Frozen shoulder is a condition that can make simple movements—like reaching for a seatbelt, fastening a bra, or taking a shirt off—feel unexpectedly difficult and painful. Many people first notice it as a sharp pull when they reach overhead or behind their back. Later, the shoulder may feel stiff even for basic tasks such as combing hair or putting on a T-shirt.
This article looks at frozen shoulder in plain language: what it is, how it typically develops, why it is not the same as a rotator cuff tear, and what a realistic path of recovery often looks like. It does not promise quick fixes, but aims to help you understand the condition and make more informed decisions about care and daily life.
What is frozen shoulder?
Frozen shoulder (also called adhesive capsulitis) is a condition in which the shoulder joint becomes painful and stiff, with a noticeable loss of movement in many directions. The shoulder joint is surrounded by a capsule—a soft tissue envelope that helps keep the joint stable. In frozen shoulder, this capsule becomes thicker, tighter and more fibrous, and the space inside the joint can become smaller.
This tightening does not usually happen overnight. It tends to develop gradually and follows a characteristic pattern over months or even years. The key features are:
- Pain, often worse with movement and at night
- Progressive stiffness, especially with lifting the arm up, turning it out to the side, or reaching behind the back
- Limitation in both active movement (what you can do yourself) and passive movement (what someone else can do when they move your arm gently)
Frozen shoulder is different from a “simple strain” or short-term shoulder ache. It also differs from conditions such as rotator cuff tears, bursitis or shoulder impingement, although sometimes these problems can coexist. A proper assessment by a healthcare professional is important to clarify the likely diagnosis.
How frozen shoulder usually develops
Although each person’s story is unique, frozen shoulder often follows a three-phase pattern that can unfold over 12–24 months or sometimes longer.
In the first phase, sometimes called the “freezing” phase, pain is prominent. The shoulder may ache at rest and be sharply painful with certain movements, particularly reaching out to the side, overhead, or behind the back. Sleep can be disturbed, especially when lying on the affected side or rolling onto it by accident at night. During this phase, movement gradually becomes more limited as the capsule tightens and the body reacts to pain by guarding.
In the second phase, the “frozen” phase, pain may reduce somewhat—especially at rest—but stiffness becomes more obvious. Everyday tasks such as dressing, grooming, reaching into cupboards and fastening bras or belts can be quite restricted. People sometimes describe the shoulder as “blocked” or “stuck”, with a hard end-feel when they or a therapist try to move it further.
In the third phase, often referred to as the “thawing” phase, range of motion gradually begins to improve. Pain usually continues to lessen, and the shoulder becomes more willing to move, although the process is often slow and uneven. Some people eventually regain near-normal movement; others have a small but persistent limitation, especially in end-range overhead or behind-the-back positions.
The timeline varies widely. Some recover within about a year; for others, it can take longer. The overall pattern—more pain and loss of movement early, more stiffness in the middle, gradual improvement later—is more consistent than the exact number of months.
Who is more likely to develop frozen shoulder?
Frozen shoulder can occur in anyone, but certain factors are associated with a higher likelihood. It is more commonly seen in people in mid-life and older adults, and it tends to be more frequent in individuals with diabetes or some other metabolic conditions. It may also develop after periods when the shoulder is used less—for example, after an injury, surgery, or prolonged immobilisation in a sling.
That said, many people with frozen shoulder do not have a clear trigger. They may simply notice a gradual onset of pain without a specific injury. This can be confusing and worrying, especially when scans do not show dramatic structural damage.
Understanding that frozen shoulder is a recognised condition, rather than a mysterious or imagined problem, can bring some reassurance. The pain and stiffness are real and reflect genuine changes in the joint capsule and the way the nervous system is interpreting movement.
What frozen shoulder feels like in daily life
In the early painful phase, pain can overshadow everything else. Simple actions such as reaching for a seatbelt, putting on a jacket, reaching into the back seat of the car, or turning over in bed may cause sharp, catching pain that makes you hold your breath. People often start to avoid moving the arm fully, partly to reduce pain and partly out of fear of making things worse.
As stiffness becomes more dominant, the limits of movement become obvious. Reaching up to hang clothes can be impossible on the affected side. Washing or drying hair may require awkward compensations, like leaning the trunk rather than lifting the arm. Fastening bras or adjusting items behind the back can be particularly challenging. Some people adapt by doing more with the other arm or changing the way they dress, drive or handle objects.
All of this can be frustrating. Frozen shoulder can interfere with work, childcare, housework, exercise and leisure. It can also make people feel older or more fragile than they are, especially when sleep is disturbed and fatigue builds up.
Medical assessment and diagnosis
If you suspect a frozen shoulder, it is important to seek an assessment from a doctor, physiotherapist or other qualified clinician. The diagnosis is based mainly on:
- Your history (how the pain and stiffness started and changed)
- A physical examination of shoulder movement and strength
- Exclusion of other conditions that can mimic frozen shoulder
In frozen shoulder, both active and passive movement are limited in a similar pattern, particularly in external rotation (turning the arm outward) and elevation. Strength may be relatively preserved within the restricted range, suggesting that the main problem is not a major tendon tear but capsular tightness and pain-related guarding.
In some cases, imaging such as an X-ray or ultrasound may be used to rule out other causes of shoulder pain (for example, severe arthritis, major rotator cuff tears or other structural problems). However, many people with frozen shoulder have relatively unremarkable imaging, which can be surprising if the pain feels severe. This does not mean the pain is “in your head”; it simply reflects that frozen shoulder is often more about soft tissue tightening and pain processing than large, obvious structural damage.
Treatment options: a gradual, multi-step approach
There is no single treatment that instantly “unfreezes” the shoulder. Management is usually a combination of approaches, chosen and adjusted depending on the phase of the condition, pain levels, general health and personal preferences.
In the painful early phase, treatment often focuses on pain relief and gentle protection. This may include medication prescribed by a doctor, targeted injections in some cases, and careful guidance on what movements to avoid pushing too hard. At the same time, completely resting the shoulder is rarely recommended; the joint still needs light, comfortable movement within a safe range to maintain as much function as possible and support circulation.
As pain becomes more manageable, structured exercise and stretching usually take a more central role. Under the guidance of a therapist, you may work on gradually increasing the range of motion through controlled stretches and active movements that respect pain but challenge stiffness. The goal is to encourage the capsule and surrounding tissues to adapt, while avoiding aggressive forcing that simply increases pain and muscle guarding.
Some people benefit from manual therapy, heat or cold applications, and specific strengthening work to support the joint. Others may be offered more interventional options such as joint distension (hydrodilatation) or consideration of procedures in stubborn cases, always after a detailed discussion with the medical team. Each option has benefits and limitations, and decisions should be individualised rather than based on one fixed protocol.
The role of occupational therapy in frozen shoulder
Occupational therapists focus on how frozen shoulder affects real-life activities. They look beyond range of motion measurements and ask questions such as:
- Which tasks at home or work are hardest with your current shoulder?
- How are you dressing, bathing, carrying, cooking and using your phone or computer now?
- What work tasks or hobbies matter most to you, and where does the shoulder stop you?
From there, OT can help in several ways.
First, by teaching activity modification: changing the way you perform tasks so that they place less strain on the stiff, painful shoulder. This might include different dressing techniques, alternative ways to lift or carry objects, or using equipment to reduce overhead reaching.
Second, by designing a graded home programme that combines functional movement with therapeutic exercises, so that practice happens not only in the clinic but also throughout the day in meaningful activities.
Third, by supporting sleep positioning and routine—experimenting with pillow arrangements, side-lying variations and rest strategies that help you get more restorative sleep despite shoulder discomfort.
This combination aims to keep you as independent and safe as possible while the shoulder moves through its natural phases and rehabilitation.
Living with frozen shoulder: pacing and expectations
Because frozen shoulder is a condition that typically unfolds over many months, pacing and realistic expectations are crucial. It is common to have weeks where progress feels more noticeable, followed by periods where pain or stiffness plateau. This does not necessarily mean that nothing is changing; sometimes improvements are very gradual or only obvious when you compare against several months earlier.
Activity pacing—spreading demanding tasks across the week, taking short breaks before pain flares, and avoiding the “do everything on a good day, crash the next day” pattern—can help reduce frustration and inflammation. It allows your shoulder and nervous system to adapt progressively, rather than repeatedly reacting to overload.
It can also be helpful to track small milestones: being able to reach one shelf higher, fasten a particular item of clothing more easily, or sleep on the affected side for a short time without as much discomfort. These practical markers often reflect meaningful change better than a single number on a goniometer.
When to seek urgent medical advice
While most frozen shoulder cases follow a slow, recognisable pattern, certain symptoms should prompt prompt medical review. These include sudden severe pain after trauma, a marked change in shoulder shape, significant weakness that appears rapidly, fever or feeling generally unwell, or pain associated with chest symptoms or shortness of breath. These signs may indicate other urgent conditions that need immediate assessment.
For ongoing shoulder pain and stiffness that match the typical frozen shoulder picture, regular follow-up with your healthcare provider or rehabilitation team can help ensure that your plan remains appropriate and that any new issues are picked up early.
A realistic and hopeful outlook
Frozen shoulder can be a discouraging condition because progress is rarely quick, and pain and stiffness can affect almost every aspect of daily life. It is understandable to feel impatient, worried or frustrated.
The more hopeful side is that many people do experience gradual improvement over time, especially with a balanced combination of medical input, guided exercise, task modification and self-care. Even when some limitations remain, it is often possible to regain a functional, comfortable shoulder for most daily activities.
The aim of rehabilitation is not to pretend that frozen shoulder is easy, but to walk alongside you through its phases: protecting the joint when pain is high, challenging stiffness when the time is right, and adapting tasks so that you can continue to live your life as fully as possible while recovery unfolds.
This article is for general education and does not replace individual medical advice. For personalised assessment and recommendations, please consult your healthcare provider or rehabilitation team.
