You never realise how much you rely on your shoulder until something as simple as reaching for a mug or tying your shoelaces becomes a painful challenge. For many people, that challenge has a name: frozen shoulder. Also known as adhesive capsulitis, this condition feels like a gradual loss of freedom—your shoulder becomes stiff and painful, and its range of motion increasingly limited. But the good news? You don’t have to navigate it alone.

I first encountered a frozen shoulder through a close friend. A passionate swimmer in her 40s, her shoulder troubles began subtly—a twinge here and there—but soon escalated to the point where even brushing her hair was unbearable. Witnessing her battle inspired me to explore more about frozen shoulder and how we can empower ourselves to overcome it using a combination of physiotherapy, acupuncture, Chinese medicine and massage.

What is Frozen Shoulder?

Frozen shoulder occurs when the connective tissue around the shoulder joint thickens and tightens. It typically develops in three stages:

1. Freezing: Shoulder pain and stiffness gradually worsen, and your range of motion decreases.

2. Frozen: Pain may decrease, but stiffness remains, making daily activities difficult.

3. Thawing: The shoulder slowly regains its range of motion as the condition improves.

The entire process can take months, sometimes years. While it may seem like a long road, you have many tools at your disposal to treat and alleviate the discomfort.

A frozen shoulder, or adhesive capsulitis, occurs when the connective tissue around the shoulder joint (the capsule) becomes inflamed, thickened, and tightened, leading to pain and restricted movement. The condition often arises after periods of immobility due to injuries, surgeries, or medical conditions like diabetes. In the early stages, inflammation increases the production of synovial fluid, causing pain. Over time, fibrous tissue develops, further thickening the capsule and forming adhesions, which limit movement even more. Physiotherapy, focusing on stretching and joint mobilizations, helps break down these adhesions and restore shoulder mobility.

One of the symptoms of a frozen shoulder is a limited range of motion in the affected shoulder. You may struggle to raise your arm, rotate it, or lift it sideways. The stiffness and restricted mobility in the shoulder joint are prominent indicators of this condition. The limited range of motion is often progressive, worsening over time as the situation develops.

Additionally, you may notice that the symptoms of a frozen shoulder have a significant impact on your sleep quality. Pain and discomfort in the shoulder can make it challenging to find a comfortable sleeping position, leading to disturbed sleep patterns. As a result, you may experience fatigue and irritability due to inadequate rest.

Frozen Shoulder and Physiotherapy

Physiotherapy plays a crucial role in managing frozen shoulder. A tailored exercise plan can help reduce pain and improve mobility during the "freezing" stage, preventing the condition from getting worse. A physiotherapist will work with you to design safe yet effective movements. These might include gentle stretches, shoulder mobilization techniques, and specific exercises designed to restore function without causing further discomfort.

At our clinic, I’ve seen patients who thought they were stuck with their frozen shoulder for life, but with consistent and gradual physiotherapy, their shoulders ‘thawed’ faster than expected. The key is consistency and not pushing yourself beyond your limits—something physiotherapists guide you through every step of the way.

Physio Treatment for Frozen Shoulder

Physio treatment often begins with manual therapy, where a physiotherapist uses hands-on techniques to mobilize the joint. This could involve joint manipulation, where the joint is carefully moved to maintain mobility, or soft tissue therapy to reduce tension in the surrounding muscles.

Exercise therapy is another mainstay. Movements like pendulum swings and passive stretching, designed specifically for your shoulder, help increase flexibility without causing strain. Heat and ice therapy may also be used to soothe pain and inflammation.

One thing I always emphasize to my patients is the importance of pacing yourself. When dealing with frozen shoulder, slow and steady wins the race.

Frozen Shoulder Massage

Massage therapy can complement physiotherapy, especially during the "frozen" stage. Frozen shoulder massage helps by working on the muscles around the shoulder to release tension, improve circulation, and promote healing. A skilled therapist, like Ben at our clinic, would focus on the surrounding tissues—neck, back, and upper arm muscles—to create more space and ease for your shoulder.

Do's and Don’ts for Frozen Shoulder

Here are a few things that helped my friend and countless others in their recovery:

Do’s:

• Do gentle stretching: Start small and work with a physiotherapist to find safe exercises that won’t aggravate the condition.

• Do use heat and cold therapy: Heat helps relax stiff muscles, while cold therapy reduces inflammation and numbs pain.

• Do seek professional advice early: Early intervention with physiotherapy can shorten the course of the condition and prevent severe loss of motion.

Don’ts:

• Don’t push through the pain: Overstretching or forcing your shoulder to move can worsen the condition.

• Don’t immobilize your shoulder for too long: Rest is important, but keeping your shoulder completely immobile can make the stiffness worse.

• Don’t neglect other treatments: A comprehensive approach—physio, massage, acupuncture, or hydrodilation—can make a big difference.

Acupuncture for Frozen Shoulder

Acupuncture has gained traction as a treatment for frozen shoulder, with many people finding relief through this ancient practice. By stimulating certain points along meridians of the body, acupuncture may help reduce pain and inflammation. Some studies suggest it helps increase shoulder circulation, promoting healing. If you’re open to alternative treatments, acupuncture could be a complementary therapy worth exploring. We work closely with Giuilia from Quiescence in Fitzroy to help patients with frozen shoulder, by combining Physiotherapy and Chinese medicine, and acupuncture together for all round treatment.

Hydrodilation for Frozen Shoulder

One of the more advanced treatments for frozen shoulder is hydrodilation, a procedure where fluid is injected into the joint to stretch the capsule and improve movement. It’s often used when other treatments haven’t provided enough relief. The process involves injecting a mixture of saline, a local anesthetic, and sometimes corticosteroids into the shoulder joint. This expands the joint capsule and helps break up adhesions.

Many people experience significant relief after hydrodilation, and it’s often a game changer for those in the "frozen" stage. At our clinic, we’ve seen patients who were facing months of reduced mobility suddenly regain a significant range of motion after this procedure.

Hydrodilation for Frozen Shoulder Cost

As for the cost, hydrodilation typically ranges between $300 to $600 in Australia, depending on whether you’re accessing it through the public or private healthcare system. While it’s not the cheapest option, many find it well worth the investment for the improvement in shoulder mobility it can provide.

When Should you See a Physiotherapist for Frozen Shoulder?

It is advisable to see a physiotherapist for a frozen shoulder as soon as you experience symptoms such as persistent shoulder pain, stiffness, and limited range of motion. Early intervention can significantly improve the outcomes and prevent the condition from worsening. If you notice any of these symptoms, it's essential to consult a healthcare professional, preferably a physiotherapist or an orthopedic specialist, for a proper evaluation and diagnosis.

Physiotherapists play a crucial role in managing frozen shoulders. They can provide specific exercises and stretches designed to improve the flexibility and mobility of your shoulder joint. These exercises are tailored to your condition and aim to gradually increase your range of motion. Physiotherapists also use manual techniques such as joint mobilisations and soft tissue manipulation to alleviate pain and improve the mobility of the shoulder.

Additionally, physiotherapists can guide you on proper posture and body mechanics to prevent further aggravation. They can also teach you self-management techniques and home exercises that you can perform regularly to enhance your shoulder's flexibility and strength.

If your symptoms are severe, or if conservative treatments like physiotherapy exercises and pain management are not providing relief, your healthcare provider might consider other interventions, such as corticosteroid injections or, in rare cases, surgical procedures. In such instances, your physiotherapist can work closely with your healthcare team to provide pre and post-operative rehabilitation to optimise your recovery.

Final Thoughts

If frozen shoulder is limiting your life, there is hope. Whether you choose physiotherapy, massage, acupuncture, or hydrodilation, the journey to recovery requires patience and persistence. Remember, you don’t have to face this alone. By understanding your treatment options, working with professionals, and taking care of your body, you’ll eventually regain the freedom that a pain-free, mobile shoulder provides.

Frozen shoulder may feel like it’s locked you up, but with the right tools, you hold the key to unlocking your mobility.