Frozen Shoulder Stages Explained: What to Expect and How Physio Helps

Have you developed shoulder pain and noticed that your shoulder is becoming increasingly stiff? Are you finding it difficult to reach overhead, put on a jacket, reach behind your back or sleep comfortably?

You may be experiencing frozen shoulder, also known as adhesive capsulitis.

Frozen shoulder can be painful and frustrating, particularly when everyday movements become difficult. Understanding the condition and its typical stages can help you know what to expect during recovery.

At AZ Physiotherapy Limited in Auckland, our physiotherapists assess shoulder pain and stiffness and provide rehabilitation to help you restore movement and function.

What is frozen shoulder?

Frozen shoulder is a condition where the tissues surrounding the shoulder joint become painful and progressively restrict shoulder movement.

The shoulder joint normally has a large range of movement. With frozen shoulder, the joint capsule becomes tighter, contributing to pain and significant restriction of movement.

Frozen shoulder commonly develops gradually. In many cases, there is no obvious injury that started the problem. It is more common between the ages of about 40 and 60, and people with diabetes are at higher risk.

People may notice difficulty with everyday activities such as:

• Reaching overhead
• Reaching behind the back
• Putting on or taking off clothing
• Washing or brushing their hair
• Reaching for objects on a high shelf
• Sleeping on the affected side
• Reaching into the back seat of a car
• Performing gym or sporting activities

Both pain and stiffness are important features of frozen shoulder.

What are the three stages of frozen shoulder?

Frozen shoulder is commonly described as having three stages:

1. Freezing stage — pain increases and movement starts to reduce
2. Frozen stage — pain may ease, but the shoulder stays very stiff
3. Thawing stage — movement gradually returns

The timing and severity of each stage can vary between individuals.

Stage 1: Freezing stage

The first stage is commonly called the freezing stage or painful stage. During this stage, shoulder pain gradually increases and shoulder movement starts becoming more restricted.

You may notice:

• Increasing shoulder pain
• Pain at night
• Difficulty sleeping on the affected shoulder
• Increasing difficulty reaching overhead
• Pain when moving the arm
• Gradually reducing shoulder movement

At this stage, trying to force the shoulder through painful movements may increase symptoms. Physiotherapy during this stage generally focuses on symptom management, maintaining as much comfortable movement as possible and addressing factors that may be contributing to reduced shoulder function.

Stage 2: Frozen stage

During the frozen stage, pain may become less intense for some people, but the shoulder can remain very stiff. You may find that your shoulder movement is significantly restricted, particularly when:

• Reaching overhead
• Reaching behind your back
• Putting your arm into a sleeve
• Reaching across your body
• Performing gym exercises
• Completing household activities

The shoulder may feel as though it is "stuck." Physiotherapy may focus on maintaining available movement, gradually improving strength and function, and helping you continue appropriate daily activities without excessively aggravating the shoulder.

Stage 3: Thawing stage

The third stage is called the thawing stage or recovery stage. During this stage, shoulder movement gradually begins to improve. You may notice:

• Less pain
• Improved shoulder movement
• Better ability to perform daily activities
• Improved sleep
• Gradual return of strength and function

Recovery can be gradual, and the shoulder may not return to normal movement immediately. A structured rehabilitation programme can help you progressively restore movement, strength and confidence in using the shoulder.

How can physiotherapy help frozen shoulder?

Physiotherapy can play an important role in managing frozen shoulder. Depending on your symptoms and stage of the condition, treatment may include:

• Movement exercises — specific exercises to maintain or gradually improve shoulder movement.
• Strengthening — as pain and movement improve, strengthening helps restore shoulder and upper-limb function.
• Manual therapy — appropriate hands-on techniques to help with pain, stiffness and movement, depending on your presentation.
• Education — understanding frozen shoulder, activity modification and what to expect during recovery.
• Gradual return to activities — support to return to work, the gym, sport and everyday activities.

Where it suits your presentation, we may also use dry needling alongside exercise to help manage muscle tension around the shoulder. Learn more about our physiotherapy service.

How long does frozen shoulder last?

Frozen shoulder can take time to recover, and the duration varies considerably between individuals. It commonly lasts from around one year to three years overall.

The three stages do not always have clear boundaries, and symptoms can overlap between stages. Because recovery can be gradual, rehabilitation is often focused on making steady improvements in pain, movement and function rather than expecting an immediate recovery.

When should you see a physiotherapist?

Consider seeing a physiotherapist if you have:

• Persistent shoulder pain
• Increasing shoulder stiffness
• Difficulty lifting your arm
• Difficulty reaching behind your back
• Night-time shoulder pain
• Difficulty dressing or performing daily activities
• Shoulder symptoms that are affecting your work, gym or sport

Not every painful and stiff shoulder is frozen shoulder. Other shoulder conditions can produce similar symptoms, so an appropriate assessment is important. You don't need a GP referral to see us, and if your shoulder problem followed an accident, ACC may help cover the cost.

Frozen shoulder physiotherapy in Auckland

If you are experiencing shoulder pain and stiffness in Auckland, AZ Physiotherapy Limited can assess your shoulder and help determine an appropriate rehabilitation approach. We see patients at our clinic in Pakuranga, East Auckland.

Whether your shoulder pain is affecting your work, sleep, gym training or everyday activities, getting the right assessment can help you understand your symptoms and plan your recovery. Book an assessment or get in touch with any questions.

Our goal is to help you move better, recover from injury and get back to the things you enjoy.

Sources

• Healthify (NZ): Shoulder pain
• NHS: Frozen shoulder