Frozen Shoulder: What Is It and Which Treatments Can Help?
Approx. 5-min read
Understanding the three stages of frozen shoulder—and how soft tissue therapy and dry needling can help ease pain, improve movement and support recovery
Reaching for a seatbelt, putting on a coat or rolling over in bed should not require careful planning. With frozen shoulder, even these ordinary movements can become painful, restricted and frustrating.
So, can treatment help?
Yes. Although no single technique instantly “releases” a frozen shoulder, the right treatment can help reduce pain, manage muscular guarding, support movement and make everyday activities more comfortable.
The key is matching treatment to the stage of the condition rather than forcing an already irritable shoulder.
What is frozen shoulder?
Frozen shoulder, also called adhesive capsulitis, occurs when the capsule surrounding the shoulder joint becomes painful, thickened and increasingly stiff.
The defining feature is a progressive loss of both:
Active movement — how far you can move your arm yourself
Passive movement — how far somebody else can move the relaxed shoulder.
External rotation — turning the forearm away from the body while keeping the elbow tucked in — is often particularly restricted.
Frozen shoulder is most common between the ages of 40 and 60 and affects women more often than men. It may be described as primary, when there is no clear initiating event, or secondary, when it follows an injury, surgery or period of reduced shoulder movement. Frozen shoulder is also more common in people with diabetes and certain thyroid conditions.
Because other shoulder conditions can produce similar symptoms, assessment matters. If the presentation does not fit a typical pattern, further clinical investigation may be required.
At Kinesis, new clients begin with an Initial Assessment & Treatment, allowing time to understand how the shoulder is behaving before deciding which techniques are appropriate.
What are the three stages of frozen shoulder?
The stages overlap and do not follow an exact timetable, but they help guide treatment.
1. The freezing stage
Pain is usually the dominant feature.
Pain gradually increases while movement reduces. Night pain is common, and sudden movements can produce an intense jolt.
This stage can last from several weeks to many months. Treatment should generally prioritise symptom relief, muscular relaxation and comfortable movement rather than repeatedly forcing the shoulder into severe pain.
2. The frozen stage
Pain may begin to settle, but stiffness becomes more prominent.
Reaching overhead, behind the back or out to the side can remain extremely restricted. Dressing, driving and lifting may still be difficult.
This stage commonly lasts several months. As the shoulder becomes less irritable, mobility work and treatment can usually be progressed more confidently.
3. The thawing stage
Movement gradually begins to return and everyday tasks become easier.
Mobility, strength and functional exercise can be progressed as the shoulder becomes more tolerant. This stage may still take many months, and the complete course of frozen shoulder can extend beyond a year.
Most people improve substantially, although some retain a degree of stiffness or reduced movement after the worst symptoms have passed.
How is frozen shoulder identified?
There is no single home test that confirms frozen shoulder.
Assessment considers the history, pain pattern and restriction of active and passive movement. A marked loss of passive external rotation is an important finding.
Other conditions — including rotator-cuff injury, glenohumeral osteoarthritis and pain referred from the neck — can produce similar symptoms. In older adults, substantial passive restriction may indicate shoulder-joint osteoarthritis rather than frozen shoulder.
Imaging is not always required, but a medical professional may recommend it to exclude another cause.
Can soft-tissue therapy help frozen shoulder?
Yes. Although soft-tissue therapy does not directly reverse the capsular process, it can play a valuable role in managing its wider effects.
As the joint stiffens, muscles around the shoulder, shoulder blade, neck and upper back often work harder to protect or compensate for lost movement. This may create additional tension, soreness and guarding.
Appropriately applied treatment can help:
Reduce surrounding muscular tension and sensitivity
Ease protective guarding
Make movement feel more comfortable
Support movement of the shoulder blade and surrounding structures
Address compensatory tension through the neck and upper back
Support relaxation when pain and poor sleep are adding to the problem
Create a better opportunity for mobility work and home exercise
Treatment should not involve trying to overpower the restriction. Pressure, positioning and movement must reflect how irritable the shoulder is on that particular day.
If you are unsure how the approaches differ, read about the difference between sports massage and soft tissue therapy.
Can dry needling help frozen shoulder?
Dry needling may provide an additional targeted option where muscular pain, sensitivity or protective guarding is contributing to the presentation.
By treating appropriate muscles around the shoulder girdle, dry needling may help reduce discomfort and create a useful window in which movement and exercise feel easier. Early research has reported improvements in pain, movement and disability when dry needling is combined with conventional rehabilitation.
Dry needling is not intended to puncture or release the joint capsule. At Kinesis, it is used selectively as part of a wider assessment-led plan rather than as an isolated cure.
What other treatment may help?
Stage-appropriate movement is important. During the painful stage, this may involve gentle, controlled movement within a tolerable range. As pain settles, stretching, mobility and strengthening can be progressively increased.
Pain relief or an intra-articular corticosteroid injection may also be considered through a GP or appropriately qualified medical professional. Current guidance supports injections for short-term symptom control in suitable cases, particularly when pain is limiting sleep and movement.
How we treat frozen shoulder at Kinesis Performance
Treatment begins by understanding:
When the symptoms started and how they have changed
Which movements and everyday activities are restricted
Whether pain or stiffness is currently the greater problem
How the shoulder, neck, upper back and opposite side are compensating
What you need to return to doing
During a more painful freezing stage, treatment may focus on comfort, supported positioning, gentle soft-tissue work, dry needling where appropriate and movement within a tolerable range.
During the frozen and thawing stages, treatment can become broader and more progressive, addressing surrounding restrictions while supporting controlled mobility and a gradual return to strength.
Movement is reassessed so that any immediate change can be measured rather than assumed. Practical home guidance may also be provided to support progress between appointments.
You can read what to expect during your first appointment before attending.
If the presentation requires imaging or injection therapy I will explain why and recommend an appropriate referral.
When should shoulder pain be assessed?
Arrange an assessment if pain or stiffness is worsening, disturbing sleep or restricting normal daily activity.
Seek more urgent medical advice following significant injury, sudden marked weakness, deformity, substantial swelling, numbness, unexplained illness or a hot, red joint. Shoulder pain accompanied by chest pain or breathlessness requires urgent medical attention.
The takeaway
Frozen shoulder can be slow and frustrating, but treatment can make the process far more manageable.
By reducing surrounding muscular pain and guarding, supporting comfortable movement and progressively restoring mobility and strength, soft-tissue therapy and dry needling can form valuable parts of a wider recovery plan.
Experiencing persistent shoulder pain or stiffness? Book an Initial Assessment & Treatment at Kinesis Performance in Welwyn Garden City. I will assess how the problem is presenting, provide appropriate treatment and refer you onwards if necessary.
This article provides general information and is not a diagnosis or substitute for individual medical advice.
References
Rupani N, Gwilym SE, on behalf of the BESS Frozen Shoulder Working Group. British Elbow and Shoulder Society patient care pathway: Frozen shoulder. Shoulder & Elbow. 2025;17(4):351–363.
Kirker K, O’Connell M, Bradley L et al. Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis. Journal of Manual & Manipulative Therapy. 2023;31(5):311–327.
Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Network Open. 2020;3(12).
Wong CK, Levine WN, Deo K et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017;103(1):40–47.
Dyer BP, Rathod-Mistry T, Burton C et al. Diabetes as a risk factor for the onset of frozen shoulder: a systematic review and meta-analysis. BMJ Open. 2023;13.
Kalia V, Mani S, Kumar SP. Short-term effect of myofascial trigger point dry-needling in patients with adhesive capsulitis. Journal of Bodywork and Movement Therapies. 2021;25:146–150.
