What is Frozen Shoulder?
Frozen shoulder, also known as adhesive capsulitis, is a musculoskeletal condition that affects the shoulder joint.
It is a common but often frustrating condition that causes pain, stiffness and a progressive loss of movement in the shoulder joint. It can significantly impact daily life and often develops gradually, making it difficult to pinpoint exactly when it started.
Although frozen shoulder can affect anyone, it is most commonly seen in women between the ages of 40 and 60, particularly during the perimenopausal and menopausal years.
The shoulder is surrounded by a capsule of connective tissue that helps stabilise the joint. With frozen shoulder, this capsule becomes inflamed, thickened and tight, leading to pain and a progressive restriction in movement.
As the capsule tightens, the shoulder becomes increasingly difficult to move, often affecting everyday activities such as:
- Reaching overhead
- Getting dressed
- Washing or styling your hair
- Reaching behind your back
- Lifting objects
- Sleeping comfortably
Although frozen shoulder is clinically common, we still don’t fully understand why it develops.
Why Is Frozen Shoulder More Common in Women?
Women are thought to be up to twice as likely to develop frozen shoulder compared to men. The exact reasons remain unclear, but there is a growing body of research investigating how lifestyle factors such as diet, sleep, stress, and exercise may influence both the development and recovery of frozen shoulder. While no single factor has been identified as the cause, these areas are receiving increasing attention as researchers seek to better understand why frozen shoulder occurs and what may support recovery.
For those interested in exploring the theories and emerging evidence in more detail, you can find information in the further readings.
Hormonal Changes
One of the leading theories relates to hormonal fluctuations, particularly changes in oestrogen levels.
Oestrogen plays an important role in maintaining healthy connective tissue and regulating collagen production. Throughout a woman’s life, hormone levels fluctuate during menstruation, pregnancy, childbirth and menopause.
During menopause, oestrogen levels decline significantly. This decline may affect collagen production, tissue repair and joint flexibility, potentially increasing susceptibility to inflammation and stiffness within the shoulder capsule.
The Three Stages of Frozen Shoulder
Frozen shoulder typically progresses through three stages.
Stage One: Freezing
This is often the most painful stage.
During this phase:
- Pain gradually increases
- Shoulder movement becomes more restricted
- Sleep may become disrupted
- Daily activities become more difficult
This stage may last anywhere from six weeks to nine months.
Stage Two: Frozen
Pain may begin to reduce, but stiffness becomes more pronounced.
People often find they have:
- Significant loss of shoulder mobility
- Difficulty reaching overhead
- Difficulty reaching behind their back
- Reduced ability to perform everyday tasks
This stage can last several months.
Stage Three: Thawing
During the thawing phase, movement gradually returns.
Pain often continues to improve and shoulder function slowly begins to recover.
Although recovery can feel frustratingly slow, most people eventually regain significant movement and function.
Who Is Most at Risk?
Frozen shoulder is more common in people who:
- Are aged between 40 and 60
- Have diabetes
- Have thyroid disorders
- Have autoimmune conditions
- Have recently had shoulder surgery
- Have experienced a shoulder injury
- Have had a period of immobilisation
One of the strongest associations is with diabetes, although researchers are still investigating exactly why this relationship exists.
Looking Beyond the Shoulder
Although frozen shoulder has traditionally been viewed as a problem affecting only the shoulder joint, researchers are increasingly exploring whether wider factors throughout the body may also play a role.
The condition is more common in women during midlife and is strongly associated with conditions such as diabetes and thyroid disease. This has led researchers to investigate potential links between hormones, inflammation, metabolic health, sleep, stress and connective tissue function.
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While we still do not fully understand what causes frozen shoulder, many experts now believe it may be influenced by a combination of local changes within the shoulder and broader changes occurring elsewhere in the body.
These theories are still evolving, but they may help explain why frozen shoulder is particularly common during the menopausal years.
For a deeper look at the emerging research surrounding menopause, hormones, metabolic health, and frozen shoulder, explore our further reading section.
How Is Frozen Shoulder Diagnosed?
A healthcare professional will usually diagnose frozen shoulder through:
- A discussion of your symptoms
- A physical examination
- Assessment of your shoulder’s range of motion
You may be asked to perform specific movements, such as reaching across your body or behind your back.
Imaging tests such as X-rays may be used to rule out other causes of shoulder pain, including arthritis or dislocation. Occasionally an MRI scan may be recommended if another shoulder condition is suspected.
Treatment Options for Frozen Shoulder
Treatment focuses on reducing pain and gradually restoring movement.
Pain relief may include:
- Paracetamol
- Anti-inflammatory medications such as ibuprofen or naproxen (where appropriate)
- Ice packs applied for 10-15 minutes several times daily
- For more severe symptoms, a corticosteroid injection may be recommended to help reduce inflammation and pain.
Manual therapy is often considered the cornerstone of frozen shoulder treatment. Initially, treatment focuses on gentle stretching exercises to improve mobility. As movement returns, strengthening exercises may be added to support recovery and shoulder function.
Exercises for Frozen Shoulder
Gentle movement is usually encouraged. Before exercising, it’s often helpful to warm the shoulder using a warm shower, bath or heat pack for 10-15 minutes.
1. Pendulum Stretch
Lean forward slightly and allow the affected arm to hang freely.
Gently swing the arm in small circles, performing 10 circles in each direction once daily.
2. Finger Walk
Face a wall and place your fingertips against it.
Slowly “walk” your fingers up the wall as high as comfortable before lowering the arm again.
Repeat 10-20 times daily.
3. Cross-Body Stretch
Use your unaffected arm to gently pull the affected arm across your chest.
Hold for 15-20 seconds.
Repeat several times throughout the day.
How Long Does Recovery Take?
One of the most challenging aspects of frozen shoulder is that recovery can take time.
Many people improve significantly with conservative treatment, but recovery may take:
- Several months
- One to two years
- Occasionally up to three years
The good news is that more than 90% of people improve without surgery when they follow an appropriate rehabilitation programme.
Supporting Your Recovery
While treatment focuses on the shoulder itself, supporting your overall health may also be beneficial.
Consider:
- Staying as active as possible
- Following your physiotherapy programme consistently
- Prioritising good sleep
- Managing stress
- Supporting healthy blood sugar balance
- Eating a nutrient-rich diet that supports healing and recovery
The Takeaway
Frozen shoulder is a common condition that causes pain, stiffness and restricted movement in the shoulder joint. It most commonly affects women between the ages of 40 and 60 and can have a significant impact on daily life.
Although recovery can be slow, most people regain substantial movement and function with a combination of pain management, manual therapy and patience.
Work Cited and Further Reading:
Perimenopause, menopause, aches and pains. Available at: https://www.drlouisenewson.co.uk/knowledge/perimenopause-menopause-aches-and-pains.
Advanced glycation end products in idiopathic frozen shoulders. Journal of Shoulder and Elbow Surgery. Available at: :https://doi.org/10.1016/j.jse.2015.10.015.
Exercises for Frozen Shoulder | Osteopath In London. Available at: https://mhvclinic.com/medical-conditions/frozen-shoulder/exercises/
Frozen Shoulder as a Systemic Immunometabolic Disorder: The Roles of Estrogen, Thyroid Dysfunction, Endothelial Health, Lifestyle, and Clinical Implications. Available at: https://doi.org/10.3390/jcm14207315.
NHS Frozen shoulder: Available at: https://www.nhs.uk/conditions/Frozen-shoulder/.
How to release a frozen shoulder. Available at: https://www.health.harvard.edu/pain/how-to-release-a-frozen-shoulder.
Frozen Shoulder: Unraveling the Gender Disparity – Reinge Clinic. Available at: https://www.reingeclinic.co.uk/post/frozen-shoulder-unraveling-the-gender-disparity/
The Chartered Society of Physiotherapy. Available at: https://www.csp.org.uk/public-patient/find-physiotherapist/find-physio.