The shoulder that won’t move, and nobody can tell you why
You woke up one day and your shoulder was stiff. Not injured, not overused, just stuck. Reaching behind your back became impossible, overhead started catching, and night pain woke you every time you rolled onto it. Imaging showed nothing obvious, and you were told it’s “frozen shoulder” that will settle on its own in 12 to 18 months. That’s not a treatment plan. It’s a prediction. Structured physiotherapy can roughly halve that timeline.
What it actually is
Frozen shoulder (adhesive capsulitis) is an inflammatory, then contractile, problem of the capsule around the shoulder joint. It’s not a muscle or rotator cuff problem, which matters, because the wrong treatment (aggressive stretching, heavy loading during the painful phase) makes it worse. It’s most common between 40 and 60, and more likely with diabetes, thyroid conditions, or a period of immobilisation.
The three phases (and why they change treatment)
- Freezing (roughly 0-3 months): pain-dominant, driven by active inflammation. Priority: settle it down, keep the range you have, manage sleep. Don’t force stretches through inflamed tissue.
- Frozen (roughly 3-9 months): stiffness-dominant, pain easing, external rotation most restricted. This is where structured physio has the biggest impact: progressive mobilisation, end-range stretching, and strengthening within range.
- Thawing (9 months+): range returns gradually. Priority: strengthen in the regained range so you don’t finish weak, compensated and prone to re-stiffening.
Why “wait it out” fails
Most people do eventually recover range, but untreated it averages 18-24 months of progressive disability, and a chunk of people are left with lasting stiffness. Supervised physio plus a daily home program beats rest alone for both pain and range. In the painful early phase, an intra-articular corticosteroid injection has good evidence and, combined with physio, can shorten the whole course. Surgery is reserved for the small number of cases that genuinely fail 6-12 months of proper rehab.
The realistic timeline with treatment
Night pain is usually first to improve, often within weeks. Expect meaningful pain reduction and range gains over the first few months, most function back by 3-6 months, and near-full recovery by 6-12, versus 18-24 months left alone. If your shoulder is progressively stiffening and painful over weeks rather than settling like a normal strain, get it assessed early. Knowing which phase you’re in changes everything.