20/08/2025
Let’s break down Frozen Shoulder (Adhesive Capsulitis) stage-wise, with specific physiotherapy protocols for each phase.
🔹 Frozen Shoulder – Stages & Physiotherapy Treatment
Frozen shoulder is a self-limiting condition but can last 12–24 months if untreated.
It progresses through 3 classic stages:
1. Freezing Stage (Painful Stage)
⏳ Duration: 2–9 months
🔹 Features:
Severe, diffuse shoulder pain (esp. at night)
Gradual loss of ROM (especially ER, abduction)
Inflammation of capsule & synovium
🎯 Physiotherapy Goals & Treatment
Pain relief:
Ice/Heat packs (based on tolerance)
TENS, IFT, Ultrasound
Maintain mobility (gentle, pain-free):
Pendulum exercises
Wand-assisted flexion & ER (within tolerance)
Passive capsular stretches – very gentle
Scapular stabilization (low-load exercises)
Education: Avoid aggressive stretching → may worsen inflammation
✅ Main aim = Pain reduction + prevent stiffness progression
2. Frozen Stage (Stiff Stage)
⏳ Duration: 4–12 months
🔹 Features:
Pain decreases gradually
Marked stiffness (capsular pattern: ER → Abd → IR)
Adhesions & fibrosis predominate
🎯 Physiotherapy Goals & Treatment
Improve ROM:
Joint mobilization → Maitland grade II–III (posterior glide for IR, inferior glide for abduction)
Active-assisted → Active ROM exercises
Stretching:
Cross-body adduction stretch
Sleeper stretch (IR)
Towel stretch for IR
Strengthening:
Theraband strengthening (rotator cuff, scapular stabilizers)
Isometric → isotonic progression
Modalities:
Heat therapy before stretching
US/Shortwave diathermy for capsule extensibility
✅ Main aim = Regain mobility + strengthen supporting muscles
3. Thawing Stage (Recovery Stage)
⏳ Duration: 6–24 months
🔹 Features:
Pain minimal
ROM slowly improves
Adhesions remodel → function returns
🎯 Physiotherapy Goals & Treatment
Aggressive stretching:
PNF techniques
End-range holds
Overhead pulleys, wall climbing
Strengthening:
Progressive resistance (theraband, dumbbells)
Functional training (pushing, lifting, reaching tasks)
Proprioceptive & functional rehab:
Closed-chain stability exercises
Sport/work-specific drills
✅ Main aim = Full ROM restoration + functional strength
Summary Table
Stage Duration Key Features Physiotherapy Focus
Freezing 2–9 months Severe pain, night pain, progressive stiffness Pain relief, gentle ROM, pendulum
Frozen 4–12 months Less pain, marked stiffness, capsular pattern Joint mobilization, stretching, strengthening
Thawing 6–24 months Minimal pain, ROM improvement Aggressive stretching, strengthening, functional rehab.
