1. Introduction / Plain Theory

Frozen shoulder, medically known as adhesive capsulitis, is a condition characterised by progressive stiffness and pain in the shoulder joint due to inflammation and thickening of the joint capsule.

The capsule — a fibrous sleeve surrounding the shoulder joint — gradually becomes tight and contracted, restricting movement in all directions.
This often occurs without a clear injury, although it may follow trauma, surgery, or prolonged immobilisation.

Frozen shoulder typically progresses through three overlapping phases:

1. Freezing phase: gradual onset of pain and stiffness (lasting 6–9 months).

2. Frozen phase: stiffness predominates; pain may lessen (4–12 months).

3. Thawing phase: slow recovery of motion and function (6–18 months).

The full course can last 1–3 years, and while most patients recover well, some residual restriction may persist.

Frozen shoulder affects about 2–5% of the population, most commonly adults aged 40–65, with increased prevalence in women and individuals with diabetes or thyroid disorders.

2. Typical Symptoms and Functional Impact

• Deep, aching pain in the shoulder and upper arm, often worse at night.

• Marked stiffness in all directions — especially rotation and abduction.

• Difficulty performing daily activities such as dressing, reaching overhead, or behind the back.

• Limited ability to lie on the affected side.

• Gradual but persistent loss of function.

Functional impact:
Frozen shoulder significantly limits independence and comfort, affecting work, exercise, and sleep.
The prolonged recovery period often causes frustration, anxiety, and compensatory tension in the neck, upper back, and opposite shoulder.

Red flags:
Sudden onset following trauma with significant weakness should raise suspicion of a rotator cuff tear rather than adhesive capsulitis.

3. Contributing Factors / Underlying Causes

The exact cause of adhesive capsulitis remains unclear, but it is thought to involve chronic inflammation and fibrosis of the joint capsule.
Contributing factors include:

• Prolonged immobilisation (after injury, surgery, or fracture).

• Systemic conditions: diabetes, thyroid disease, cardiovascular or autoimmune disorders.

• Postural imbalance: thoracic rigidity and rounded shoulders limiting scapular movement.

• Hormonal influences: increased incidence in perimenopausal women.

• Cervical or upper thoracic dysfunction: altering shoulder mechanics and neural input.

• Emotional stress: increased sympathetic tone affecting muscle tension and circulation.

From an osteopathic perspective, frozen shoulder represents a multifactorial restriction — involving both local capsular changes and global adaptive patterns throughout the thorax, cervical spine, and ribs.

4. Osteopathic Approach

Osteopathic care aims to reduce pain, maintain mobility, and support recovery throughout all phases of frozen shoulder.
Treatment is always gentle, respecting the inflammatory stage and individual tolerance.

An osteopathic assessment may include:

• Evaluation of global movement patterns — shoulder, scapula, cervical and thoracic regions.

• Gentle mobilisation to improve joint and rib mobility.

• Myofascial and soft-tissue release to ease compensatory tension.

• Indirect and functional techniques to modulate pain and support circulation.

• Breathing and relaxation techniques to reduce sympathetic overactivity.

• Guidance on gradual, pain-free movement and home exercises to maintain mobility.

Osteopathic treatment complements medical and physiotherapy care — supporting the body’s natural recovery by improving movement variability, fluid dynamics, and neuromuscular balance.

5. Scientific Evidence & References

Evidence supports manual therapy, education, and gentle mobilisation as safe and beneficial approaches in managing frozen shoulder, especially when combined with active movement and self-care.

Studies show that improving scapulothoracic motion, posture, and thoracic mobility can reduce secondary strain and improve function, even during the restricted phase.
While the condition tends to resolve over time, osteopathic treatment may reduce pain, speed up recovery, and improve quality of life during all stages.

References

1. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231–236. Link

2. Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017;103(1):40–47. Link

3. Maund E, Craig D, Suekarran S, et al. Management of frozen shoulder: systematic review and cost-effectiveness analysis. Health Technol Assess. 2012;16(11):1–264. Link

4. Kelley MJ, Shafer L, Kuhn JE, et al. Shoulder pain and mobility deficits: adhesive capsulitis clinical practice guidelines. J Orthop Sports Phys Ther. 2013;43(5):A1–A31. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for shoulder stiffness and pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Sun Y, Lu S, Zhang P, Wang Z, Chen J. Effectiveness of physiotherapy and manual therapy for adhesive capsulitis: systematic review and meta-analysis. Clin Rehabil. 2020;34(1):1–13. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for adhesive capsulitis: network meta-analysis. Front Pain Res. 2024;15:1507412. Link