If you’ve been diagnosed with frozen shoulder, you know how frustrating and painful it can be. It may make you wonder if treatment approaches, like exercises are even effective.

Frozen shoulder make simple tasks- like washing your hair or reaching in your back pocket for your wallet- feel impossible.

Once you know what frozen shoulder is and why certain treatments are utilized at certain times, the recovery process becomes clearer, which can help ease some of the frustration frozen shoulder can cause.

This article will explore what frozen shoulder is, the different phases of frozen shoulder, and exercises for frozen shoulder that can help decrease pain and restore function.

How Does a Shoulder “Freeze”?

“Frozen shoulder” is the commonly used name for a condition called Adhesive Capsulitis.

While the shoulder is not technically “frozen”, it can feel as though it is. Range of motion decreases over time, making it feel like the shoulder is stuck or “frozen” in position.

What is believed to actually occur is increased inflammation in the capsule of the shoulder joint, which leads to stiffness and pain.

What is the Shoulder Capsule?

The shoulder joint is made up of the humerus and the glenoid. The humerus is the long arm bone and the glenoid is a shallow, circular bone on the scapula.

The two bones come together to make a shallow joint, and they are enclosed by a layer of collagenous tissue called a capsule.

The capsule is made up of a thick layer of outer tissues and an inner layer of synovial tissue, which is softer and produces synovial fluid, which lubricates the joint.²

When the shoulder capsule becomes inflamed, an excessive amount of fibrotic tissue is laid down in the synovial tissue layer, which can lead to increased stiffness.

This is where the name adhesive capsulitis comes in. Adhesions are created within the capsule.

What Are the Symptoms of Frozen Shoulder?

Those who experience frozen shoulder generally experience shoulder pain with no known cause.

Pain is not necessarily only in the shoulder. One may feel pain from the upper neck all the way down into the hand.¹

Usually a decreased range of motion is present in what is called the capsular pattern. The capsular pattern for the shoulder is decreased external rotation (the motion needed to wash the back of the head/hair), abduction (raising the arm out to the side), and internal rotation (the motion needed to reach into the back pocket).

Range of motion will be limited when the individual attempts to move their arm on their own, and when a physical therapist moves it passively.¹

Difficulty sleeping may be caused due to shoulder pain.¹

Symptoms may appear gradually and get worse over time.

What Causes Frozen Shoulder?

There are two types of frozen shoulder, primary and secondary.

The cause of primary frozen shoulder is known to be idiopathic. This means that the cause is unknown. It seems that some people are just more prone to developing it.

Secondary frozen shoulder is caused by a prior condition, such as following surgery, stroke, shoulder injury, diabetes, thyroid conditions (hyper- or hypothyroidism) and/or metabolic syndrome.¹

Metabolic syndrome is a combination of conditions that can lead to increased risk for diabetes, cardiovascular disease, and stroke. They include high blood sugar, high cholesterol, and excess fat mass around the waist.⁵

Although frozen shoulder is seen more frequently in those with thyroid conditions compared to the general population, the exact reason for this is unclear.⁶

Who is Most at Risk for Frozen Shoulder?

It’s estimated to affect 2-5% of the population. However, it impacts about 20% of individuals with diabetes.

The reason that those with diabetes have a higher prevalence of adhesive capsulitis is due to sugar in the bloodstream. Sugar sticks to collagen tissue, which can cause increased stiffness.³

People 40 and older (usually 40-60)⁶ are at higher risk for developing frozen shoulder, as are females. ⁴

Things like immobility of the shoulder, such as following a surgery, or after a stroke also increase the risk.⁴

Can Frozen Shoulder Be Prevented?

Although frozen shoulder may impact some individuals for no known cause, managing one’s health can help reduce the risk.

As with most conditions, increasing mobility (both in the shoulder and throughout the body), maintaining a healthy weight, and managing underlying conditions can all help lessen the risk of adhesive capsulitis.

What Are the Stages of Frozen Shoulder?

There are three phases or stages of frozen shoulder: Freezing, Frozen, and Thawing

1. Freezing

This stage can last from 2-9 months. In this phase, pain can be high and shoulder stiffness gradually worsens.

2. Frozen

This stage can last from 4-12 months. In this phase, pain is reduced, but range of motion continues to worsen, making shoulder function difficult.

3. Thawing

This is the final stage, which can last 5-24 months. In this stage range of motion improves and function becomes easier.

How Is Frozen Shoulder Treated?

Frozen shoulder is treated differently depending on the stage it’s in.

Studies have found that corticosteroid injections have good short-term effects if an individual has had frozen shoulder for less than 6 months (i.e. in the freezing stage).¹

Seeing a physical therapist is a very common treatment method. This can occur in any stage.

Research has found that manual therapy in combination with exercises have led to decreased pain and increased range of motion.¹

With this condition in particular, seeing a physical therapist and doing a home exercise program are essential!

Stretching the capsule and strengthening the muscles properly takes a lot of time and won’t be achieved just seeing a physical therapist three times a week for an hour.

Is Surgery Required?

If range of motion does not improve enough, it’s possible that surgical intervention may be utilized, although it’s not commonly required.

A capsular release is when the surgeon cuts out and restores the excessively thickened capsular tissue.¹

Another option is called hydrodilation. In this procedure, sterile fluid mixed with a steroid is injected into the capsule to create increased space and ability for the joint to move.¹

Will Heat Help a Frozen Shoulder?

While it does seem to make sense that heating a “frozen” shoulder would be beneficial, it’s actually best to put ice on it.

Remember, the shoulder is not literally frozen, rather it’s likely the result of inflammation.

Ice can help reduce the pain caused by inflammation.

Will Frozen Shoulder Resolve on Its Own?

The term “self-limiting” is commonly associated with frozen shoulder, which means that if no treatment is done, it would resolve on its own.

While that may sound like good news, it can take 3 years to resolve and range of motion may be more limited than if other treatment had occurred.

Additionally, pain management is part of successful treatment, so getting care is highly recommended.

How Long Does Recovery Take?

As previously mentioned, each stage has a general timeline, which varies from individual to individual.

Although frozen shoulder is considered self-limiting, it is possible to have some deficits in motion even after that 3 year time period.

This journey can be long and trying, and unfortunately, there’s no set timeline.

7 Exercises for Frozen Shoulder

Click HERE to see the video of Dr. Katie performing all of these exercises.

1. Pendulums

Pendulums utilize gravity to help increase space within the joint and allow for motion. Additionally, while the focus is on the shoulder, this exercise actually focuses on movement in the legs to produce the movement in the shoulder joint. 

Why move the legs for a shoulder issue? It’s all about the kinetic chain. Basically, mobility, strength, and power don’t just happen at one joint, but the whole body provides the stability or mobility needed for movement to occur.

50% of forces at the shoulder joint come from muscles below the waist (hips, legs), 30% comes from the torso, and 20% occurs at the shoulder.

If this seems confusing, think about a golfer or a baseball player. They don’t only move their arms when they swing their club or throw a pitch. They wind up- they use their legs, hips, abdominals, and then their arms to gain strength and power in their movements.

So pendulums and other exercises on this list will utilize lower body and torso movements to help regain shoulder range of motion.

1. Stand next to a counter or stable surface that is slightly lower than shoulder height.
2. Place the non-injured shoulder on the stable surface.
3. Take a split stance (ensuring you still have good balance).
4. Tip forward at the hip, allowing the injured arm to hang straight down, fingertips pointing towards the floor.
5. Shift your weight forward and backward in your legs. DON’T ACTIVELY MOVE YOUR ARM! Allow the movement in the legs to let the arm sway.
6. Repeat 10x forward and backward.

1. Stand upright.
2. Place feet a little wider than shoulder width apart.
3. Tip forward at the hip, allowing the injured arm to hang straight down, fingertips pointing towards the floor.
4. Shift your weight left and right in your legs. DON’T ACTIVELY MOVE YOUR ARM! Allow the movement in the legs to let the arm sway.
5. Repeat 10x left and right.
6. Stand upright.

2. Assisted Range of Motion

Stretching is an essential part of regaining range of motion. This exercise allows for controlled stretching of the capsule. You control how far to move the arm, and the different directions allow for stretching different parts of the shoulder capsule.

While some discomfort is likely present with this exercise, avoid pushing your arm into excessive pain as that can limit the capacity for stretch to occur. 

This exercise will be done in multiple planes of motion to help restore movement reaching overhead, out to the side, and behind the head and back.

Flexion

1. For these exercises you can use a cane, dowel, PVC pipe, or even a clean broom.
2. Lie on your back in a comfortable position (place pillow under knees or bend knees to help maintain comfort).
3. Hold the top of the cane/dowel with your injured hand, so your thumb is pointing up towards the ceiling.
4. Keep the elbow of the injured arm straight as you use your non-injured hand to gently guide your injured arm up towards your ear (as if you were raising your hand).
5. Note that it’s the non-injured arm that’s moving and the injured arm is just going along for the ride.
6. Hold for 10 seconds at the top of your range, keeping in mind that your range may be low if pain limits you.
7. Return the injured arm to the starting position, using the non-injured arm to guide the cane back down.
8. Repeat 10x in this direction.

External Rotation

1. Hold the top of the cane/dowel with your injured hand, so your thumb is pointing towards the top of the bed/mat table you’re lying on.
2. Bend the elbow of the injured arm.
3. Place the elbow away from your body slightly so that there’s space between your arm and torso.
4. Place a towel roll under your elbow.
5. Hold the top of the cane with your injured hand so your thumb is pointing towards the top of the bed/mat table.
6. Use your non-injured hand to gently guide your injured arm out to the side.
7. Note that it’s the non-injured arm that’s moving and the injured arm is just going along for the ride.
8. Hold for 10 seconds at the top of your range, keeping in mind that your range may be low if pain limits you.
9. Return the injured arm to the starting position, using the non-injured arm to guide the cane back.
10. Repeat 10x in this direction.

Abduction

1. Hold the top of the cane/dowel with your injured hand, so your thumb is pointing towards the top of the bed/mat table you’re lying on.
2. Keep the elbow of the injured arm straight as you use your non-injured hand to gently guide your injured arm up towards your ear (as if you were making a snow angel).
3. Note that it’s the non-injured arm that’s moving and the injured arm is just going along for the ride.
4. Hold for 10 seconds at the top of your range, keeping in mind that your range may be low if pain limits you.
5. Return the injured arm to the starting position, using the non-injured arm to guide the cane back down.
6. Repeat 10x in this direction.

3. Wall Washes

Wall washes are aimed at stretching the capsule and increasing range of motion in the shoulder. It’s a way to provide yourself with a stretch while performing active range of motion. 

This exercise may take time to build up. It may feel frustrating that you’re not able to move your hand very far up the wall, but it’s important to let pain guide you. If the pain is too much, back it down. 

Overstretching or overusing muscles does not help recovery of frozen shoulder, in fact, it may make it worse. 

1. Have a kitchen towel nearby.
2. Face a wall with feet hip distance apart.
3. Place the towel under the hand of the injured arm against the wall.
4. Slide the injured arm up the wall, slowly and with control, avoiding pain if possible (this may mean you need to start low and gradually increase height).
5. Hold for 5 seconds at the top, slide back down slowly and with control.
6. Repeat 8-10 reps, rest for 1-3 minutes, repeat for 3 sets total.

1. Move your arm out so the hand is by your side.
2. Slide arm up the wall, like you’re making a snow angel motion, slowly and with control, only to where you don’t have pain.
3. Hold for 5 seconds at the top, slide back down slowly and with control.
4. Repeat 8-10 reps, rest for 1-3 minutes, repeat for 3 sets total.

4. Internal Rotation Stretch

This stretch helps to increase range of motion in the direction of internal rotation, or the hand in the back pocket motion.

It also helps to stretch the posterior, or back surface of the capsule.

1. Use a towel, stretch strap or belt for this exercise.
2. Place the towel over your non-injured shoulder.
3. Hold the towel in the front of your body with your hand on the non-injured arm.
4. Using the hand of the injured arm, grab the towel behind your back.
5. Using the non-injured arm, gently pull the injured hand upwards.
6. This can be an intense stretch, so know that at first the range of motion may be very limited.
7. Hold for 30 seconds.
8. Slowly lower towel and injured arm back down.
9. Rest for 1-3 minutes.
10. Repeat 3 times.

5. Lunges with Rotation

As previously mentioned, 50% of the power at the shoulder comes from below the waist, and another 30% comes from the torso. That’s why we want to work the lower limbs and abdominals.

If you would like an additional challenge, you can hold a medicine ball or a dumbbell between your hands at chest height. This exercise can also be done without weight.

1. Stand with feet hip-distance apart.
2. If you need balance support, stand next to a stable chair or counter.
3. Take a long step backward with your right leg.
4. Keeping your weight evenly distributed between your right and left leg, bend both knees about 6 inches. 
5. Make sure you’re not lunging forward or backward, but keeping centered as you lower.
6. If you’re able to add the rotation, hold that lunge position as you rotate your torso towards your left leg.
7. Think about the rotation coming from your abdominals, rather than your shoulders. 
8. Turn your torso back to center and press through both feet to return to standing.
9. If the rotation causes pain, don’t do the rotation and just do the lunges.
10. Repeat 10x on the right leg, then switch to the left leg.
11. Complete 3 sets on each leg. 

6. Resisted External Rotation

These next two exercises work the rotator cuff, which attach to the shoulder capsule and support the shoulder joint. 

The resisted external rotation works the infraspinatus, teres minor, and supraspinatus. 

1. Tuck a towel roll between your elbow and your rib cage.
2. Tie a knot in a resistance band and place it in a doorway, close the door so the band won’t pop out (or you can hold the band at your hip as shown above).
3. Stand perpendicular to the door, about 2 feet away, with the injured shoulder further from the door.
4. Hold a theraband around your hand (or you can do this motion without a band, once again, let pain determine if the resistance is too much).
5. Start with your closed fist on your belly button (thumb should touch your belly button).
6. Keep your elbow bent and towel in place as you move your forearm away from your body. The motion should be upward and to the side (aim for moving towards the point where the wall meets the ceiling).
7. Although the motion appears to be from the forearm, you should feel the movement in the shoulder and shoulder blade. If you feel the muscles of the forearm or wrist, you are not completing the motion correctly.
8. Repeat 8-10 reps, rest for 1-3 minutes, repeat for 3 sets total.

7. Resisted Internal Rotation

The resisted internal rotation exercise strengthens the subscapularis. Ensuring that the internal rotators are strong enough to balance/control the external rotation is important for healthy shoulder function.

1. Tuck a towel roll between your elbow and your rib cage.
2. Tie a knot in a resistance band and place it in a doorway, close the door so the band won’t pop out.
3. Stand perpendicular to the door, about 2 feet away, with the injured shoulder closer to the door.
4. Hold a theraband around the hand of the injured shoulder (or you can do this motion without a band, once again, let pain determine if the resistance is too much).
5. Keep your elbow bent and towel in place as you move your forearm towards your body. Aim to bring your fist to your belly button.
6. Although the motion appears to be from the forearm, you should feel the movement in the shoulder and shoulder blade. If you feel the muscles of the forearm or wrist, you are not completing the motion correctly.
7. Repeat 8-10 reps, rest for 1-3 minutes, repeat for 3 sets total.

Have the Strength to Live Life to the Fullest!

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Sources:

1. Physioplus
2. https://www.hss.edu/condition-list_synovitis.asp
3. https://www.mdorthospecialists.com/blog/the-link-between-diabetes-and-frozen-shoulder#:~:text=If%20you%20have%20chronically%20high,your%20shoulder%20starts%20to%20stiffen.
4. https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684
5. https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916#:~:text=Metabolic%20syndrome%20is%20a%20cluster,abnormal%20cholesterol%20or%20triglyceride%20levels.
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458737/
7. All pictures created on canva.com