Frozen shoulder: understanding this progressive stiffness and getting back to your activity

What is frozen shoulder?

Joint capsule anatomy

The joint capsule is a fibrous envelope surrounding the shoulder joint, containing the synovial fluid needed for lubrication. Frozen shoulder, also called adhesive capsulitis, is a progressive thickening and tightening of this capsule, causing a significant loss of shoulder mobility, often with pain, without any initial trauma.

Why does this stiffness appear?

Frozen shoulder classically progresses through three phases: an initial painful phase, a stiffness phase where pain decreases but mobility remains very limited, then a gradual recovery phase. Its exact cause often remains uncertain, but it’s more common after a period of immobilisation, in people with diabetes, or following significant stress.

Who is affected by frozen shoulder?

Frozen shoulder affects athletes less specifically than other shoulder conditions, but certain factors increase the risk:

• Prolonged immobilisation after an injury or surgery
• Diabetes and certain hormonal conditions
• Stress or a difficult period in life
• An age between 40 and 60, more common in women
• A history of frozen shoulder in the other shoulder

Treating frozen shoulder in rehab with a sports physio

The goal of treatment is to adapt the intensity of rehab to the phase of frozen shoulder: gentle and pain-relieving in the painful phase, more active to regain mobility in the recovery phase.

1. 1Managing pain in the acute phase
2. 2Gentle, progressive passive mobility
3. 3Targeted capsular stretches
4. 4Assisted active mobility
5. 5Light strengthening of the cuff
6. 6Progressive overall strengthening
7. 7Reintroducing everyday movements
8. 8Reintroducing sporting movements
9. 9Progressive return to your sport
10. 10Return to full activity

Why the physio’s initial assessment matters

During the initial assessment, the physiotherapist aims to identify the current phase of the frozen shoulder (painful, stiff or recovery), how long the symptoms have been present, and any contributing factors (recent immobilisation, diabetes, stress).

“You don’t force a frozen shoulder, you support it phase by phase.”

Progressive mobility, the cornerstone of treatment

Mobility work must be adapted to the phase: gentle and pain-relieving early on, more active and sustained once pain has decreased. Muscle strengthening complements this work once mobility is on the way to recovery, to regain a fully functional shoulder.

In brief

• Mobility adapted to the phase of the frozen shoulder
• Progressive capsular stretches
• Strengthening once mobility is recovering
• Patience: progress is measured in months

Should you rest or keep playing sport?

Total rest is not the answer for frozen shoulder: gentle, regular movement, adapted to the phase, is essential to prevent the stiffness from worsening. That said, you should avoid forcing a very stiff shoulder abruptly during the painful phase.

When should you see a specialist for frozen shoulder?

A medical opinion is recommended as soon as the first symptoms appear, to confirm what’s going on and rule out other causes of stiffness, and also if pain is very intense or there’s no improvement despite several months of suitable rehab.

The HOPP care programmes to treat your frozen shoulder and regain your mobility

Frozen shoulder requires patient support adapted to each phase of its progression. HOPP offers you a precise exercise programme, adjusted to how you feel each day, to support you throughout this sometimes lengthy process.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your shoulder is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

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