You slip your arm into the sleeve of your jacket and, halfway through, the shoulder stops. You try again, twisting your body in an awkward way, and it finally goes in. A month ago you would not have given it a thought.
If on top of that your shoulder has woken you up in the early hours this week, it could be a frozen shoulder. Or it could be something else, which is why it is worth looking at calmly.
We will tell you how to tell it apart from an overload, what we check in clinic and what clinical physiotherapy can offer when movement starts to fall short.
Frozen shoulder or a one-off overload: how to tell them apart
An overload usually has a recognisable origin. You painted a ceiling, trained harder than usual, carried a heavy suitcase. It hurts with certain movements, and if someone gently lifts your arm, the shoulder usually gets close to where it should.
A frozen shoulder, or adhesive capsulitis, works differently. The capsule surrounding the joint thickens and loses elasticity. The shoulder runs out of range, both when you move it yourself and when someone else moves it for you.
The movement that is lost most is external rotation: turning the arm outwards, as when combing your hair or putting on a jacket. Reaching a hand behind your back or raising your arm above your head also becomes difficult.
Another common sign is night pain. Many people say they cannot sleep on that side or wake up when they change position.
It usually appears between the ages of 40 and 60, somewhat more often in women. It is more common in people with diabetes or thyroid conditions, and it can also appear after an injury or surgery. Sometimes it appears for no clear reason.
None of this is meant to diagnose you from home. It is meant to help you know when to ask for an assessment: if your shoulder is gradually losing range and the pain bothers you at night, do not wait for it to pass on its own.
The phases of a frozen shoulder and why they are not all treated the same way
A frozen shoulder changes over the course of its evolution. It is described in three phases, and what the shoulder needs is different in each.
In the painful phase, pain dominates. There is discomfort at night and movement starts to shrink. The aim is to calm the shoulder, not push it.
In the stiff phase, pain tends to ease, but range is at its most limited. Here we work on mobility gradually, at a level your shoulder tolerates.
In the recovery phase, movement returns little by little. Strength and control work is added so the arm regains confidence.
Duration varies a lot from person to person. It can range from several months to more than a year, and in some cases it lasts longer. That is why a single routine does not suit everyone, nor the whole evolution of the same shoulder.
What we check in the assessment: movement, strength and daily life
The first session starts by listening to you. We want to know when it began, what your nights are like, whether there was an injury or an operation, and whether you have diabetes, thyroid problems or take medication.
Then we examine. We compare both shoulders and measure movement in two ways: the movement you make yourself and the movement we make with your arm relaxed. That difference helps us separate a frozen shoulder from an overload or from a rotator cuff problem.
We check rotation, elevation and the movement of reaching your hand behind your back. We assess the strength of the shoulder and the shoulder blade. We also look at the neck and the upper back, because they often play a part.
And we ask about daily life: getting dressed, combing your hair, fastening the car seatbelt, reaching something on a shelf, sleeping. Those limitations, more than the degrees we measure, are what shape the plan.
If anything we find suggests you need your doctor’s opinion, we tell you at that moment.
The role of clinical physiotherapy: education and exercise within your tolerance
Clinical physiotherapy is one of the foundations of frozen shoulder treatment. But it is not about forcing the shoulder until it gives way.
We start with education. We explain which phase you are in, what you can expect and how to look after it day to day. For example, how to position yourself at night, with a pillow supporting the arm, so the shoulder rests better.
Then comes exercise adapted to your tolerance. Gentle, short, frequent movements that the shoulder accepts without setting off the pain. If something hurts intensely or leaves you worse the next day, we have overdone it and we adjust the dose.
One important clarification: intense stretching is not the universal solution. In an irritable phase, forcing the range can increase pain and make the shoulder guard itself more. Stretching is a tool used at the right time and to the right degree.
Manual work can help reduce pain and let movement flow better. What we do avoid is leaving the arm immobile for long periods, because it encourages more stiffness.
Over time the programme progresses: more range, then strength and finally the specific movements of your daily life or your sport.
Goals that matter: the shelf, the jacket, the night
A shoulder is not recovered in degrees. It is recovered in things you can do again.
That is why, before we begin, we agree practical goals with you. Reaching the second shelf in the kitchen without leaning your body. Putting on your jacket without thinking about how. Combing your hair normally. Sleeping a whole night without the shoulder waking you.
Those goals help us choose the exercises and measure how you are doing. Maybe one week the range barely changes, but you have slept better. That is progress too, and we take it into account.
How long it takes: expectations that vary from person to person
It is the question we are asked most, and the honest answer is that it depends.
It depends on the phase you arrive in, how long it has been going on and how irritable the shoulder is. Other conditions matter too, such as diabetes. Some people notice relief within a few weeks.
Others need months. And the course is rarely a straight line: there will be weeks of progress and others of standing still.
That is why we do not promise a fixed number of sessions. We review how you respond at regular intervals and adjust the plan according to what we see.
There are cases where it is also advisable for your doctor to assess it: if you have diabetes or a thyroid problem, if the shoulder began after surgery or a knock, or if after a reasonable period of work you notice no improvement. It is part of doing things properly, and we coordinate it with you.
An assessment in Los Montesinos to agree your plan
At Fisio Physio Clinic Salinas, in Los Montesinos (Costa Blanca Sur, province of Alicante), the first session lasts more than an hour. We take your history, carry out the assessment and, with what we find, propose a plan built around your shoulder and what you want to be able to do again.
If your shoulder is changing the way you dress, sleep or reach for things, there is no need to wait for the phase to pass on its own. Book an appointment and we will look at it together, calmly and step by step.