Joints, muscles and tendons
Frozen shoulder
The one condition where we will tell you at the first visit roughly how long this will take, and the honest answer is measured in seasons rather than weeks.
Adhesive capsulitis is a progressive stiffening and then gradual release of the shoulder capsule. It is genuinely miserable, it is not caused by anything you did, and it has a characteristic course: a painful freezing phase, a stiff frozen phase where the pain settles but movement does not return, and a long thawing phase.
The most useful thing anybody can tell you about it is the timescale, because almost every frustration with this condition comes from expecting it to behave like an ordinary shoulder problem. It does not.
The three phases and why the plan changes
Freezing: painful, progressively stiffening, and highly irritable. Aggressive stretching in this phase makes things worse rather than better and it is the commonest mistake made by both patients and clinicians. Treatment here is pain management, gentle range within comfort, and keeping the rest of the arm and the shoulder blade working.
Frozen: the pain settles substantially and the stiffness stays. This is where range work earns its place and where progress becomes measurable again.
Thawing: range returns gradually. Loading and strengthening take over, because a shoulder that has not been used properly for eight months is weak as well as stiff, and the weakness outlasts the stiffness if nobody addresses it.
Treating a freezing shoulder with a thawing shoulder's programme is the single most reliable way to make somebody worse, and it is why the phase assessment happens at every visit rather than once.
What we can and cannot change
We do not shorten the natural history by very much, and we are not going to claim we do. What treatment reliably changes is how much function you keep during it, how much pain you are in, and how much strength you have to rebuild at the end.
That sounds modest and it is not. The difference between a well-managed frozen shoulder and an unmanaged one, at the eighteen-month mark, is substantial — and it is mostly the difference between someone who kept working the rest of the arm and someone who protected the whole thing for a year.
Hydrodilatation and corticosteroid injection are worth asking a physician about, particularly in the painful phase. We will say when we think that conversation is worth having.
Nothing here is a promise that treatment will work. Nothing on this site is a promise that treatment will work. Physical therapy has good evidence behind it for a great many musculoskeletal problems and poor evidence for a few of the things it is sold for, and we would rather tell you which of those you have than take the appointment either way. We publish no success rate, no star rating and no before-and-after photographs, because a clinic that chooses which outcomes to show is not reporting outcomes.
Included as standard
How we treat this
Phase identified at every visit
Because the programme for a freezing shoulder and a thawing one are opposites, and getting it wrong makes people worse.
No aggressive stretching in the irritable phase
It is the commonest error in this condition and it prolongs the misery rather than shortening it.
The rest of the arm kept working
The difference between a well-managed and an unmanaged frozen shoulder at eighteen months is mostly this.
Honest timescales at the first appointment
Measured in seasons. We would rather say so than have you conclude at week six that treatment has failed.
Strength rebuilt in the thawing phase
A shoulder unused for eight months is weak as well as stiff, and the weakness outlasts the stiffness if nobody trains it.
We will suggest asking about injection
Where the painful phase is severe, a corticosteroid injection or hydrodilatation is worth a physician's view.
When to make an appointment
Signs this is worth an assessment
- Your shoulder has been getting progressively stiffer over weeks or months.
- You cannot reach behind your back or across your body, and it is getting worse.
- Somebody else moving your arm is just as restricted as you moving it yourself.
- The pain is worst at night and you cannot find a comfortable position.
- You have diabetes or a thyroid condition, both of which raise the risk.
- It started without an injury and you cannot account for it.
Frozen shoulder — how long a course usually takes
- Spread across a course that may run a year. Adhesive capsulitis has three phases and aggressive stretching in the wrong one makes it worse, which is why the plan changes as it moves.12 – 24 visits
This is a typical number of visits for this problem, not a quote and not a promise. You get an estimate specific to you, in writing, at the first appointment, and we reassess against the same measurements at visit four rather than at visit ten — so a course that is not working gets changed or stopped instead of extended. What each visit costs is published on the pricing page: $190 for the initial evaluation and $140 for a treatment visit if you are paying yourself, or your plan's copay if you are not. We do not sell blocks of visits in advance.
Questions we are actually asked
Frozen shoulder — frequently asked
How long does frozen shoulder last?
Frequently a year to two years through all three phases, and sometimes longer. We will give you our honest estimate at the first appointment. Physical therapy does not shorten the natural history by very much; what it reliably changes is how much function and strength you keep during it, and how much you have to rebuild at the end.
Should I push through the pain to stretch it out?
Not in the painful freezing phase — that is the commonest mistake in this condition and it prolongs things. In the frozen and thawing phases, range work earns its place. Which is why we reassess the phase at every visit rather than running one programme throughout.
Is it true that someone else moving my arm is just as restricted?
Yes, and it is one of the more useful distinguishing features. In frozen shoulder the capsule itself is restricted, so passive movement is limited to about the same degree as active. In most other shoulder problems, someone else can move it considerably further than you can.
Would an injection help?
In the painful phase, quite possibly. Corticosteroid injection and hydrodilatation both have a reasonable evidence base for the early stages, and we will suggest asking a physician when we think the conversation is worth having. We do not inject — physical therapists do not.
Will it come back?
In the same shoulder, rarely. In the other shoulder, it happens to a meaningful minority of people, particularly with diabetes. Knowing the early signs is genuinely useful, and we will tell you what to watch for.
Related conditions
Often seen alongside this
Shoulder pain
Five structures in a small space, all of which hurt in roughly the same place. The examination is what separates them.
8 – 14 visits
Rotator cuff
A tear on a scan is not automatically the tear causing your pain, and loaded exercise beats rest for most of them.
10 – 18 visits
Neck pain
Desk necks, phone necks, slept-badly necks and the ones that are actually a shoulder. Telling them apart is most of the first appointment.
5 – 10 visits
Persistent pain
For pain that has outlasted the injury. Not a cure, not a lecture about it being in your head, and not something we will pretend is quick.
12 – 20 visitsSixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.