Physio · 7 minute read

Somewhere around the third week of putting your jacket on one-armed, it occurs to you this might not be going away. Reaching for the seatbelt went first, and now the top shelf has become somebody else’s job. If your shoulder has slowly stopped doing what it’s told, it may be a frozen shoulder, and there’s more you can do about it than wait.

Frozen shoulder is an odd one because there’s usually no injury to blame. It just crept up on you, and the pain at night has become the worst of it.

It affects around 2% to 5% of people, peaks in the mid-50s and is rare before 35.

What’s happening inside your shoulder

Your shoulder joint sits inside a bag of tough tissue called the capsule. In a frozen shoulder the capsule becomes inflamed and thickened, and scar-like tissue forms, so it tightens around the joint and there’s less room to move. Think of a roomy jumper shrinking in the wash with your arm still inside it.

Diabetes is a well-known link: people with diabetes are about five times more likely to get it, and roughly 13% of them do. Ask your GP whether your blood sugar or thyroid needs checking.

Is it menopause?

You may have seen this one online, and it’s a fair question, since frozen shoulder peaks at the same time of life. We don’t know yet.

The big Taiwanese study doing the rounds was about calcific tendinitis, a different problem where calcium builds up in a tendon. A US pilot study of hormone therapy and frozen shoulder didn’t show a clear difference, and a small trial is under way in California. So if someone online says hormones will fix your shoulder, they’re ahead of the science.

How to tell it from other shoulder problems

The classic difference is what happens when somebody else moves your arm for you.

With a rotator cuff problem (the tendons around your shoulder), it’s usually painful or weak when you lift your arm, but a physio can often move it further for you. With a frozen shoulder, the joint itself has run out of room, so your arm stops at the same point when you move it and when someone else does.

You can get a rough idea at home. Tuck your elbows into your sides, bend them to 90 degrees and swing both forearms outwards, like opening a pair of saloon doors. If one side stops well short of the other, that’s a clue, so get someone to look at it.

Book a physio appointment

How it tends to go

You’ll hear about three stages: freezing, when pain builds and movement starts to go; frozen, when it’s stiff but often less sore; and thawing, when movement slowly returns. They overlap, the timing varies a lot, and without treatment it may take one to three years.

You might have been told it fixes itself, and that’s only half true. Left alone, you’ll usually get some movement back, mostly early on, but maybe not all of it (the research here isn’t great). In one long-term study, about 4 in 10 people still had some symptoms years later, nearly all of them mild.

What helps

A steroid injection, early on. If your shoulder has been sore for less than a year, an injection into the joint has given the best short-term results across 65 studies, and the benefit may last up to about six months. You’d do it alongside exercises at home. Talk it through with your GP or physio, particularly if you have diabetes, as steroids can affect blood sugar.

Exercise that matches where you’re at. When your shoulder is sore and cranky, you want gentle movement that doesn’t stir it up. In one small study of 77 people, those who did gentle exercises and let pain be their guide did better than those who pushed through intensive stretching.

Surgery is rarely the first step. A big UK trial of 503 people compared physio plus a steroid injection with two kinds of surgery. A year on, none had come out clearly ahead, and the keyhole surgery carried more risk.

How a physio can help, and when to book

First, a physio can check it really is a frozen shoulder, because other shoulder problems need different things. They’ll work out what stage you’re at and match your exercises to it: gentle while it’s sore, then building movement and strength as it settles. They’ll also show you easier ways to sleep and get dressed, and tell you if it’s worth asking your GP about an injection.

Sooner is better. Book in if your shoulder hasn’t settled after a couple of weeks, if it’s waking you at night, or if you’ve noticed you can’t reach as far as you could.

Getting through the day

Keep it moving, gently. Keeping it completely still can make the pain worse, so do a bit, several times a day.

Try two simple movements. Lean over a table and let your arm swing gently like a pendulum, or walk your fingers up a wall as far as is comfortable.

Use heat. A heat pack for up to 20 minutes can settle things before bed.

Support your arm at night. A pillow under your arm can take the strain off, whether you sleep on your back or your good side.

Change the small stuff. Do your bra up at the front and slide it around, put the sore arm into your sleeve first, and move the mugs to a lower shelf for now.

The takeaway

If your shoulder hurts and keeps losing movement, get it checked sooner rather than later. There’s plenty you can do in the meantime, starting with where you keep the mugs.