Massage therapy · Kitchener–WaterlooFrozen Shoulder

In frozen shoulder, the capsule thickens and becomes stiff and tight. Thick bands of tissue, known as adhesions, develop. In many cases there is less synovial fluid in the joint. One of the main signs of this condition is not being able to move your shoulder, whether you try on your own or someone else moves it for you (AAOS, n.d.).

Diagnosis is usually based on range-of-motion tests: first you raise and lower your arm yourself, and then the doctor gently moves your shoulder. An X-ray or MRI may be used to rule out other problems, though scans are not needed to diagnose frozen shoulder (AAOS, n.d.).

Frozen shoulder often develops in three stages (according to the textbook, although be aware this is not always the case, and the stages can overlap) (AAOS, n.d.; Rangan et al., 2015). In the first stage, the "freezing stage", pain slowly increases and the shoulder loses range of motion; this typically lasts from 6 weeks to 9 months. In the "frozen stage", the pain may ease, but the shoulder stays stiff and daily activities can be very difficult; this typically lasts 4 to 6 months. The third stage is the "thawing stage", when shoulder movement slowly improves; a return to normal or close to normal typically takes from 6 months to 2 years (AAOS, n.d.). However, frozen shoulder does not always settle on its own, and some people need further treatment (Rangan et al., 2015).

1. Pain Relief

The NHS advises avoiding movements that cause you pain and moving your shoulder gently. It suggests trying paracetamol first, taken regularly up to the recommended daily dose, and if that does not work, trying an anti-inflammatory painkiller such as ibuprofen, stopping it if it does not help (NHS, 2024). (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

2. Home Exercises

Keep your shoulder moving, as keeping it still can make the pain worse, but do not make up your own strenuous exercises, for example using gym equipment, as this can make the pain worse (NHS, 2024). Follow the exercises I give you, or those from your family doctor, nurse practitioner or physiotherapist.

3. Heat

To ease pain and loosen the shoulder before stretching, you can put a heat pack or hot water bottle wrapped in a tea towel on your shoulder for up to 20 minutes at a time (NHS, 2024).

If your symptoms are not improving, your family doctor, nurse practitioner or specialist may talk to you about other options. It is important to discuss the chances of recovering with simple treatments, as well as the risks of any procedure (AAOS, n.d.).

Options outside my scope

• Stronger prescribed painkillers: these may be offered for a short time if over-the-counter pain relief is not enough (NHS, 2024).
• Steroid (cortisone) injection: a strong anti-inflammatory medicine injected into the shoulder joint to ease pain (NHS, 2024; AAOS, n.d.).
• Hydrodilatation: a large volume of fluid, usually saline with a steroid, is injected into the shoulder joint, guided by X-ray or ultrasound, to stretch the tight capsule (AAOS, n.d.; Royal Berkshire NHS Foundation Trust, 2024).
• Manipulation under anaesthetic (MUA): while you are asleep, the surgeon moves the shoulder firmly to stretch or release the tight capsule (AAOS, n.d.).
• Arthroscopic (keyhole) capsular release: the surgeon cuts through tight parts of the capsule using small instruments through small cuts around the shoulder (AAOS, n.d.; Rangan et al., 2015).

If you have any procedure, follow your medical team's own instructions and rehabilitation plan afterwards.

How I can help (see the My Approach tab)

• Hands-on work and gentle joint mobilisation, matched to the stage you're in
• Stretching and range-of-motion exercises, with a home programme
• Advice on heat, sleeping positions and everyday tasks

• Gentle massage for the neck, upper back and shoulder blade muscles, which work overtime, including the subscapularis (a deep muscle on the front of the shoulder blade)
• Warmth for the neck and upper back, and warm or cool applications on the shoulder, whichever eases it more
• Small, pain-free joint movements and relaxed pendulum swings
• At home: pendulum swings, stick-assisted exercises and gentle neck movement

When It's Stiff (Frozen)

• Warmth first, then firmer joint mobilisation, using slow movements and never quick or forceful ones
• Cross-fibre and myofascial work on tight muscles around the shoulder
• Assisted stretches where you push gently against my hand, then relax a little further
• Walking your fingers up a wall to track progress, plus gentle strengthening

Sleeping with the sore arm uppermost, supported on pillows, often helps. Armpit work needs your informed consent, and chest wall work also needs a written consent form; you can say no at any time. Shoulder pain with chest pain, shortness of breath or feeling unwell needs medical help first: call 911 if it comes on suddenly.