Frozen shoulder (adhesive capsulitis) causes pain and stiffness, severely limiting shoulder mobility. This occurs when the connective tissue capsule thickens and tightens, often forming scar tissue. Although the exact cause is unclear, the condition is self-limiting and will improve over time. Full recovery can take one to three years, so recognizing the distinct phases is key to understanding recovery.
Understanding the Stages of Frozen Shoulder
Adhesive capsulitis progresses through three stages. The initial Freezing stage involves gradual pain onset (often worsening at night) and slow loss of shoulder range of motion. This phase lasts six weeks to nine months as inflammation causes the joint capsule to tighten.
The second phase is the Frozen stage, where stiffness reaches its maximum, significantly restricting movement. Severe pain from the first stage often lessens during this time. This maximal stiffness makes daily activities challenging and usually lasts four to twelve months.
The final phase is the Thawing stage, characterized by slow, steady improvement in mobility. Stiffness begins to resolve, and the shoulder’s ability to move returns. This recovery period is typically the longest, often lasting six months to two years, as the shoulder gradually regains function.
Key Indicators of the Thawing Transition
The most significant sign that the shoulder is entering the Thawing phase is a noticeable, sustained improvement in range of motion. The shoulder begins to loosen, unlike the Frozen phase where movement was extremely limited. This improvement is gradual, increasing the distance the arm can travel (e.g., lifting the arm overhead or reaching behind the back).
A reduction in overall pain, particularly sharp, movement-limiting pain, accompanies this return of motion. While some discomfort may remain when pushing new limits, the constant, dull ache from earlier stages begins to diminish. Patients often report decreased tension in the shoulder and surrounding neck and upper back muscles.
Tangible evidence of thawing includes the ability to perform previously impossible daily tasks. Movements like reaching into a back pocket, fastening a seatbelt, or combing hair become more manageable. This return of functional movement confirms that the scar tissue within the joint capsule is softening and stretching.
Appropriate Movement During the Recovery Phase
Once thawing begins, management shifts from pain control to restoring full function. Physical therapy is recommended to guide this transition, moving from gentle, passive stretches to more active movements. The goal is to progressively increase the frequency and duration of stretching to encourage the joint capsule to lengthen.
A consistent exercise routine must be maintained without causing re-injury or significant inflammation. Movements should be performed within a tolerable range, avoiding aggressive motions that push pain beyond a moderate level. Simple exercises, such as pendulum swings or using a broomstick to assist lifting and rotating, are often introduced to mobilize the joint.
As mobility improves, strengthening exercises are gradually introduced to stabilize the joint and support the regained motion. This combination of flexibility and strength training allows for a complete return to normal activities. Regular communication with a therapist ensures appropriate exercise intensity.
Recognizing Stalled Recovery and Next Steps
The duration of the Thawing phase is highly variable, requiring patients to expect slow, steady improvement over many months. Recovery is considered stalled if there is no measurable gain in range of motion over two to three months despite consistent adherence to rehabilitation. In these cases, the joint capsule may remain severely adhered, preventing natural resolution.
If progress halts, consultation with an orthopedic specialist is warranted to discuss advanced interventions. Options include image-guided hydrodilatation (injecting fluid to stretch the capsule). Alternatively, manipulation under anesthesia or an arthroscopic capsular release may be considered to physically break up adhesions and restore mobility.