Synapse Physiotherapy | Physio Center | Rehab Malaysia

Shoulder Pain


Frozen shoulder, also known as adhesive capsulitis, is a painful and debilitating condition that affects the shoulder joint. It is a condition that causes a gradual loss of movement in the shoulder joint. The shoulder joint is a ball and socket joint and it is one of the most mobile joints in the body. However with a frozen shoulder, the joint feels stuck and its movement is limited. The shoulder capsule thickens and becomes stiff and tight. Thick bands of tissue called adhesions develop and there will be less synovial fluid in the joint to lubricate the joint, which will make it painful and stiff to move.

Symptoms and Causes

Individuals experiencing frozen shoulder often find their daily activities compromised due to varying degrees of symptoms such as:

  • Dull and aching pain.
  • Stiffness and difficulty to move the shoulder joint.
  • Typically worse in the earlier phase of the condition.
  • Usually located over the outer shoulder area and sometimes the upper arm.

There is no known specific cause for frozen shoulders. It is most often caused by inflammation of the tissues surrounding the joint or immobilisation of the shoulder after an arm injury or inflammation of the muscles and tendons (such as rotator cuff tendinitis or bursitis).

The following are some of the risk factors for frozen shoulder:

  • People aged 40 and older, particularly women
  • History of immobility and injury/trauma to the shoulder
  • Stroke
  • Recovery from surgery
  • Systemic diseases such as diabetes, thyroid disorders, cardiovascular diseases and Parkinson’s disease.


Stages of Frozen Shoulder

For people who are suffering from this condition, symptoms may develop suddenly and have a slow recovery phase. Recovery may take up to 2 or 3 years. Frozen shoulder develops in three stages:

 Stage 1 – Freezing

Any movement of the shoulder causes pain, and the shoulder’s ability to move becomes limited. Typically at this stage, the patient will experience an increase in pain. The freezing stage lasts from 2 to 9 months

Stage 2 – Frozen

Painful symptoms may lessen during this stage however stiffness remains or increases. Using the shoulder for daily activities during this stage may be very difficult. The frozen stage lasts from 4 to 12 months.  

 Stage 3 – Thawing

Shoulder movements begin to improve. There will be a complete or near complete return to normal strength and motion. This thawing stage typically takes anywhere from 6 months to 2 years.

Physiotherapy Treatment for Frozen Shoulder

Fortunately, there are a range of effective physiotherapy treatments for frozen shoulders to alleviate symptoms and restore shoulder function. At Synapse Physiotherapy, we will be able to help address these symptoms and help you recover to full health. Undoubtedly, physiotherapy plays a crucial role in managing frozen shoulders. Here at Synapse Physiotherapy, we aim to reduce pain, increase range of motion, and enhance overall shoulder function. Our professionally trained physiotherapists employ a variety of techniques, exercises, and modalities to achieve these goals. The following are some of the treatment techniques and exercises that are carried out by our physiotherapists: 

1. Passive Range of Motion (PROM) Exercises:

Passive range of motion exercises involve a therapist gently moving the patient’s arm through various motions. This helps maintain flexibility and prevent further stiffness. PROM exercises are particularly beneficial in the painful and early stages of shoulder dysfunction.

 2. Active Range of Motion (AROM) Exercises:

As pain decreases and the shoulder begins to thaw, active range of motion exercises become crucial. Patients are encouraged to perform controlled movements on their own, gradually improving their ability to move the shoulder. These exercises are designed to restore strength and flexibility.

 3. Stretching Exercises: 

Stretching exercises target the muscles and connective tissues around the shoulder joint. Stretching helps improve flexibility and reduce stiffness. Therapists may incorporate techniques such as wall stretches, pendulum exercises, and towel stretches to address specific areas of tightness. 

4. Strengthening Exercises:

Strengthening the muscles surrounding the shoulder is essential for restoring function. Therapists design tailored exercise programs that focus on building strength in a progressive manner. Resistance bands, dumbbells, and bodyweight exercises may be utilised to target specific muscle groups. 

5. Joint Mobilisation:

Joint mobilisation involves the therapist gently moving the joint in specific directions to improve its mobility. This technique helps reduce stiffness and enhances the shoulder range of motion. It is often used in conjunction with other exercises to optimise results.

6. Heat and Cold Therapy:

Applying heat or cold to the affected shoulder can provide relief from pain and inflammation. Heat therapy helps relax muscles and increase blood flow, while cold therapy helps reduce swelling. Physios may recommend alternating between these modalities based on the individual’s needs.

7. Ultrasound Therapy:

Ultrasound therapy uses sound waves to stimulate deep tissues and promote healing. It can be effective in reducing pain and inflammation associated with frozen shoulders. Physios may incorporate ultrasound as part of a comprehensive treatment plan.

8. Electrical Stimulation:

Electrical stimulation, such as transcutaneous electrical nerve stimulation (TENS), can be employed to alleviate pain. By sending low-level electrical currents through the skin, this technique disrupts pain signals and provides relief. It is often used in combination with other therapeutic interventions.

9. Home Exercise Programs:

To ensure continuity of care, our physiotherapists will prescribe home exercise programs. They are designed to empower individuals to continue their rehabilitation independently. Consistent engagement with prescribed exercises contributes significantly to the success of physiotherapy treatment.

Frequently Asked Questions (FAQs) about Frozen Shoulder Treatment

1. What causes frozen shoulders, and who is at risk?

Frozen shoulders can develop from various factors, including inflammation of the tissues surrounding the joint, immobilization after injury, or underlying health conditions such as diabetes, stroke, or thyroid disorders. People aged 40 and older, particularly women, individuals with a history of shoulder immobility or trauma, and those recovering from surgery are at higher risk.

2. How long does it take to recover from a frozen shoulder with physiotherapy?

The recovery timeline for frozen shoulder varies depending on the severity of the condition and individual response to treatment. With consistent physiotherapy sessions and home exercises, significant improvement can be seen within a few weeks to months. However, complete recovery may take up to two to three years, especially in severe cases.

3. Is physiotherapy painful for frozen shoulder treatment?

Physiotherapy for frozen shoulder aims to alleviate pain and improve mobility, but some discomfort may be experienced during certain exercises or therapeutic modalities. However, the level of discomfort should be manageable and should not cause excessive pain. Your physiotherapist will adjust the treatment plan according to your tolerance levels.

4. Can frozen shoulder recur after treatment?

While frozen shoulder can recur in some cases, especially if underlying risk factors are not addressed, proper management and rehabilitation can significantly reduce the likelihood of recurrence. Following a comprehensive physiotherapy program, maintaining shoulder mobility through regular exercises, and addressing any contributing factors can help prevent recurrence.

5. Are there any precautions to take during frozen shoulder physiotherapy?

During frozen shoulder physiotherapy, it’s essential to communicate any discomfort or pain to your physiotherapist. They can adjust the intensity or technique of exercises accordingly. It’s also essential to follow the prescribed home exercise program diligently to maximize the benefits of treatment. Additionally, avoiding activities that exacerbate shoulder pain or stiffness can help facilitate recovery.


Frozen shoulders can be a challenging condition, but with the right physiotherapy interventions, individuals can experience significant improvement in pain and mobility. The key to successful treatment lies in early intervention and a tailored approach to address the specific needs of each patient. Whether through targeted exercises, modalities, or a combination of therapies, physiotherapy offers a path to improved mobility and restoring the joy of pain-free shoulder movement. If you suspect you have frozen shoulder symptoms, come to Synapse Physiotherapy for a consultation today with a qualified physiotherapist and take a crucial step towards a comprehensive and effective treatment plan to tackle frozen shoulder.