Physiotherapy for Frozen Shoulder: Safe Exercises to Regain Arm Movement and Reduce Pain
Frozen shoulder, or adhesive capsulitis, is a common yet often misunderstood condition that causes pain, stiffness, and limited movement in the shoulder joint. If left untreated, it can lead to chronic discomfort and long-term mobility issues. Fortunately, physiotherapy—when started at the right time and followed consistently—can significantly improve symptoms and speed up recovery.
In this guide, we’ll take a comprehensive look at how physiotherapy can help frozen shoulder, explain the different stages of the condition, and provide a step-by-step breakdown of safe exercises to reduce pain and regain mobility.
What is a Frozen Shoulder?
Frozen shoulder develops when the connective tissue surrounding the shoulder joint (called the joint capsule) becomes inflamed and thickened. Over time, the capsule contracts and forms scar tissue (adhesions), which limits the shoulder’s ability to move freely.
Common Symptoms:
Dull or aching pain in the outer shoulder and upper arm
Increasing stiffness
Difficulty with everyday activities (e.g., brushing hair, reaching overhead)
Pain that worsens at night
Risk Factors:
Age: Most common between ages 40–60
Gender: More prevalent in women
Medical Conditions: Diabetes, thyroid issues, Parkinson’s disease
Injury or Surgery: Immobilization of the shoulder due to injury or surgery can trigger frozen shoulder
Prolonged Inactivity: Sedentary lifestyle or long periods without shoulder movement
Stages of Frozen Shoulder (Adhesive Capsulitis)
Understanding the stages helps tailor physiotherapy interventions effectively.
1. Freezing Stage (Lasts 6 weeks to 9 months)
Pain gradually increases
Range of motion starts to decrease
Movement becomes more painful, especially at night
2. Frozen Stage (Lasts 4 to 6 months)
Pain may reduce, but stiffness is severe
Daily activities are significantly limited
Movement is restricted, especially in reaching and rotating arms
3. Thawing Stage (Lasts 6 months to 2 years)
Pain diminishes
Range of motion gradually returns
Most people recover fully with proper therapy
How Physiotherapy Helps in Frozen Shoulder
Physiotherapy is the cornerstone of conservative treatment for frozen shoulder. A physiotherapist creates a personalized plan that evolves with your recovery stage. Treatment typically includes:
Range of Motion Exercises: Prevent further stiffness
Stretching: Gradually improve flexibility of the joint capsule
Strengthening Exercises: Support shoulder stability
Manual Therapy: Hands-on techniques to mobilize the joint
Modalities: Heat, ice, TENS, and ultrasound to relieve pain and inflammation
Postural Correction: Prevent compensatory movement in the neck or spine
Safe and Effective Exercises for Frozen Shoulder
These exercises can help reduce stiffness, regain range of motion, and minimize pain. Perform them daily, and always warm up with a heating pad or warm shower before starting.
Note: Always consult a physiotherapist before starting an exercise regimen, especially if you have diabetes or heart conditions.
1. Pendulum Exercise (Codman’s Exercise)
Purpose: Relieves pain and promotes gentle joint movement
When to Use: Best in the freezing and frozen stagesInstructions:
Stand next to a table and lean forward slightly.
Let the affected arm hang down loosely.
Swing the arm gently in small circles (clockwise and counter-clockwise).
Perform for 2 minutes, 2–3 times daily.
Tip: Keep the body still and allow momentum to move the arm.
2. Towel Stretch (Internal Rotation Stretch)
Purpose: Improves internal shoulder rotation
When to Use: Effective during frozen and thawing stagesInstructions:
Hold a towel behind your back with both hands.
Use your healthy arm to gently pull the towel upward, stretching the affected arm.
Hold for 30 seconds, repeat 3–5 times.
Variation: Use a cane or a resistance band if a towel is hard to manage.
3. Cross-Body Arm Stretch
Purpose: Enhances shoulder flexibility and targets posterior capsule
Instructions:
Sit or stand with your spine straight.
Bring your affected arm across your chest.
Use the opposite hand to gently push the elbow toward your chest.
Hold for 20–30 seconds, repeat 4–5 times.
Avoid: Shrugging the shoulders or twisting the torso.
4. Wall Walk (Finger Climbing Exercise)
Purpose: Increases shoulder elevation
When to Use: Frozen and thawing stagesInstructions:
Face a wall and place your fingertips on it at waist height.
Walk your fingers up the wall as far as possible without pain.
Hold for a few seconds at the top, then slowly walk back down.
Repeat 10–15 times daily.
Tip: Do this exercise in front of a mirror to monitor your posture.
5. External Rotation with Resistance Band
Purpose: Strengthens rotator cuff muscles
When to Use: Thawing stage and ongoing rehabilitationInstructions:
Anchor a resistance band to a doorknob or fixed object.
Hold the band with the affected arm bent at 90 degrees.
Keep the elbow close to your body and rotate your forearm outward.
Slowly return to the starting position.
Do 10–15 reps for 2–3 sets.
Progression: Increase resistance as strength improves.
6. Overhead Pulley Stretch (Advanced)
Purpose: Improves shoulder elevation and flexibility
When to Use: Late frozen or thawing stageInstructions:
Use a shoulder pulley system over a door.
Sit on a chair and hold the pulley handles in both hands.
Pull down with the healthy arm to lift the affected arm overhead slowly.
Hold for 10 seconds, repeat 10 times.
Note: This should be done under supervision during early use.
Tips for Effective Frozen Shoulder Rehabilitation
✅ Consistency is key: Do your exercises daily for lasting results.
✅ Pain is a guide: Mild discomfort is normal, sharp pain is not.
✅ Stay active: Avoid immobilizing the shoulder too much.
✅ Combine stretching and strengthening: Both are necessary for recovery.
✅ Use heat and cold therapy: Heat helps loosen the joint before exercise, cold helps reduce inflammation afterward.
When Should You See a Physiotherapist?
While some cases of frozen shoulder can improve with home care, professional physiotherapy is highly recommended in the following situations:
Pain interferes with sleep or daily tasks
You cannot raise your arm above shoulder height
The condition has persisted for more than 3–4 weeks
You have underlying conditions like diabetes or arthritis
A trained physiotherapist can:
Accurately assess the stage of your condition
Design a customized exercise and treatment plan
Use advanced manual techniques for faster recovery
Prevent long-term complications such as joint instability
How Long Does Recovery Take?
Recovery depends on the individual, but with physiotherapy:
Mild cases improve in 3–6 months
Moderate cases improve in 6–12 months
Severe cases may take up to 2 years
Even though the condition can resolve on its own, active rehabilitation shortens recovery time and improves outcomes.
Final Thoughts
Frozen shoulder can be a long and frustrating journey, but with the right physiotherapy approach and consistent effort, recovery is well within reach. Safe and structured exercises not only reduce pain and stiffness but also restore shoulder mobility and function, enabling you to return to a pain-free, active lifestyle.
If you're struggling with shoulder stiffness or suspect adhesive capsulitis, consult a qualified physiotherapist as early as possible. Early intervention leads to better results and a smoother recovery.
