Frozen Shoulder: who to see and what helps

Frozen Shoulder · Kitchener, Waterloo & Cambridge

Frozen shoulder is a painful, stiff shoulder: the tissue around the joint becomes inflamed and tightens, and the arm becomes hard to move. It can take months or years to get better, though it usually does, and a steroid injection from a physician combined with stretching exercises relieves pain better over the following four to six weeks than the exercises alone. At CARESPACE a physiotherapist leads the care.

What frozen shoulder is

Frozen shoulder, also called adhesive capsulitis, is stiffness, pain and a limited range of movement in the shoulder. The tissue around the joint becomes inflamed, then tightens, shrinks and scars. It usually comes on slowly.

What sets it apart from the other shoulder conditions on this site is that the shoulder will not move fully whether you move it or someone else moves it for you. With rotator cuff tendinopathy, shoulder impingement or shoulder bursitis, the main complaint is pain while using the arm. A rotator cuff tear is a torn tendon, and when it happens suddenly the pain is very bad and the arm is difficult to move at all.

A 2013 guideline from the American Physical Therapy Association describes four stages: a first stage lasting up to three months, a painful “freezing” stage from about three to nine months, a “frozen” stage from nine to 15 months, and a “thawing” stage from 15 to 24 months.

Symptoms of frozen shoulder

• Shoulder pain, which can be worse at night and disturb sleep
• Stiffness that makes the shoulder hard to move
• A gradual onset that gets steadily worse

The stiffness makes ordinary reaching awkward: the seatbelt, a back pocket, or stretching across a frosted windshield with an ice scraper.

What causes frozen shoulder

Often it is not clear why it happens. It is more likely:

• After an injury or surgery that stops you moving the arm normally
• If you have diabetes or thyroid disease
• Between about 40 and 65
• In women, especially after menopause
• If your other shoulder has had it before

If you have diabetes, keep up your regular check-ups.

How frozen shoulder is diagnosed

From an examination. Frozen shoulder is suspected when shoulder movement is limited; one large trial defined it as outward rotation of the arm, when moved by the examiner, of less than half that of the other shoulder. An X-ray may be done to see whether arthritis or a broken bone is the real cause. It is arranged through a physician or nurse practitioner, or a chiropractor can order one.

When a painful, stiff shoulder needs urgent care

Frozen shoulder comes on slowly. Shoulder pain that behaves differently needs medical attention. Call 911 for discomfort in the shoulder, arm, neck, jaw or back that comes with chest pressure or pain, sweating, nausea, shortness of breath or light-headedness: these are signs of a heart attack. See a physician or nurse practitioner, or go to an urgent care clinic or emergency department, the same day if a painful shoulder comes on suddenly or after a fall, if both shoulders become severely painful, if the shoulder is hot, badly swollen or has changed shape, if you lose feeling in the arm, or if you feel feverish or unwell.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating frozen shoulder

• What this section draws on. The 2013 guideline, a Cochrane review (2014), a 2020 review of treatment trials, and UK FROST, a 2020 trial of 503 people in the United Kingdom. “Strong” evidence below means several studies that agree, including at least one of the top level; “weak” means a single lower-level study or consensus opinion.
• An injection with exercises beats exercises alone, for a while. An injection into the joint, combined with mobility and stretching exercises, is more effective for pain and function over four to six weeks than the exercises alone (strong evidence). The 2020 review recommends an injection for a frozen shoulder of less than a year’s duration, with a home programme of simple movement exercises and stretches. Injections are given by a physician, not at CARESPACE.
• Hands-on treatment with exercise, without an injection, is slower early and similar later. It probably improves pain and function less than an injection for the first seven weeks; by six and 12 months the difference was not clinically important. No trial has tested manual therapy with exercise against a placebo or no treatment.
• Stretch to what the shoulder tolerates, not through pain. Stretching exercises should be taught, with the intensity set by how irritable the shoulder is. Stretching beyond painful limits may lead to poorer results.
• Joint mobilization may help. Mobilization of the shoulder joint may be used to reduce pain and improve movement and function (weak evidence). Adding supervised mobilization and an electrotherapy modality to the injection and home programme may bring benefit in the medium term.
• Acupuncture did not add benefit. The 2020 review found that adding acupuncture to physiotherapy did not seem to bring any added benefit.
• Procedures are for shoulders that do not respond. UK FROST compared physiotherapy that included an injection with two hospital procedures, manipulation under anaesthesia and keyhole capsular release. None was clinically superior at 12 months. Capsular release led to the fewest further treatments but the most serious complications (in 4% of that group, against 1% after manipulation and none with physiotherapy), and 15% of the physiotherapy group went on to further treatment. The authors encourage surgeons to use capsular release selectively, when less invasive options have failed.

What a physician or surgeon may offer

These are arranged outside CARESPACE.

• Pain relief. Acetaminophen or an anti-inflammatory, sometimes stronger prescribed painkillers, and the steroid injection described above.
• Manipulation under anaesthesia. You are put to sleep, and the surgeon moves the arm to stretch the tightened tissue.
• Arthroscopic capsular release. Keyhole surgery in which the tight and scarred tissue is cut.

How each CARESPACE service treats frozen shoulder

Physiotherapy

A physiotherapist leads frozen shoulder care from start to finish, and the work changes with the stage. While the shoulder is very painful, a physiotherapist can help with pain management, advise on which movements to avoid for now and teach gentle movement exercises kept short of pain. As the pain eases, stretching can become firmer and joint mobilization can be added. They can also explain the course to expect, set a home programme and tell you when it is worth asking a physician about an injection. After a manipulation or capsular release, physiotherapy restarts quickly: in UK FROST it normally began within 24 hours and ran for up to 12 sessions over as long as 12 weeks.

See our physiotherapy team → · Post-surgical physiotherapy →

Chiropractic

A chiropractor can provide mobilization of the shoulder joint, the hands-on technique the guideline supports on weak evidence, along with mobilization of the neck and upper back. “Manipulation under anaesthesia”, which you may read about, is a hospital procedure done while you are asleep, not a chiropractic adjustment.

See our chiropractic team →

Other services people ask about

Massage therapy, acupuncture and osteopathy are all offered at CARESPACE. For acupuncture, the 2020 review found that adding it to physiotherapy did not seem to bring any added benefit; for massage and osteopathy the 2013 guideline makes no recommendation, for or against, so we do not claim that either changes the course of the condition. If you choose one for comfort, it should not take time or budget away from the stretching programme.

Where most people start

Start with Physiotherapy. A physiotherapist can tell you whether the pattern fits frozen shoulder and begins treatment at the first visit. It is also worth seeing your physician early, because the injection, which gives the best short-term relief, comes from them.

How your team works together

Over the long course of a frozen shoulder, the aim is to keep you moving without overdoing it. A physiotherapist can set the stretching programme and adjust it as the stages change, your physician handles pain medicine and any injection, and a chiropractor can add joint mobilization.

Browse by service: physiotherapists, chiropractors, registered massage therapists, acupuncture practitioners and osteopathic manual practitioners.

What to expect at your first visit

1. Background. When the stiffness started, how you are sleeping, any injury or surgery beforehand, and whether you have diabetes or a thyroid condition.
2. Movement testing. How far the shoulder goes when you move it and when the physiotherapist moves it, compared with the other side.
3. What it means. Whether the pattern fits frozen shoulder, what stage it looks like, and whether a physician should check anything else.
4. Treatment to start with: pain-relieving measures, the first gentle exercises, and a plan to leave with.

What you can do at home

• Do the exercises you have been given, and keep the shoulder moving: keeping it still makes the pain worse.
• Avoid the particular movements that cause pain.
• Put a heat pack or hot water bottle, wrapped in a tea towel, on the shoulder for up to 20 minutes at a time.
• If you need pain relief, take acetaminophen regularly, up to the recommended daily dose; a pharmacist can advise.
• Do not invent strenuous exercises of your own. Gym equipment can make the pain worse.

How long frozen shoulder lasts

Expect months, possibly years, and expect improvement: HealthLink BC says it can take a year or more and nearly always gets better over time. The guideline notes that mild to moderate pain and stiffness may still be there at 12 to 18 months, and that mild symptoms can persist for years. In the UK, NHS physiotherapy for frozen shoulder usually lasts at least six weeks. Go back to your physician or physiotherapist if you are still in pain when your sessions end.

Frozen shoulder treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener, Massage Therapy in Kitchener, Acupuncture in Kitchener and Osteopathy in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo, Massage Therapy in Waterloo, Acupuncture in Waterloo and Osteopathy in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge and Acupuncture in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How long will my frozen shoulder take to get better?

Months to years. The stages near the top of this page run to about two years.

Should I get a cortisone injection for frozen shoulder?

The evidence favours it early on, together with stretching exercises. Ask your physician; CARESPACE does not give injections.

Should I push through the pain when I stretch?

No. Keep moving, but short of pain, and let your physiotherapist decide when to make the stretches firmer.

Can I get frozen shoulder in the other shoulder?

Yes. Having had it in one shoulder makes it more likely in the other.

Is surgery ever needed for frozen shoulder?

Not usually as a first step. It is kept for shoulders that have not responded to less invasive treatment.

Where can I get help for a frozen shoulder in Cambridge?

At CARESPACE Hespeler Road, which offers physiotherapy, the lead service for frozen shoulder, as well as acupuncture. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. Clinical Practice Guidelines from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 2013.
• Page MJ, Green S, Kramer S, et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews, 2014.
• Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Network Open, 2020.
• Rangan A, Brealey SD, Keding A, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST). The Lancet, 2020.
• NHS (UK). Frozen shoulder. Reviewed June 2024.
• HealthLink BC. Frozen Shoulder. Current as of November 2022.
• NHS (UK). Shoulder pain. Reviewed May 2023; its next review was due in May 2026.
• Heart and Stroke Foundation of Canada. Signs of a heart attack.

Related conditions

Rotator Cuff Tendinopathy

Rotator Cuff Tear

Shoulder Impingement

Shoulder Bursitis

Ready to book?

Book online with a physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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