When your shoulder starts to hurt and won’t move-no matter how hard you try-it’s easy to think it’s just a bad strain or a pinched nerve. But if the pain creeps in slowly, gets worse at night, and your arm feels locked in place even when someone else tries to move it, you might be dealing with something more specific: frozen shoulder, or adhesive capsulitis.
This isn’t just stiffness. It’s your shoulder joint capsule-the bag of tissue that holds everything together-thickening, tightening, and shrinking. Studies show the capsule can lose nearly half its volume, dropping from a normal 30-35 mL down to just 10-15 mL. That’s like trying to stretch a shrunken T-shirt over your shoulder. The result? Pain that doesn’t go away, and movement that feels impossible.
What Happens Inside Your Shoulder?
The shoulder joint is the most mobile in your body, but that flexibility comes at a cost: it’s unstable. The joint capsule wraps around the ball-and-socket joint, lined with a thin layer of tissue called the synovium. In frozen shoulder, that lining becomes inflamed. Over time, it turns into scar tissue. This isn’t glue sticking things together, despite the name “adhesive” capsulitis. It’s a contracture-a tightening that pulls the capsule down like a drawstring.
The tightness follows a clear pattern. External rotation (turning your palm up) is hit hardest-often 60-70% lost. Then comes abduction (lifting your arm out to the side), followed by internal rotation (reaching behind your back). If you can’t scratch your back or reach into your back pocket, this is why. And it’s not just you moving the arm-your doctor or therapist can’t move it much either. That’s the key difference from a rotator cuff tear, where passive motion (someone else moving your arm) is still possible.
The Three Stages of Frozen Shoulder
This condition doesn’t hit all at once. It unfolds in three stages, and knowing which one you’re in changes everything about how you treat it.
Stage 1: Freezing (6 weeks to 9 months)
Pain is the main player here. It starts mild, then builds. You might notice it more at night-waking up because your shoulder feels like it’s on fire. Movement hurts, but you can still move it, even if it’s painful. This is the most confusing stage. Many people think rest will help. It won’t. In fact, doing nothing makes it worse.
Stage 2: Frozen (4 to 6 months)
Pain starts to fade, but stiffness takes over. This is when people say, “It doesn’t hurt as much, but I can’t move it at all.” You might still be able to lift your arm a little, but not beyond shoulder height. Reaching behind your head or putting on a seatbelt becomes impossible. This is the stage where most people finally seek help-because they can’t live like this.
Stage 3: Thawing (6 months to 2 years)
Slowly, movement returns. Not fast, not dramatically, but it comes. You start getting back a few degrees of motion each week. This stage can last a long time without treatment. With the right mobilization, it can shrink from two years to under six months.
Who Gets Frozen Shoulder-and Why?
It’s not just something that happens to older people. While it’s most common between ages 40 and 60, anyone can get it. But certain groups are at much higher risk.
People with diabetes are 10 to 20 times more likely to develop frozen shoulder. Why? High blood sugar causes abnormal collagen buildup in tissues-including the shoulder capsule. Thyroid disorders, heart disease, and Parkinson’s also increase risk. Even if you’re otherwise healthy, a shoulder injury, surgery, or long period of immobilization (like after a broken arm) can trigger it.
And here’s the catch: it’s misdiagnosed nearly half the time. Many doctors mistake it for a rotator cuff tear or arthritis. The clue? If both active and passive motion are limited equally, and you have no history of trauma, it’s likely frozen shoulder.
Mobilization Strategies That Actually Work
Here’s the good news: frozen shoulder almost always gets better. But waiting it out isn’t the best plan. Studies show that with the right mobilization, recovery time drops from 24-40 months to 6-12 months.
The key? Timing and technique. What works in the freezing stage can hurt you in the frozen stage.
During the Freezing Stage: Gentle Motion Only
Forcing your shoulder to move beyond pain causes more inflammation. Think of it like poking a bruise. You don’t want to make it worse.
- Pendulum exercises: Lean forward, let your arm hang loose. Gently swing it in small circles-clockwise and counterclockwise-for 5 minutes, twice a day. This keeps the joint lubricated without stressing it.
- Towel stretch: Hold a towel behind your back with both hands. Use your good arm to gently pull the towel upward, helping the affected arm stretch. Don’t force it-just enough to feel a mild pull.
- Heat before movement: Apply a warm towel or heating pad for 10 minutes before exercises. Heat relaxes the capsule and makes stretching safer.
Research from Healthgrades shows patients who started these moves within 8 weeks of symptoms had 65% less pain at 6 months compared to those who waited.
During the Frozen Stage: Gradual Progression
Pain is lower, so you can do more. But you still need patience. This is where supervised physical therapy makes the biggest difference.
- Doorway stretch: Stand in a doorway, place your hand on the frame at shoulder height. Gently lean forward until you feel a stretch across the front of your shoulder. Hold 30 seconds. Repeat 3 times.
- Wand exercises: Use a broomstick or a special rehab wand. Lie on your back, hold the wand with both hands. Use your good arm to lift the affected arm overhead, slowly. Stop at the point of resistance-not pain.
- External rotation stretch: Lie on your side with the affected shoulder down. Bend your elbow to 90 degrees. Use your good hand to gently push your forearm toward the floor, increasing external rotation.
Patients in a 2023 study using a device called ShoulderROM (which tracks motion in real time) recovered 32% faster than those doing standard exercises. The feedback helped them stay within safe limits.
What Doesn’t Work (and Can Make Things Worse)
Not all advice is good advice.
Aggressive stretching during the freezing stage? That’s a common mistake. One patient on Cleveland Clinic’s review said forced cross-body stretches turned their pain from 4/10 to 8/10 for three weeks. That’s not progress-that’s injury.
Manipulation under anesthesia (MUA)-where a doctor forcibly moves your shoulder while you’re asleep-is sometimes offered. But it’s risky. The AAOS says it should only be considered after 6 months of failed conservative care. It can cause fractures, nerve damage, or torn tendons if done too early.
Corticosteroid injections? They help some people with short-term pain relief (4-8 weeks), but studies show no real improvement in long-term mobility. They’re not a cure.
What You Can Do Today
You don’t need expensive gear. A towel, a doorframe, and a heating pad are enough to start.
Here’s your daily plan:
- Morning: Apply heat to your shoulder for 10 minutes.
- After heat: Do 5 minutes of pendulum swings.
- Afternoon: Do 3 sets of towel stretch (30 seconds each).
- Evening: Do 3 sets of doorway stretch (30 seconds each).
Track your progress. Measure how far you can reach overhead or behind your back every week. Even 5 degrees of improvement is a win.
Most people see results in 4-6 weeks. If you’re not moving better by then, or if pain spikes, see a physical therapist. Don’t wait until you can’t button your shirt.
Support and Real-World Help
You’re not alone. Over 12,000 people are in the Adhesive Capsulitis Support Group on Facebook. They share videos of their exercises, tips for sleeping better, and stories of recovery.
Many employers now cover virtual physical therapy for conditions like this. If you’re working remotely or have a corporate health plan, check if you have access to telehealth rehab.
And if you have diabetes? Managing your blood sugar isn’t just about your heart or kidneys-it’s directly linked to how fast your shoulder heals.
When to See a Doctor
Most cases resolve on their own. But some red flags mean something else is going on:
- Fever or night sweats
- Unexplained weight loss
- Swelling or redness in the shoulder
- Pain that spreads down your arm or into your neck
If you have any of these, get checked. It could be an infection, tumor, or nerve issue.
For most people, though, frozen shoulder is just a long, slow road back to movement. And with the right approach, it doesn’t have to take years.
Can frozen shoulder go away on its own without treatment?
Yes, frozen shoulder can resolve on its own, but it often takes 1 to 3 years. Without treatment, most people regain full motion, but many are left with lingering stiffness or discomfort. Early mobilization can cut recovery time in half-down to 6 to 12 months.
Is frozen shoulder the same as a rotator cuff tear?
No. A rotator cuff tear involves damage to the tendons that stabilize the shoulder. With a tear, you can usually still move your shoulder passively (someone else can move it for you), and pain is often sharp and localized. With frozen shoulder, both active and passive motion are severely limited, and the pain is dull and constant, especially at night.
Why does my frozen shoulder hurt more at night?
At night, your body is still, and inflammation builds up in the joint. Also, lying on the affected side puts pressure on the capsule, and without distractions, you notice the pain more. Sleeping on your back with a pillow under the affected arm can help reduce pressure and improve comfort.
Should I use ice or heat for frozen shoulder pain?
Use heat before stretching or exercising to relax the tight capsule. Use ice only if you have a flare-up after activity-apply it for 15 minutes to reduce swelling. Heat helps mobility; ice helps inflammation from overdoing it.
Can I do these exercises at home, or do I need a therapist?
You can start with simple exercises at home, especially in the early stages. But if you’re not improving after 4-6 weeks, or if you’re unsure about proper form, seeing a physical therapist is critical. Studies show supervised therapy leads to 28% faster recovery than home-only programs.
Is surgery ever needed for frozen shoulder?
Surgery is rare-only about 13% of cases require it. It’s usually considered only after 6 to 12 months of consistent physical therapy with no progress. Procedures like arthroscopic capsular release can remove scar tissue and restore motion, but they’re not a first-line option.
Does diabetes make frozen shoulder worse?
Yes. People with diabetes are 10 to 20 times more likely to develop frozen shoulder, and their recovery tends to be slower. High blood sugar causes excess collagen buildup in tissues, making the joint capsule stiffer and harder to stretch. Controlling blood sugar levels can improve outcomes.
How long should I do each exercise?
Start with 5 minutes total per session-split between pendulums, towel stretches, and doorway stretches. Do them twice a day. As you improve, increase to 10-15 minutes. Consistency matters more than duration. Five minutes daily is better than 30 minutes once a week.
