Adhesive Capsulitis (Frozen Shoulder Contracture Syndrome, Rotator Cuff Interval Contracture Syndrome)

What is Frozen Shoulder?

Adhesive Capsulitis/Frozen Shoulder Contracture:

Is a progressive painful condition with a gradual lack of of both active and passive shoulder mobility. In other words Frozen shoulder is the shortening, thickening, and chronic inflammation of the soft tissue surrounding the shoulder joint.

As the name says, in this condition a person gets restriction in moving his/her shoulder in certain directions, and eventually it becomes frozen as no ranges at all if left unaffected. There are numerous common names out there for frozen shoulder, such as, Adhesive capsulitis, Periarthritis and painful stiff shoulder. In short, we can define it as a painful condition which progresses with a gradual lack of active as well as passive shoulder movements.

What Causes Frozen Shoulder?

Here are two major types of Frozen Shoulder/Adhesive Capsulitis:

  1. Primary Adhesive Capsulitis is of unknown cause
  2. Secondary Adhesive Capsulitis occurs as a result of another condition. These can be as a result of:            Intrinsic Factors: Occurring due to pathology with the shoulder complex itself. For example. Calcific Tendinosis, Rotator cuff Tendinopathy, Biceps Tendinopathy or post shoulder surgery.                                                            Extrinsic Factors: Occurring due to pathology away from the shoulder either above or below the shoulder joint. For example: Fracture at the arm or collarbone, pinched nerve at the neck, breast surgery on that side, and stroke.
  3. Systemic Adhesive Capsulitis may include: Diabetes, Thyroid Abnormalities, Heart Disease.

What Are the Signs & Symptoms of Frozen Shoulder?

The symptoms of frozen shoulder are pain and loss of movement in the shoulder joint. Lifting, reaching and daily activities, such as getting dressed, putting on a shirt, pulling pants up, reaching behind your back or above your head. Some patients may experience referral pain towards the forearm too. Lying on a painful shoulder may affect overall sleep.  Supporting the affected arm with other hand helps to relieve this pain.

4 Stages of Frozen Shoulder


Stage Name Symptoms
1 Pre-freezing

·       0-3 months duration

·       Limited Movements & Pain

2 Freezing

·       3-9 months duration

·       Severely limited movements & Pain

3 Frozen

·       9-15 months duration

·       Severe stiffness & minimal pain

4 Thawing

·       Improving movements

·       Minimal pain

Physiotherapy Treatment For Frozen Shoulder?

Education about the condition is an essential part of this treatment to help patients in reducing frustration and encouraging belief. Physiotherapy treatment is based on the stage of the condition:

In the First, Pre-freezing stage people usually do not show up at the clinic and there is no evidence yet for the effects of treatment in this stage.

Stage Treatment

·       Low intensity joint mobilization

·       Thoracic manipulation

·       Stretching program

·       Pendulum exercises

·       Assisted shoulder Range of Motion

·       Heat, Acupuncture/Dry Needling, Massage


·       Moderate intensity joint mobilization

·       Soft tissue release

·       Gentle to moderate stretching

·       Isometric/isotonic exercises

·       Shoulder sling

·       Pendulum exercises


·       End-range joint mobilization

·       Stretching program

·       Mobilization with movement

·       Strength training with Thera-band

·       Resisted exercises


These stages are commonly recognizable in most patients, even though everyone is different in terms of clinical presentation and recovery pattern. After a period of worsening symptoms, frozen shoulder tends to get better, although full recovery my take up to 3 years. The goal of Physiotherapy is to shorten each stages.

At Integrative Physiotherapy, we provide a personalized treatment plan based on the level of condition and it’s symptoms that the patient presents with. If you believe that you are experiencing any of the above signs or symptoms of frozen shoulder, we are more than happy to provide help.


    Written by: Anjali Patel. Registered

    Physiotherapist Resident. Orthopaedic Physiotherapist. Concussion Management


    Orthopaedic Division Canadian Physiotherapy Association. Theory Manual

    Integrative Physiotherapy is a Barrie-based clinic that believes in a one-on-one patient-centred, manual therapy (hands-on) approach to physiotherapy. We aim to empower our patients by providing quality care that is personalized to each patient in an interactive and friendly manner. Through the use of the best available treatment techniques, we aim to provide exceptional care so that each patient feels engaged and motivated.

    Our therapists are continually upgrading their skills and taking time to provide comprehensive assessment and treatment techniques that are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  

    Our therapists would be happy to help you to achieve your goals, get in touch to schedule your appointment.  Don’t let pain ruin your day!

    Integrative Physiotherapy, Empowering Patients with Personalized Care.