Frozen shoulder can be a painful and frustrating condition. Simple everyday movements such as putting on a coat, reaching into a cupboard, fastening a bra or getting comfortable in bed can become surprisingly difficult.
The medical term for frozen shoulder is adhesive capsulitis. It causes pain and progressive stiffness in the shoulder and can sometimes take many months to fully resolve.
At The Bath Practice, we regularly see people with shoulder pain and restricted movement. An important part of your first appointment is establishing whether your symptoms are consistent with frozen shoulder or whether another shoulder problem may be responsible.
If frozen shoulder is suspected, our osteopaths in Bath can assess how your shoulder is moving, explain what may be happening and discuss appropriate treatment, exercise and strategies for managing the condition while it recovers.
What is frozen shoulder?
The shoulder is surrounded by a flexible layer of connective tissue called the joint capsule. With frozen shoulder, this capsule becomes painful and progressively stiff, significantly restricting movement at the shoulder joint.
One of the characteristic features of frozen shoulder is that movement becomes restricted both when you move your arm yourself and when somebody else attempts to move the shoulder for you. This can help distinguish frozen shoulder from some other causes of shoulder pain.
Symptoms can include:
- Pain around the shoulder and upper arm
- Increasing stiffness
- Difficulty lifting your arm overhead
- Difficulty reaching behind your back
- Problems putting on a coat or jacket
- Difficulty washing or brushing your hair
- Pain when reaching for a seatbelt
- Difficulty sleeping on the affected side
- Night pain that can disturb sleep
- A progressive loss of shoulder movement
Frozen shoulder usually affects one shoulder, although some people may subsequently experience it in the other shoulder.
What causes frozen shoulder?
In many cases, there is no obvious reason why frozen shoulder develops. This is sometimes known as primary or idiopathic frozen shoulder. The condition most commonly affects people between approximately 40 and 60 years old and is more common in people with certain medical conditions, particularly diabetes and thyroid disorders.
In other cases, frozen shoulder can develop following an injury or a period during which the shoulder has not been moving normally. This might occur following:
- A shoulder injury
- Surgery involving the shoulder or arm
- A fracture
- Another painful shoulder condition
- A prolonged period of reduced shoulder movement
This is sometimes referred to as secondary frozen shoulder. Not everyone who experiences shoulder pain or temporarily reduces movement will develop frozen shoulder, and it is not always possible to identify one specific cause.
What are the stages of frozen shoulder?
Frozen shoulder is traditionally described as progressing through three stages: freezing, frozen and thawing. These stages can be helpful for understanding the condition, although in reality there may not be a clear point where one stage ends and another begins.
The freezing stage
This is often the most painful stage. Pain gradually increases and movement at the shoulder becomes progressively more restricted. Night pain can be particularly troublesome. Sudden or unexpected movements may also produce surprisingly intense pain. People sometimes describe accidentally reaching for something and experiencing a severe, sharp pain through the shoulder and upper arm.
The frozen stage
During this stage, pain may begin to reduce, but stiffness often becomes the main problem. The shoulder can feel physically restricted even when it is no longer particularly painful. Reaching behind your back and rotating the arm outwards are often especially difficult. Everyday activities such as getting dressed, washing your hair or reaching into a cupboard can therefore remain challenging.
The thawing stage
Movement gradually begins to return. This can be a slow process, but shoulder function usually improves as the condition progresses through this stage.
The overall course of frozen shoulder can be lengthy. Recovery commonly takes many months and for some people can take considerably longer. Understanding this can be important – slow progress does not necessarily mean that something is being damaged or that the shoulder will remain permanently frozen.
Is all shoulder pain a frozen shoulder?
No. “Frozen shoulder” is sometimes used as a general description for any painful or stiff shoulder, but adhesive capsulitis is a specific condition. Other causes of shoulder pain can include problems involving the rotator cuff, muscles, tendons or joints around the shoulder. Pain can also sometimes be referred to the shoulder or upper arm from the neck.
This is why assessment is important. If you visit The Bath Practice with shoulder pain, Rosie will consider how your symptoms began, how the shoulder moves and whether the pattern of restriction is consistent with frozen shoulder. Where appropriate, we may also examine your neck, upper back and surrounding areas.
If your symptoms do not appear consistent with a straightforward musculoskeletal shoulder problem, we may recommend assessment by your GP or another appropriate healthcare professional.
How can osteopathy help with frozen shoulder?
Osteopathy cannot simply “unfreeze” a frozen shoulder, and treatment cannot guarantee to shorten the natural course of the condition. However, osteopathic care may form part of the management of musculoskeletal pain and restricted movement associated with frozen shoulder.
Your treatment is based on your individual symptoms and, importantly, the stage of the condition. Depending on your presentation, this may include:
- Gentle mobilisation of the shoulder
- Soft tissue techniques
- Treatment of surrounding areas where appropriate
- Advice about maintaining comfortable movement
- Exercises to help maintain or gradually restore mobility
- Advice about modifying activities while the shoulder is particularly painful
Treatment should not simply involve aggressively forcing a painful shoulder to move. Particularly during the painful freezing stage, repeatedly pushing the shoulder significantly beyond what it currently tolerates may aggravate symptoms. As pain begins to settle, the emphasis can gradually shift towards restoring movement and function.
Our aim is to help you understand the condition, maintain appropriate movement and find practical ways of managing your shoulder while it recovers.
What should I expect at an osteopathy appointment?
If you visit The Bath Practice for frozen shoulder or shoulder pain, your first appointment will begin with a detailed consultation. Your osteopath will ask about:
- When your symptoms began
- Where you experience the pain
- How the symptoms have changed over time
- Which movements have become difficult
- Whether your sleep is affected
- Previous shoulder or neck problems
- Previous injuries or surgery
- Your work, exercise and everyday activities
- Relevant medical conditions
- Any medication you are taking
Your medical history is particularly relevant because some health conditions are associated with an increased likelihood of developing frozen shoulder.
Examination
With your consent, your osteopath will then examine your shoulder. We will usually assess how far you can move the shoulder yourself and how the joint moves when it is moved for you. This distinction is useful when assessing a possible frozen shoulder. We may also assess the strength and function of the shoulder and examine your neck, upper back or other surrounding areas where appropriate.
Following the examination, we will explain what we think may be causing your symptoms and discuss the options with you. If osteopathic treatment is appropriate, treatment can usually begin at your first appointment.
Do I need an X-ray or MRI for frozen shoulder?
Not necessarily. Frozen shoulder can often be suspected from the history of the problem and a physical examination. There isn’t a single MRI finding required to diagnose frozen shoulder. However, an X-ray, scan or other investigation may occasionally be appropriate if the diagnosis is unclear or another cause of your symptoms needs to be considered.
If we believe further investigation is warranted, we will explain why and recommend that you speak to your GP or another appropriate healthcare professional.
Should I exercise a frozen shoulder?
Usually, some movement is encouraged, but more is not necessarily better. The appropriate amount of exercise can depend on which stage of frozen shoulder you are experiencing and how irritable the shoulder currently is.
During a particularly painful stage, repeatedly forcing the shoulder into painful positions may make symptoms more difficult to manage. Gentle, tolerable movement may be more appropriate. As pain reduces and the shoulder begins to “thaw”, exercises can often be gradually progressed with greater emphasis on restoring movement and function. Your osteopath can help you decide which movements are appropriate and how much to do.
What other treatment is available for frozen shoulder?
Osteopathy is not the only management option for frozen shoulder. Depending on the severity and stage of your symptoms, management may also involve advice and exercise, physiotherapy or medical treatment.
Pain relief or anti-inflammatory medication may sometimes be considered by your GP or pharmacist where appropriate. For some people with significant symptoms, particularly where pain is preventing sleep or making movement extremely difficult, a GP or specialist may discuss options such as a corticosteroid injection. Less commonly, persistent cases may require further specialist assessment and other procedures.
If your symptoms are not responding as expected, we will discuss whether another approach or medical opinion may be appropriate.
When should I seek urgent medical advice for shoulder pain?
Seek prompt medical assessment if:
- Your shoulder pain followed significant trauma and you cannot move the arm
- The shoulder appears visibly deformed
- You develop sudden significant weakness or loss of sensation in the arm
- The shoulder is red, hot or significantly swollen, particularly if you also feel unwell or have a fever
- You develop severe unexplained shoulder pain alongside chest pain, breathlessness, sweating or other concerning symptoms
You should also seek medical advice if you have unexplained persistent pain, significant unexplained weight loss or other symptoms that concern you.
Frequently Asked Questions
Osteopaths can assess people with shoulder pain and restricted movement and may be involved in the management of symptoms associated with frozen shoulder.
Depending on the stage and severity of the condition, treatment may include gentle manual therapy, movement advice and appropriate exercises.
We will also consider whether another cause of shoulder pain may be responsible and whether further medical assessment is required.
Frozen shoulder is often a slow condition.
Symptoms commonly persist for many months and, for some people, the complete process can take considerably longer.
Recovery times vary, and the condition does not always progress neatly through the traditional freezing, frozen and thawing stages.
Generally, aggressively forcing a painful frozen shoulder is not advisable.
Particularly during the painful freezing stage, repeatedly pushing significantly into pain may aggravate symptoms.
Gentle movement within a tolerable range may be more appropriate initially, with exercises progressed as the condition changes.
It is relatively unusual for frozen shoulder to recur in exactly the same shoulder once it has fully resolved.
However, some people who have experienced frozen shoulder on one side later develop it in the opposite shoulder.
Book a frozen shoulder assessment in Bath
Our osteopaths assess and treat a range of musculoskeletal problems, including shoulder pain and restricted shoulder movement.
If you think you may have frozen shoulder, or have persistent shoulder pain and aren’t sure what is causing it, you can book an initial consultation at The Bath Practice for a full assessment.
Book online or call us on 01225 427835.
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Email at: info@thebathpractice.co.uk
or call: 01225 427835
The Bath Practice is located at: 26 Monmouth St, Bath BA1 2AP