Frozen Shoulder: Understanding It, What May Help and Why Early Advice Matters

Frozen shoulder arrives quietly and then takes over. What starts as a niggle, movements such as when you reach for a seatbelt irritate it. Over the weeks that follow the shoulder aches deeply and wakes you at night and it will not turn or lift the way it should. People often arrive to see me worried they have done something serious or have read that nothing can be done to help a frozen shoulder and they simply have to wait years for it to get better. Neither is quite right.

Frozen shoulder is common, it is not dangerous and while it does run its own course, there is value in getting the diagnosis confirmed early, understanding which stage you are in and dealing with the associated pain and stiffness that can build up around a frozen shoulder. That is where chiropractic could help.

“Leslie is always extremely kind, caring, incredibly supportive and effective. He gives time to you and listens.”

“Leslie is without doubt the best chiropractor I have been treated by. When I first met him I had one or two other health problems, including a frozen shoulder so I was not in great shape. Leslie has always been extremely kind, caring, incredibly supportive and effective. He gives time to you and listens. He has a wealth of knowledge and has a natural ability to put you at ease with his charming and gentle manner. I feel in a very fortunate position that I can call on this utterly professional and compassionate man for help when I need it. Thank you so very much Leslie”

Rebecca P

what is a frozen shoulder

Frozen shoulder, which doctors call adhesive capsulitis, affects the capsule: the soft tissue envelope that wraps around the ball and socket joint. For reasons still not fully understood, the capsule becomes inflamed, thickened and contracted, making the shoulder painful first and then progressively stiff.[3] It is surprisingly common, affecting roughly one in twelve men and one in ten women of working age, most often between 40 and 60.[1] It classically moves through phases: a painful “freezing” stage, a stiff “frozen” stage where pain eases but movement stays limited and a gradual “thawing.” Most people recover well over one to three years though for some, mild stiffness lingers longer, one more reason to look after the shoulder properly along the way.[1][3]

common causes of frozen shoulders

Most frozen shoulders arrive without any injury at all, meaning they are idiopathic, which is part of what makes them so puzzling. Some follow a period of immobility, such as after a fracture, surgery or a spell of shoulder pain that made you stop using the arm.

Health background plays a role: people with diabetes are several times more likely to develop it, with around three in ten affected at some point and thyroid conditions also raise the risk.[4] It appears slightly more often in women and occasionally follows on the other side years later. What it is not, is your fault. It is not caused by poor posture, sleeping awkwardly or failing to exercise. Knowing that makes many of my patients feel better and more positive about the condition.

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graph of the stages of a frozen shoulder and its symptoms and how long frozen shoulder pain may last

The stages of a frozen shoulder

The stages of a frozen shoulder recovery explained:freezing, frozen, thawing and recovery. Pinpointing the stage it is most restricted
movement restriction patterns of frozen shoulder and what else the condition could be causing your pain if it's not a frozen shoulder

Frozen Shoulder and its differentials

Explaining what conditions could be causing your shoulder pain if it is not diagnosed as a frozen shoulder
compensation around a frozen shoulder

frozen-shoulder-compensatory-muscles

When the shoulder does not function correctly other muscles compensate and are recruited to work harder.

symptoms of a frozen shoulder

The early stage is dominated by pain: a deep, dragging ache in the shoulder and upper arm, sharp when the arm is jolted or moved quickly and often at its worst at night. As weeks pass, stiffness takes over. Reaching into a back pocket, fastening a bra or reaching behind you to do up a zip, reaching upwards when combing your hair or reaching across to the passenger seat becomes difficult and the arm simply stops short.

The distinguishing feature and the thing I examine for specifically is that a true frozen shoulder is stiff in every direction even when I move the arm for you. That is relevant because around half of the stiff, painful shoulders I assess turn out to be something else: a rotator cuff problem guarding and mimicking stiffness, arthritis in the joint or pain referred from the neck.[3] Each condition is managed differently and pain with pins and needles down the arm points to the neck rather than the shoulder at all. Getting this correctly addressed and early on why the thorough assessment I carry out is paramount.

how I can help you

I do offer help with your frozen shoulder and it is threefold and each part has value.

Firstly, diagnosis. Confirming whether this is a true frozen shoulder or one of its mimics changes everything about what happens next and it is a clinical judgement made with the hands and a careful history rather than a scan.[3]

Secondly, timing. The evidence suggests a corticosteroid injection, arranged through your GP, helps most in the early painful stage especially when it is combined with a simple home exercise programme, so knowing your stage means acting at the right moment rather than too late.[2] I will happily write to your GP to support that.

Thirdly, the pain and stiffness around the problem. A shoulder that stops moving drags the neck, shoulder blade and upper back into compensating and that surrounding joint and muscle pain is something I do treat with gentle mobilisation, soft tissue work and stretching matched to your stage, keeping everything that can move moving while the capsule does its slow work.

No hands-on treatment, from any profession, has been shown to shorten the course of a true frozen shoulder itself. A major UK trial comparing physiotherapy with two forms of surgery found no clinically meaningful difference between them at one year, which is reassuring: most people do not need an operation.[1] So my role is not to promise to fix the capsule but to possibly assist with associated pain. Care is individualised to how your shoulder responds and we proceed based on your recovery pattern.

If a frozen shoulder is getting in the way of things you would rather be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

Book a free consultation

Or call for a chat on 01202 937568

Headshot of Leslie Budzynski DC, BCA registered Bournemouth Chiropractor at Bournemouth Chiropractic

red flags

Frozen shoulder itself is benign and the situations below are uncommon.

See your GP promptly if the shoulder became stiff and painful after a significant fall or accident, if it is hot, swollen or accompanied by fever, if you have a history of cancer and develop new unexplained shoulder pain or if you are losing weight or feeling generally unwell alongside it. A shoulder that cannot lift at all immediately after an injury needs assessment for a large tear. And because pain in the left shoulder and arm can occasionally come from the heart, call 999 if shoulder pain arrives with chest tightness, breathlessness or sweating.

your first visit to Bournemouth Chiropractic 

 

If your shoulder is painful, stiff and confusing and frustrating you do not spend weeks or  months wondering what to do. Come in to see me at the chiropractic clinic and let me examine things properly. You will leave with a clearer picture and knowing what it is and what is worth doing about it.

Your first appointment starts with your medical history: how it began, what has changed, your health background and what the pain is stopping you from doing. I then examine the shoulder properly, checking movement in each direction both actively and with the arm relaxed, testing the rotator cuff and screening your neck, since these findings separate a true frozen shoulder from its possible imitators. You leave with a explanation of what is going on, which stage you are in and an agreed plan if you want one, whether that involves chiropractic care with me, your GP or both. You can read more on the your first visit page.

Frequently Asked Questions

Where chiropractic treatment can help a frozen shoulder is confirming the diagnosis because half of stiff shoulders are caused by something else in the neck or shoulder area. If you proceed with a course of treatment I will advise on timing so options like a GP arranged injection are used when they work best. I would also be treating the associated neck, shoulder blade and joint pain that builds up around a shoulder that will not move. According to evidence no manual treatment on the actual capsule itself that is frozen has been shown to shorten a true frozen shoulder’s course.[1] Chiropractic addresses the associated muscles which have been working more than they normally should to compensate for the injury.

Most frozen shoulders run their course untouched over one to three years, moving through painful, stiff and thawing stages.[1] That sounds long and daunting but the painful stage is the worst of it and does pass and most people regain good, usable movement. A minority are left with mild lasting stiffness, which is worth knowing.[3]

Forcing a frozen shoulder to move tends to flare it, especially early on. Gentle, regular movement within comfortable limits is right and what the word “comfortable” means alters between stages. This is exactly the sort of thing worth getting individual chiropractic advice on.

Usually not. Frozen shoulder is a clinical diagnosis, made from your history and the pattern of restriction on examination.[3] An X-ray is sometimes useful to rule out arthritis in the joint, which can mimic a frozen shoulder. I will tell you if I think imaging would change anything in your case.

A frozen shoulder very rarely returns in the same shoulder once thawed. The other shoulder is affected in a minority of people, sometimes years later and the risk is higher with diabetes.[4] If you feel the familiar ache beginning on the other side, come in early to see me: that is precisely when advice and injection timing matter most.[2]

Whatever is possibly behind your frozen shoulder, come and find out

Frozen shoulder can be a slow, frustrating condition and most people want to understand what's happening and what to do about it before it impedes everyday life even more. I'd happily see you for an assessment to help make sense of it. During your consultation I'll give you an honest opinion on what's going on and where you're likely to get the best help.

Frozen shoulder is a common reason people contact me for guidance locally in Bournemouth and Poole.

For some people, chiropractic care alongside the wider management of frozen shoulder including any pain and stiffness around the problem is a well-tolerated option and well worth exploring and I'll explain clearly what I think may help in your particular individual case. If I think you'd be better served by your GP, a physiotherapist or another specialist, I'll help point you in the right direction.

Call, message or email, whatever's easiest and we'll take it from there.

References

[1] Rangan A, Brealey SD, Keding A, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet. 2020;396(10256):977-989. https://doi.org/10.1016/S0140-6736(20)31965-6

[2] Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. https://doi.org/10.1001/jamanetworkopen.2020.29581

[3] Lewis J. Frozen shoulder contracture syndrome: aetiology, diagnosis and management. Man Ther. 2015;20(1):2-9. https://doi.org/10.1016/j.math.2014.07.006

[4] Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J. 2016;6(1):26-34.

Medical Disclaimer: The information on this website is for general informational purposes only and does not constitute medical advice, nor is it a substitute for diagnosis, treatment, or guidance from a qualified healthcare practitioner. If you have any health concern, please consult your GP or another appropriately qualified clinician. Chiropractic treatment isn’t suitable for everyone. Suitability is assessed at your initial consultation, with referral to another healthcare professional made where appropriate. Treatment outcomes vary between individuals, and no guarantee of results is made or implied.

Practitioner: Leslie Budzynski D.C. | Doctor of Chiropractic | GCC registration: 00043 | BCA membership number: 0072

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