The Three Stages of Frozen Shoulder
Frozen shoulder (adhesive capsulitis) follows a predictable pattern: Painful Phase (3–9 months) — increasing pain and stiffness; Frozen Phase (9–15 months) — pain reduces but movement is severely restricted; Thawing Phase (15–24 months) — gradual return of movement.
Why Most Treatments Fail
Corticosteroid injections provide temporary pain relief but do not address capsular fibrosis. Rest worsens adhesion formation. Aggressive mobilization in the painful phase can worsen inflammation.
Evidence-Based Physiotherapy Approach
Gradient mobilization matched to the stage: Pain-dominant phase — gentle range of motion and pain management. Stiffness-dominant phase — progressive end-range capsular stretching, joint mobilization (Mulligan techniques), and hydrodilation.
Fastest Evidence-Based Recovery Protocol
Hydrodilation (injection of fluid into the joint) combined with immediate physiotherapy mobilization has the best evidence for rapid recovery in the frozen phase.