Frozen Shoulder Explained: Stages, Symptoms, and How to Find Relief

Shoulder pain can be frustrating—especially when it lingers without a clear cause. One day, your shoulder feels stiff and achy; the next, even reaching for something on a high shelf becomes a struggle. After weeks or months of discomfort, you finally see a doctor and hear the diagnosis: Frozen Shoulder, also known as adhesive capsulitis.

If you’ve found yourself in this situation, you’re not alone. Frozen Shoulder is a common yet often misunderstood condition that affects mobility and causes significant discomfort. But the good news? With the right approach—combining medical care, physical therapy, and patience—you can overcome it.

In this blog post, we’ll break down what Frozen Shoulder is, its four stages, and the steps you can take to regain mobility and reduce pain. Read on!

The 4 Stages of Frozen Shoulder

Adhesive capsulitis, or frozen shoulder (FS), is an inflammatory condition that is characterized by increased stiffness involving the capsular ligaments on the anterior (front) aspect of the shoulder joint. Restriction of motion will follow a capsular pattern with initial loss of external rotation, followed by flexion/abduction, and then internal rotation. It is described as a continuous pathology that occurs across 4 stages each lasting for varying durations.

Stage 1 – Onset

This stage can last up to 3 months.

Symptoms may include:

• Sharp pain at end range movement
• Achy pain at rest
• Sleep Disturbances

Frozen Shoulder can be difficult to differentiate from shoulder impingement in this stage because there is minimal loss of range of motion. Additionally, Arthroscopic examination will not reveal any adhesions or contracture at this point.

At this early stage, it’s normal to feel uncertain about what’s happening with your shoulder. Focus on managing discomfort, staying as active as your pain allows, and seeking professional guidance early. Remember, catching Frozen Shoulder in its initial phase can make a big difference in your recovery journey.

Stage 2 – Freezing

This is the most painful stage of Frozen Shoulder and can last anywhere from 3-9 months.

This stage is characterized by:

• Gradual loss of range of motion in all directions due to pain
• Pain at rest
• High tissue irritability

In this stage, your goals in physical therapy will orient around:

• Pain reduction
• Improve function
• Activity modification
• Preserve passive range of motion without increasing tissue irritability

The freezing stage is tough, but you’re not alone in navigating the pain and stiffness. This is the time to focus on small, intentional steps like modifying activities and working with your physical therapist to reduce discomfort. Every bit of effort now helps lay the groundwork for smoother progress later.

Stage 3 – Frozen

This is also known as the “transitional” stage and can last 4-12 months.

This stage is characterized by:

• Little change to pain levels compared to the previous stage
• Loss of motion in the capsular pattern is most evident in this stage
• Moderate tissue irritability

When working with a physical therapist in this stage, your goals will orient around:

• Pain reduction
• Improve function
• Activity modification
• Prevent further loss of passive range of motion with gentle-moderate stretching exercises
• Initiate moderate-intensity manual therapy interventions based on tolerance and tissue irritability

The frozen stage can feel frustrating, but it’s a transition point in your healing. By working consistently with your physical therapist and staying patient, you’ll maintain what mobility you have and start regaining strength. This phase is about persistence—small, steady actions lead to big improvements over time.

Stage 4 — Thawing

There’s light at the end of the tunnel! This is the stage where range of motion begins to improve, tissue irritability is typically low, and lasts anywhere from 12-42 months.

As you transition back into mobility and your shoulder starts to “unfreeze” you’ll work with your physical therapist to:

• Perform manual therapy interventions working into tissue resistance
• Increase the intensity of stretching activities without increasing tissue irritability
• Integrate high-demand strengthening and functional activities

Am I at Risk for Frozen Shoulder?

Exact causes of developing frozen shoulder are still not clearly understood, but there are some some factors that correlate with Frozen Shoulder onset and symptoms, such as:

• Diabetes Mellitus
• Thyroid Disease
• Female
• 40-65 years of age

Additionally, the following factors are weakly correlated but have been reported in the clinical practice guideline:

• Previous adhesive capsulitis in other shoulder
• Immobilization
• Myocardial Infarction (Heart Attack)
• Trauma
• Autoimmune Disease

This is a space to celebrate the progress as your shoulder begins to regain its range of motion. Stay committed to your therapy plan and embrace the activities that bring you joy. You’re on your way to reclaiming full mobility and strength.

Are There Medical Options for My Frozen Shoulder?

There sure are! There is strong evidence supporting the use of corticosteroid injections during stages 1-3 for short-term pain management, to improve overall function, and tolerance to stretching exercises. However, it will not decrease the duration of the pathological process.

You can discuss other medical options with your orthopedic surgeon which may include procedures like:

• Manipulation under Anesthesia
• Anterior capsule release
• Hydrodilation of the capsule

How Can Physical Therapy Help?

When seeking a physical therapist to help you with your Frozen Shoulder, you want a PT with a deep understanding of the stages and how to reduce pain and improve function as the pathology progresses.

Your PT should utilize interventions including patient education, activity modification guidance, manual therapy, stretching exercises, strengthening exercises, and modalities and should personally tailor your program based on your tissue irritability and healing timeline.

Conclusion

Your life doesn’t have to freeze just because your shoulder did! Finding a physical therapist is essential in diagnosing your condition, educating you, providing guidance, evolving your treatments along the FS healing timeline, and coordinating care with your medical team!

References

1. Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(5):A1-A31. doi:https://doi.org/10.2519/jospt.2013.0302
2. Frozen Shoulder – Adhesive Capsulitis – OrthoInfo – AAOS. Aaos.org. Published 2010. https://orthoinfo.aaos.org/en/diseases–conditions/frozen-shoulder/