the muscles around the joint.
• Finger Walk: Stand facing a wall and ‘walk’ your fingers up the wall as far as comfortable. Gradually increase the height over time to enhance shoulder flexibility.

Strengthening Exercises to Restore Shoulder Strength and Movement

As the shoulder begins to recover, especially during the thawing stage of the frozen shoulder, strengthening exercises become an important part of rehabilitation. Strengthening is most effective when done consistently and progressively, in line with your individual recovery timeline. Like stretching, strengthening should be introduced gradually and always based on your physiotherapist’s guidance to avoid strain or injury. 

Here are some common strengthening exercises used during the recovery phase:

• Isometric External Rotation: Stand with your elbow bent at 90 degrees and pressed into your side. Push the back of your hand against a wall or door frame without moving your arm. Hold for a few seconds, then release.
• Isometric Internal Rotation: With the same starting position, push the palm of your hand into a wall or door frame. This targets the internal rotator muscles of the shoulder.
• Wall Push-Ups: Stand facing a wall and perform a push-up by bending your elbows and bringing your chest toward the wall. This builds strength safely without overloading the joint.
• Resistance Band Rows: Using a light resistance band secured in front of you, pull the band toward your body by squeezing your shoulder blades together. This helps strengthen the upper back and shoulder muscles.
• Scapular Retraction: Sit or stand upright and gently pull your shoulder blades back and down, holding for a few seconds before releasing.

Conclusion

Recovering from a frozen shoulder takes time, and consistency plays a major role in regaining movement and comfort. For those who find it difficult to attend regular clinic sessions due to pain, mobility issues, or scheduling challenges, physiotherapy at home can be a practical alternative. To begin sessions at your convenience and pace, consider choosing at-home physiotherapy  sessions. It’s a flexible option for anyone ready to take the next step towards better shoulder movement and recovery.