Frozen shoulder

Overview

Frozen shoulder, medically known as adhesive capsulitis, is a condition characterised by progressive stiffness, pain, and restricted range of motion in the shoulder joint. The shoulder capsule—a connective tissue structure surrounding the joint—becomes thickened, tight, and inflamed, severely limiting movement in all directions. This debilitating condition typically develops gradually through distinct stages: an initial "freezing" phase with increasing pain and stiffness, a "frozen" phase where pain may decrease but severe stiffness persists, and a "thawing" phase of gradual mobility recovery that can take months to years.

While the exact cause often remains unclear, frozen shoulder frequently affects individuals aged 40-60, particularly women, and those with diabetes, thyroid disorders, or previous shoulder immobilisation. The condition significantly impacts daily activities—reaching overhead, dressing, or performing routine tasks becomes challenging and frustrating. Traditional, Complementary, and Integrative Health (TCIH) modalities offer valuable approaches for managing frozen shoulder by addressing soft tissue restrictions, reducing inflammation, improving circulation, restoring mobility, and supporting the body's natural healing processes through hands-on therapies and movement-based interventions.

Common Causes and Contributing Factors

• Prolonged immobilisation - Extended periods of shoulder inactivity following injury, surgery, or arm fractures allow capsular tissue to thicken and adhere
• Diabetes mellitus - Individuals with diabetes face 2-4 times higher risk, possibly due to glycation of collagen fibres and impaired tissue healing
• Thyroid disorders - Both hyperthyroidism and hypothyroidism are associated with increased incidence of adhesive capsulitis through unclear mechanisms
• Previous shoulder injury - Rotator cuff injuries, tendonitis, or bursitis can trigger protective immobilisation, leading to capsular adhesions
• Systemic inflammatory conditions - Autoimmune diseases, rheumatoid arthritis, and chronic inflammation contribute to tissue changes and adhesion formation
• Cardiovascular disease - Heart disease and stroke survivors show higher rates, potentially related to reduced arm use during recovery
• Age and gender - Peak incidence occurs between 40-60 years, with women affected more frequently than men
• Postural imbalances - Chronic poor posture, rounded shoulders, and muscle imbalances create mechanical stress on the shoulder joint
• Repetitive strain - Occupational or recreational activities requiring repetitive shoulder movements may contribute to tissue irritation
• Genetic predisposition - Family history suggests possible genetic factors affecting collagen formation and inflammatory responses

Signs and Symptoms

• Progressive pain - Dull, aching shoulder pain that worsens at night, disrupts sleep, and intensifies with attempted movement
• Severe stiffness - Marked reduction in both active and passive range of motion, particularly external rotation and overhead reaching
• Gradual onset - Symptoms typically develop slowly over weeks to months rather than appearing suddenly after an acute injury
• Difficulty with daily activities - Challenges reaching behind the back, putting on coats, fastening bras, or retrieving items from high shelves
• Night pain - Increased discomfort when lying on the affected shoulder, often the most troublesome symptom affecting sleep quality
• Compensatory patterns - Development of abnormal movement patterns as the body compensates for limited shoulder mobility
• Muscle atrophy - Wasting of shoulder muscles, particularly the deltoid and rotator cuff, due to disuse and pain-related inhibition
• Bilateral involvement - In some cases, the opposite shoulder develops similar symptoms months or years after the first
• Restricted overhead motion - Inability to raise arm fully overhead, one of the most characteristic and limiting features
• Capsular pattern - Specific pattern of limitation with external rotation most restricted, followed by abduction, then internal rotation

Holistic and TCIH Approaches

Holistic and Traditional, Complementary and Integrative Healthcare (TCIH) care addresses frozen shoulders through manual therapies that restore mobility, reduce pain, improve tissue quality, and support natural healing processes.

• Physiotherapy or Physical Therapy provides evidence-based assessment and treatment, including progressive stretching exercises to gently restore range of motion, joint mobilisation techniques to address capsular restrictions, strengthening exercises for stabilising muscles, pain management through modalities like heat or ice, postural correction to address contributing factors, and functional retraining to restore normal movement patterns for daily activities^[1,2].
• Acupuncture addresses frozen shoulder through traditional Chinese medicine principles, inserting fine needles at specific points to reduce pain and inflammation, improve local circulation and tissue healing, release trigger points in surrounding muscles, modulate pain perception through endorphin release, and restore energy flow (qi) through meridians affecting the shoulder, often combined with electroacupuncture or moxibustion for enhanced therapeutic effect^[3,4].
• Osteopathy employs comprehensive manual therapy addressing not just the shoulder but related structures throughout the body, including gentle joint articulation to improve capsular mobility, soft tissue techniques to release muscular restrictions, treatment of thoracic spine and rib restrictions affecting shoulder mechanics, lymphatic drainage to reduce inflammation, and correction of postural imbalances that contribute to shoulder dysfunction^[5.6].
• Remedial Massage targets soft tissues surrounding the frozen shoulder with therapeutic techniques including deep tissue work to release muscle tension and adhesions, trigger point therapy for referred pain patterns, gentle stretching to improve flexibility, circulatory massage to enhance healing blood flow, and techniques addressing compensatory tension in the neck, upper back, and chest muscles that develop due to altered movement patterns^[7].
• Myofascial Release Therapy addresses the fascial restrictions that contribute to frozen shoulder through sustained, gentle pressure applied to restricted connective tissue, releasing adhesions in the shoulder capsule and surrounding fascia, improving tissue hydration and mobility, addressing fascial connections throughout the arm and torso, reducing pain through mechanoreceptor stimulation, and restoring three-dimensional movement patterns essential for normal shoulder function^[8].
• Chiropractic care focuses on spinal and extremity joint function affecting shoulder mechanics, including adjustments to thoracic spine segments that influence shoulder nerve supply, treatment of rib restrictions that limit shoulder blade movement, gentle shoulder joint mobilisation appropriate for capsular restrictions, soft tissue therapies to address muscular components, and corrective exercises to maintain improvements and prevent recurrence^[9].
• Bowen Therapy offers a gentle, non-invasive approach using precise rolling movements over specific muscles and connective tissues to stimulate the body's healing response, address fascial restrictions contributing to shoulder stiffness, promote relaxation and reduce muscle guarding, improve circulation and lymphatic drainage, and allow the nervous system to reset movement patterns, performed with pauses that facilitate integration and healing^[10,11].

Self-Care and Lifestyle Practices

• Perform gentle daily exercises - Practice prescribed stretching and mobility exercises consistently, even when uncomfortable, to gradually restore range of motion
• Apply heat before activity - Use warm compresses or showers before exercise to relax tissues and improve circulation, making stretching more effective
• Use ice after exercise - Apply cold packs following stretching sessions to manage inflammation and reduce post-exercise soreness
• Maintain good posture - Practice upright posture with shoulders back to prevent additional strain and support optimal shoulder positioning
• Sleep positioning - Use pillows to support the affected arm in a comfortable position and avoid lying directly on the painful shoulder
• Stay active within limits - Continue using the shoulder for daily activities within pain tolerance to prevent further stiffening while respecting healing
• Practice stress management - Engage in relaxation techniques as stress and tension worsen muscle guarding and pain perception
• Modify daily activities - Adapt tasks temporarily to reduce shoulder strain while maintaining functional use—use the unaffected arm for heavy lifting
• Avoid prolonged immobility - Even during painful phases, perform gentle pendulum exercises and avoid complete rest, which worsens stiffness
• Be patient with recovery - Understand that frozen shoulder recovery typically takes 12-24 months, and maintain consistent effort throughout all phases

When to Seek Professional Support

Conventional medical practitioners should be consulted for accurate diagnosis through physical examination and imaging, to rule out other conditions such as rotator cuff tears or arthritis. They can also assess for underlying factors like diabetes, determine whether corticosteroid injections are appropriate for severe pain or inflammation, and evaluate the need for surgical capsular release if conservative treatment fails over time. Immediate medical attention is essential if there is sudden, severe shoulder pain that may indicate acute injury rather than adhesive capsulitis, signs of infection such as fever or warmth, rapidly worsening symptoms, complete loss of shoulder function, or symptoms appearing in both shoulders at once.

A verified SoulAdvisor practitioner can work collaboratively with medical providers to create a comprehensive treatment plan that integrates appropriate TCIH modalities. This approach recognises that frozen shoulder recovery is slow and requires patience, consistency, and a multifaceted strategy. Effective care addresses mechanical restriction, pain, inflammation, and functional limitation while supporting the body’s natural healing process. Through gentle, progressive interventions that respect tissue capacity, this integrative pathway empowers individuals to take an active role in their recovery and regain comfortable movement over time