Frozen Shoulder: Physical Therapy Treatments and Exercises

Adhesive capsulitis, also called shoulder contracture or frozen shoulder, occurs when the soft tissue around the shoulder joint swells, thickens and contracts. Scar tissue forms, leaving less room for the upper arm to move around. This can cause pain, stiffness and an inability to move the shoulder freely. Symptoms usually begin slowly and get worse over time. Although frozen shoulder can, in some cases, resolve itself eventually without treatment, this is not the best course of action. Getting physical therapy and doing special frozen shoulder exercises at home can provide some relief.

A physical therapist wroking with a patient raising their arm.

“Frozen shoulder can be pretty painful, but we can speed up recovery with physical therapy and other treatments,” says Jaclyn Smulofsky, PT, DPT, a physical therapist at HSS. “Since some treatments are time-sensitive – meaning the earlier you start, the better your recovery will be – it’s important to see a professional if you think you may be suffering from it.”

Experts don’t know exactly why it happens, though some people are more at risk, including those with diabetes, those with thyroid issues, and those who have had to immobilize their shoulder after surgery or an injury (like a broken arm or collarbone).

Symptoms of frozen shoulder

If you’re experiencing any of the following, frozen shoulder might be the cause:

  • pain and stiffness in the shoulder that often gets worse at night
  • difficulty lifting your arm above your head
  • difficulty extending your arm across your body or reaching behind your back

Frozen shoulder can usually be diagnosed only through a physical exam. Your doctor will assess your range of motion by moving your arm and shoulder around, and they’ll ask you to move it around yourself as well.

Treatment for frozen shoulder

Pain relievers, anti-inflammatories like ibuprofen, and/or corticosteroid injections can help ease pain and reduce inflammation. Physical therapy can help improve range of motion by loosening tight muscles and increasing joint motion.

To get the most out of your physical therapy appointment, Smulofsky suggests writing a list of things that make your shoulder feel worse, as well what makes it feel better. “That’s good information for the therapist – if we know how irritable the patient is, we know what exercises we can and can’t do right away,” she says.

At your first appointment, the therapist will assess your range of motion by comparing the movement of your two arms. They’ll also evaluate your arm and shoulder strength and do some gentle stretching to loosen up the shoulder, depending on how severe the stiffness is. The first appointment will probably be about an hour; later sessions will last anywhere from a half hour to 45 minutes, depending on the doctor’s request and where you get your PT. “I usually recommend at least one to two visits a week, and would expect to see some degree of relief within the first six to eight weeks,” says Smulofsky.

Frozen shoulder exercises

To get some relief at home, try the stretches below. Start out doing each stretch 10 times, holding for about 10 to 15 seconds at a time. Once you can handle 10 times, work your way up to 20. You can do these every day (at a minimum, do them five days per week) and up to twice a day.

  • Lie on your back with your arms at your sides. Use the hand of the healthy arm to lift the affected arm and stretch it back over your head as far as you can.
  • Sit up comfortably and use the hand of your healthy arm to lift your affected arm at the elbow and bring it up and across your body. Put some gentle pressure on the elbow to stretch the shoulder.
  • Stand and lean over slightly, holding on to something like a tabletop or the back of a chair with your good arm, while you allow the affected arm to hang down. Gently swing the affected arm around in a small circle clockwise 10 times, then go counterclockwise 10 times. As your shoulder loosens up, you’ll be able to widen the circle.
  • Sit up comfortably and squeeze your shoulder blades together.
  • Stand up and hold one end of a towel behind your back with your affected arm, then grab the other end with your good arm. Holding the towel horizontally, use your good arm to pull the towel upward (to the side), which will stretch the affected arm.
  • Stand up and hold a small pillow behind your back with your good arm, then pass it to the affected arm, continuing to pass it back and forth.

The stretches may feel uncomfortable, even a little painful, at first. “I usually tell patients to do them right after a shower or bath, when their muscles are warmed up and a little looser, which can help you get deeper into the stretch less painfully,” says Smulofsky.

In cases where physical therapy does not provide adequate relief, two surgical options are available: manipulation under anesthesia (which involves no incisions) or a minimally invasive procedure called arthroscopic capsular release.

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