Frozen shoulder treatment
Frozen shoulder treatment may help relieve a condition also known as adhesive capsulitis, that is characterized by a limited range of motion in the shoulder secondary to adhesions within the glenohumeral joint capsule. Individuals affected by this condition typically report high irritability, joint stiffness, and shoulder pain, as well as decreased quality of life.
Key takeaways
- Frozen shoulder progresses through three stages, including freezing, frozen, and thawing, and can significantly limit shoulder mobility and daily function.
- Physical therapy plays an important role throughout recovery by reducing pain, restoring range of motion, and helping patients regain function.
- Frozen shoulder treatment should match the stage of the condition, progressing from pain management to stretching, joint mobilization, and functional strengthening. Therapists can easily manage and access treatment plans using an all-in-one EHR.
- Current evidence suggests frozen shoulder may not fully resolve without treatment, making early intervention especially valuable.
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What are the stages of frozen shoulder?
It is suspected to involve an inflammatory reaction that progresses to fibrotic contractures, which then limit shoulder range of motion. Clinically, most cases of frozen shoulder progress through 3 sequential phases: freezing, frozen, and thawing.
Freezing
The freezing phase is the most painful and can last up to 9 months. It is characterized by acute inflammation in the joint capsule, pain that is worse at night and can be severe, and extensive synovitis throughout the glenohumeral joint.
Frozen
Next, the frozen phase is characterized by a significant increase in stiffness and a decrease in ROM in all planes of motion.
Thickening and contracture of the joint capsule occurs and synovial fluid shows signs of chronic inflammation. F
Thawing
Finally, when the patient reaches the thawing phase, they experience a gradual reduction in inflammation and synovitis and a gradual return of ROM, pain, and function. This phase can last 5-36 or more months.
How Frozen Shoulder is diagnosed
The 2013 JOSPT Clinical Guidelines for Adhesive Capsulitis indicate PT’s can consider ruling in frozen shoulder based on the presence of the findings below:
• Patient’s age is between 40 and 65 years
• Patient reports a gradual onset and progressive worsening of pain and stiffness
• Pain and stiffness limit sleeping, grooming, dressing, and reaching activities
• Glenohumeral passive range of motion (ROM) is limited in multiple directions, with external rotation the most limited, more particularly in adduction
• Glenohumeral external or internal rotation ROM decreases as the humerus is abducted from 45° toward 90°
• Passive motions into the end ranges of glenohumeral motions reproduce the patient’s reported shoulder pain
• Joint glides/accessory motions are restricted in all directions
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Who gets Frozen Shoulder?
Frozen shoulder affects approximately 2-5% of individuals, and higher rates are observed among women. Risk factors include diabetes, hyperthyroidism, prior fracture, radiation therapy, and shoulder or cervical spine surgery.
About one-third of people affected will eventually experience frozen shoulder on the contralateral side as well.
Does Frozen Shoulder go away without treatment?
Many consider frozen shoulder to be a self-limiting condition, meaning that even without intervention, frozen shoulder will progress through each phase until it resolves on its own. While this was considered fact for many years, a 2017 systematic review, revealed that this assumption is based on low-quality evidence and that there is, in fact, no evidence to support the theory that frozen shoulder will progress to complete resolution without treatment.
So if this condition is unlikely to resolve without treatment, what role does physical therapy play in the management of frozen shoulder?
Frozen shoulder stage | Primary symptoms | Physical therapy focus |
Freezing | Increasing pain, inflammation, worsening ROM | Pain control, patient education, gentle ROM, low-grade mobilization |
Frozen | Severe stiffness with less pain | Progressive stretching, joint mobilization, restore scapulohumeral mechanics |
Thawing | Gradual return of motion | End-range stretching, strengthening, return to daily and recreational activities |
Persistent symptoms | Limited improvement after conservative care | Coordinate with physician; consider surgical consultation after prolonged nonsurgical management |
Physical therapy is an important treatment modality for frozen shoulder and a valuable choice to help prevent the need for surgical intervention.
Evidence-based frozen shoulder treatments
During the high irritability phase, when pain and discomfort are quick in onset and slow to improve, physical therapists should consider the following interventions:
- Heat and electrical stimulation for pain modulation
- Ultrasound for pain modulation
- Patient education on positions of comfort and activity modifications to reduce pain and limit tissue inflammation
- Low-intensity joint mobilizations within pain-free accessory ranges and glenohumeral positions
- Pain-free passive and active-assisted exercises
- As irritability decreases to the more moderate phase, therapists should begin to progress their treatment. The following interventions are recommended at this phase
- Heat and electrical stimulation for pain modulation as needed
- Ultrasound for pain modulation as needed
- Patient education on safely progressing activities to gain motion and function without worsening tissue inflammation
- Moderate intensity joint mobilizations with progressing amplitude and duration into tissue resistance (without eliciting posttreatment inflammation or pain)
- Gentle to moderate progressive stretching (without eliciting posttreatment inflammation or pain)
- Interventions to normalize scapulohumeral rhythm
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Finally, when irritability reaches a low state, evidence-based treatments for frozen shoulder include:
- Patient education on how to progress toward high-demand functional and recreational activities
- End-range joint mobilization, including high amplitude and long duration mobilizations into tissue resistance
- Longer duration stretching into tissue resistance (without eliciting posttreatment inflammation or pain)
- Exercises to integrate gains in mobility into normal scapulohumeral movement with an emphasis on functional and recreational activities
Recent systematic reviews underscore the important role physical therapy has in frozen shoulder treatment. According to their research, extra-corporeal shockwave therapy, stretching exercises, and corticosteroid injections, along with other PT techniques, could be strongly recommended to improve pain, range of motion, and functional status of patients in the frozen and thawing phases.
Moderate evidence was available to support the use of other interventions like PNF techniques, joint mobilization, continuous passive motion, dynamic scapular recognition exercises, and others during the second and third phases of recovery.
Surgical interventions such as arthroscopic capsular release or manipulation under anesthesia are often considered after 9-12 months of failed nonsurgical management. However, in many cases, physical therapy can reduce the need for this approach.
Using an evidence-based approach for frozen shoulder treatment
While the body of literature on the treatment and management of frozen shoulder continues to grow, patients should be encouraged to seek out physical therapy treatment to improve their shoulder range of motion, reduce their pain, and improve their physical function.
A multidisciplinary approach through collaboration with physicians or surgeons is an optimal way to support your patients in improving their quality of life after frozen shoulder.
How EHRs can help with documentation
Modern EHR/practice management platforms (such as TheraPlatform) assist greatly with documentation by providing HIPAA‑compliant, integrated systems for note entry, storage, scheduling, and billing.
They allow therapists to:
- Use and customize templates (e.g., SOAP, DAP, and others) or build their own to streamline note writing and ensure consistency.
- Link notes to treatment plans, goals, and session history so client progress is easily tracked over time.
- Utilize e-fax and secure document sharing via client portal to safely exchange information with clients or other providers while maintaining confidentiality.
- Leverage dictation and telehealth transcription, which can automatically convert sessions into therapy or assessment notes, saving time and reducing manual entry.
- Take advantage of AI features that streamline documentation by automatically populating intake form data into assessment templates and generating complete therapy and assessment notes from the information you provide, all with a single click.
Watch this video to learn how to save time on therapy notes
Meanwhile, AI‑assisted note tools are emerging which can further help clinicians by:
- Automatically transcribing session audio (if permitted) and highlighting key moments (e.g. emotional shifts, major themes).
- Suggesting draft notes or filling in objective or assessment sections based on observed data, freeing up clinicians’ time.
- Supporting consistency and reducing missing components in notes, which helps from both clinical, legal, and insurance perspectives.
Together, structured SOAP‑type notes, good EHR platforms, and smart AI tools support better therapeutic outcomes, more efficient workflows, and stronger accountability.
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- Flexible notes
- Template library
- Billing & payments
- Insurance claims
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- Telehealth
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References
- Sullivan E, Bhandari-Young S, Kamat A, Best TM. Thawing the Ice: The Clinical Diagnosis and Effective Management of Adhesive Capsulitis. Orthop Nurs. 2025 Sep-Oct 01;44(5):269-277. doi: 10.1097/NOR.0000000000001149. Epub 2025 Sep 23. PMID: 40986875; PMCID: PMC12517722.
- Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, Godges JJ, McClure PW. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013 May;43(5):A1-31. doi: 10.2519/jospt.2013.0302. Epub 2013 Apr 30. PMID: 23636125.
- Mullen JP, Hauer TM, Lau EN, Lin A. Adhesive Capsulitis of the Shoulder. Arthroscopy. 2025 Jul;41(7):2176-2178. doi: 10.1016/j.arthro.2025.03.027. PMID: 40545326.
- Wang K, Ho V, Hunter-Smith DJ, et al. Risk factors in idiopathic adhesive capsulitis: a case control study. J Shoulder Elbow Surg. 2013;22(7):e24–29
- Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA, Schram GA, Strang BL. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017 Mar;103(1):40-47. doi: 10.1016/j.physio.2016.05.009. Epub 2016 Jun 21. PMID: 27641499.
- Kirker K, O'Connell M, Bradley L, Torres-Panchame RE, Masaracchio M. Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis. J Man Manip Ther. 2023 Oct;31(5):311-327. doi: 10.1080/10669817.2023.2180702. Epub 2023 Mar 2. PMID: 36861780; PMCID: PMC10566414.
- Costantino C, Nuresi C, Ammendolia A, Ape L, Frizziero A. Rehabilitative treatments in adhesive capsulitis: a systematic review. J Sports Med Phys Fitness. 2022 Nov;62(11):1505-1511. doi: 10.23736/S0022-4707.22.13054-9. Epub 2022 Feb 18. PMID: 35179326.
- Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review. J Back Musculoskelet Rehabil. 2021;34(2):195-205. doi: 10.3233/BMR-200186. PMID: 33185587.
FAQs about Frozen Shoulder treatment
What is frozen shoulder?
Frozen shoulder (adhesive capsulitis) is a condition that causes shoulder pain, stiffness, and progressive loss of motion due to tightening of the joint capsule.
Can physical therapy help frozen shoulder?
Yes. Physical therapy can reduce pain, improve range of motion, restore function, and may help many patients avoid surgery.
How long does frozen shoulder last?
Recovery varies, but symptoms often progress through three stages and may last from several months to more than two years depending on severity and treatment.
