Frozen shoulder: making choices about treatment

Cochrane UK’s Sarah Chapman blogs about evidence and experience in treating adhesive capsulitis, or ‘frozen shoulder’, with the help of another Sarah, a physiotherapist. 

I have happy memories of races round my grandparents’ garden on the pair of crutches Grandpa used while his knee (the cap blown away on the Western Front) was healing. They were brilliant things, which I suspect he must have made or altered himself; wooden, with curved runners on the bottom, which allowed us to propel ourselves round at some speed! I rediscovered them a few years ago and had to have another go. I’ve always taken a grateful delight in having a body that does what I ask of it. Give me a supermarket trolley and a clear aisle, and I can’t resist scooting along with my feet off the ground, and every now and then I like to check that I can still stand on my head. On leaving the care home I’d been visiting recently, I sprinted across the courtyard, just for the joy of being able to do so.

But I’ve recently turned into a ‘bad arm in first’ kind of person and, horror of horrors, have caught myself uttering “oofs” and “ahs” when exerting myself. I’ve developed a cunning technique for pegging washing on the line, involving a sort of launch-and-slide manoeuvre. I now wash my hair one-handed and act my age in supermarkets. It turns out that the reason for all this is that I have adhesive capsulitis, or ‘frozen shoulder’. So, as an example of making everyday health choices, I thought I’d write about it.

Three important things

Ideally, health choices are made on the basis of three things: the best available evidence from research, the patient’s preferences and values, and clinical expertise.

evidence-based practice diagram

The three elements of evidence-based practice

Unlike this tidy diagram, these elements won’t necessarily make an equal contribution and, as I’m all too aware, there may not be reliable evidence to inform a decision. Let’s see…

Health choices begin when the problem does

My first choice, on developing a sore arm, is to do nothing and hope it resolves. But actually, a decision has to be made even at this point; should I rest it or use it? I don’t think ‘sore arm’ will bear much fruit in Google or the Cochrane Library, so I don’t try the internet. Instead, I do that thing that forms part of our decision-making about health and much else: I ask other people what they think it might be, and listen to tales of other people’s sore arms and what it was and what they did. I drop out of my exercise class, although aware that this is not a good move for my general health and fitness, and otherwise carry on as near normally as possible. After all, it’s not that bad.

Next stop, the GP

Fast forward a few weeks, I see a GP. He thinks it’s a rotator cuff problem and gives me a leaflet showing shoulder exercises for unspecified problems and suggests I take ibuprofen for a week. He mentions that, if it doesn’t improve, physiotherapy might help. I don’t feel very confident about the effectiveness of the exercises, but resolve to do them diligently. I don’t do them diligently… I do them sometimes, when I remember, and decide to give it a couple of weeks before seeing a physiotherapist. I’m reluctant to take the ibuprofen; I don’t want to be taking medication for weeks and I’m not so sore I feel I have to so, after a few doses, I don’t. I’m reminded of that terrible phrase given to patients (I’ve become a patient!) like me – ‘non-compliant’. Ugh!

Better see a physiotherapist

Three weeks on and I am more restricted in what I can do and, if I move my arm suddenly, the pain is enough to stop me in my tracks. I am fortunate in being able to take myself to a physiotherapist, also called Sarah. She is great. I am a bit horrified at just how limited my range of movement is shown to be. She tells me this isn’t a rotator cuff problem but adhesive capsulitis. The good news is that it will resolve by itself. The bad news, this is likely to take one to two years. YEARS! Is there anything I can do while I’m waiting, other than invent gadgets that will help me do stuff, like hang out the washing (where are you, Grandpa?)?

It seems there are a few things that may help increase my range of movement, at least a little, and reduce pain. Injected steroids, manipulation, and exercises. Before I’ve even looked at the evidence for each option, my preferences come into play. I reject the idea of steroids and resolve to embark on the exercises Sarah has shown me. I now need to do two things: get hold of a walking stick with which to perform the exercises and look for evidence about the benefits and harms of each intervention.

Woman having physiotherapy for frozen shoulder

Treating frozen shoulder: what does the evidence say?

What’s the evidence on treating frozen shoulder?

I start with the Cochrane Library, hoping there are some relevant Cochrane Reviews, bringing together the best available primary research on treatments for frozen shoulder.

Evidence on manual therapy and exercise

There is a Cochrane review on manual therapy and exercise for frozen shoulder. Manual therapy includes any movement of the joints and other structures or manipulation done by a clinician (such as a physiotherapist), while exercise in this context includes any purposeful movement of a joint, muscle contraction or prescribed activity. These components combined in a physical therapy intervention are commonly used to treat frozen shoulder.

The Cochrane review brings together the evidence from 32 trials with 1836 people. None of the trials compared the treatments with placebo (a dummy, or inactive, treatment) or with doing nothing. The review shows that a combination of manual therapy and exercise, compared with glucocorticoid injection, probably results in less improvement at seven weeks and a similar number of adverse events. Of the 56 people who had manual therapy and exercise, 26 (46%) reported treatment success, compared with 40 people (77%) of the 52 who had the injection. There were no differences between the groups after 12 months in terms of pain and function. Greater uncertainty remains about other treatment combinations and comparisons.

…and for rotator cuff disease?

I also had a sneaky look at the Cochrane review on manual therapy and exercise for rotator cuff disease, which includes 60 trials but only one which ‘compared a combination of manual therapy and exercise reflective of common current practice to placebo’. The evidence is high quality (and so reliable) and shows no clinically important difference between groups in any outcome.

Evidence on electrotherapy

Electrotherapy, such as therapeutic ultrasound or low-level laser therapy (LLLT), may also be offered as part of a physical therapy intervention. A Cochrane review looking at the benefits and harms of these for frozen shoulder found 19 studies with 1249 people. It leaves us with more questions than answers with no or only limited evidence on the benefits and harms of a range of electrotherapy treatments. There is evidence of benefit for only one type of electrotherapy, LLLT, which, when added to exercise, is probably better than placebo in improving pain and function at four weeks and four months. On its own, LLLT may be more effective than placebo at the end of six days of treatment.

Back to Sarah, my physiotherapist

When I return for a second appointment, Sarah and I have both done some homework on the evidence and I have even done the exercises, with maybe a slight improvement. Maybe… Very slight…

So, over to Sarah:

“In my career as a musculoskeletal physio, I have seen and treated many true frozen shoulders, not to be confused with stiff shoulders caused by osteoarthritis.  Some practitioners like to x-ray to rule out osteoarthritis, fractures, and rare but serious problems such as secondary metastases (cancers) in the humeral head. Treatments have come and gone as evidence is collected on the effectiveness of each. Some physios have very strong personal preferences on how to treat their patients and some favour certain techniques.

Frozen shoulder is one of the conditions that proves problematic for many physios, if I am honest. Most standard physiotherapy treatment such as massage, joint mobilsation, manipulation, passive stretching, acupuncture, electrotherapy can vary widely regarding the evidence and effectiveness. But, and this is the bit that does vary from physio to physio, some physiotherapy treatments are poorly evidence-based at un-stiffening a frozen shoulder but very beneficial for pain relief, such as massage or acupuncture. That may be a good clinical decision to get the pain down to allow the patient to start their exercise. I have tried all of the above with huge variances in success, and I have seen the results of more invasive treatments, including steroid injections and manipulation under anaesthetic. Again, the outcomes for the patient vary on a big scale, much like the UK weather.

However, there seems to be gathering evidence in the physio world on the use of eccentric muscle strengthening exercises. These are specific exercises to load a muscle in a lengthened position (think about a biceps curl; well when you straighten the arm out again, that’s loading the biceps in a lengthened position). It seems that a stiff and very painful shoulder does respond to this method. We don’t know how this strategy works yet on the shoulder (we do in the lower limb), but it may be something to do with relieving pain resulting from muscle guarding around the shoulder. Guarding muscles become painful just adding to the misery of an already sore and tight capsule. For me, I have got good results in both reduction in pain and increase in range of movement. The two things that patients want to change! So I tend not to bother with the other treatments now and just concentrate on this exercise based therapy.”

So what now?

After the session learning eccentric muscle strengthening exercises with Sarah, I was pretty sore, so I left it for a day. Then I was away from home and busy (feeble excuses I know…) so I left it a bit longer. That slid into a week or so and then I noticed my shoulder felt a little better, and I had a bit more movement. But I don’t know if this is the result of one intensive exercise session, rest, or just natural recovery, which leaves me not knowing what to do next! The realities of managing a condition and making choices about it!

In the interests of my general health and fitness, I’ve gone back to my Jazzercise classes. I have discovered something too: the walking stick, no longer required for my exercises, is the very thing I need for pulling down the washing line and pushing things onto it. And I’m not forgetting to be thankful that I don’t (yet) need to use it to help me walk.

Update January 2021: To all of you going through this….

In the three years since I wrote this blog, many of you have found this post and shared your own experiences in the comments – thank you. What a lot of suffering comes across in your stories and so much common ground. I hope that, as well as finding something useful in the blog, you can take something from other people’s experiences here – perhaps most of all the knowledge that the  pain and limitations you are experiencing WILL go. It’s so hard while it’s going on though, isn’t it? But hang on to that.

Like all the blogs, I will update this one when there is any new evidence to add. Meanwhile, keep sharing your stories and I hope, if you’re suffering right now, you will see some improvement sooner than you expect, as I did. I still don’t know what helped, if anything, but I made a full recovery in – I think – a year to 18 months. You’d think I’d remember, given how debilitating it was, yet now it’s firmly in the past – thank goodness! Wishing you all the very best in your recovery.

Join in the conversation on Twitter with @SarahChapman30 @CochraneUK or post a comment here.

References may be found here.

Sarah Chapman has nothing to disclose.

Page updated 13 January 2021

Frozen shoulder: making choices about treatment by Sarah Chapman

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

68 Comments on this post

  1. Avatar

    This is my 2nd experience with frozen shoulder, adhesive capsulitis. I had it for about 18 months on the left shoulder 3 years ago, and now I have it on the right. I was hoping that I would cope with it better the second time around, but I’m still quite miserable and cry just about every day. Most people don’t seem to understand how incredibly painful it is. It’s validating just to read your comments. I did everything you could think of the first time around. I would say that the thing that worked the best for me was getting a dog and changing my focus and attention to her. This time around I’m doing chiropractic, laser treatment, constant ice, Meloxicam, Gabapentin, twice daily dog walks in the park, prayer every morning, and psychotherapy. I’m trying to accept the pain and distract myself with joyful things. I’m wishing you all healing and sending you compassion in this very painful experience.

    Laurie Hall / Reply
    • Sarah Chapman

      It must be very miserable to have to go through this a second time. I’m glad you’ve found reading the blog and comments helpful and have adopted strategies that you are finding beneficial.
      Best wishes for a good recovery,
      Sarah Chapman [Blogger and Editor]

      Sarah Chapman / (in reply to Laurie Hall) Reply
  2. Avatar

    So happy to stumble on your blog! I have FS and have found acupuncture and taking Gabapentin (anti-seizure medicine) to be the most helpful. My question is- my Physical Therapist is pushing me to expand my range of motion and it’s overly painly and I’m back to have shooting nerve pain down my arm for days from this. Anyone else experiencing this? Should I trust my instinct and say “no” or just endure the pain in order to gain my range back?

    BTW- I learned that FS is so common for women in peri-menupause- that in Chinese medicine is called “50 Year Old Shoulder” not FS.

    Dayna Taus / Reply
  3. Avatar

    I hate to think that commiseration can help, but it’s just good to hear that what you are suffering with, is understood by some. It gives me hope and reminds me, that this too, shall pass. I’m about 10-11 months into my FS. I’m wondering how many of you dealt with secondary issues with muscles, tendons, nerves etc. in neck and down arm? I have a lot of random burning, tight, pains in neck, collarbone, arm, and sometimes hand. Sometimes it even spans onto my good side( non FS). I’m wondering about nerve compression or circulation issues stemming from the FS? Anyone else having these problems?

    Theresa Flynn / Reply
  4. Avatar

    Sorry if I repeat anything that’s already been asked or said , I don’t have time to read all your comments!
    I feel the exact same dilemma , to exercise or not , cause it hurts so damn much! My problem started around Easter 20 during lockdown , think I may have caused a strain doing heavy gardening. I’ve had a stress jab which appeared to make no difference, saw a chiropractor who was quite a bully about must do exercises, Him trying to manipulate it was sheer hell, never felt such pain.
    My confusion is that what I think of as my shoulder doesn’t have any pain or stiffness , although it has a limited ROM , but that seems to be because of the excruciating pain in my supraspinatus… posh name for what I think of as inside my upper arm , the muscle. That’s where they put the jab ? So it’s been about 9 months I guess and no real change 😔 so is it classic frozen shoulder ? What stage is it at ? What do I do ? Fortunately I did seem to regain some ROM or I’ve got used to it , but can hook my bra and dry myself without quite the pain I had !

    Ruth / Reply
    • Sarah Chapman

      Hi Ruth,
      Sorry you’re in this situation and it is hard not knowing what to do isn’t it? Are you able to see a physiotherapist? For me, this was the most helpful thing. I happened to be talking to a physio friend yesterday and she said that frozen shoulder is often wrongly diagnosed as there are several conditions that can look like each other. Tricky! You may have seen this but here is the NHS page on frozen shoulder and, as well as some basic information and advice, it links to where you can find registered physiotherapists.
      Best wishes,

      Sarah Chapman / (in reply to Ruth) Reply
  5. Avatar

    I have had frozen shoulder for around 4 months now and it hasn’t gotten any better. I used to pride myself in feeling good but now I am in pain constantly. I can’t imagine living with this for another year or two. I have had a steroid shot which didn’t help, nothing seems to help but I continue to walk and hike and live my life but it’s in pain most of the time. I don’t like taking ibuprofen because it affects your kidneys eventually. This is the worst thing that has ever happened to me and I can’t wait for it to go away.

    Kerry Banks / Reply
    • Sarah Chapman

      Hello Kerry, it is so very miserable isn’t it and I’m sorry you’re suffering. You have prompted me to add an update to the blog. It’s a pity there’s not yet any new evidence to add, but I hope you can take something from the blog and from the community of people who have shared similar experiences in the comment – and most of all hope that it WILL get better. I do hope you recover sooner than you expect, as I did.
      Best wishes,

      Sarah Chapman / (in reply to Kerry Banks) Reply
      • Avatar

        Thank you so much for updating this. It has really helped reading everyone’s comments and tips for coping. I’ve had a frozen shoulder diagnosed in right shoulder since Oct last year. Can feel it starting in other one too which is very worrying. Hardly any movement now, and very painful muscle spasms which needs medication to manage. Sleep is improving once I accepted I had to lie on my back. I put pillows both sides to tilt me slightly so it feels like sleeping on my side. I find heat helps, so keeping warm and moving the arm gently. I get up for an hour or so in night and move around which eases the heavy arm feeling. My doctor says there has been an epidemic of this during the pandemic and thinks the stress of it plus WFH without proper set up has triggered more cases. I’m just praying the freezing stage is coming to an end soon.

        Penni / (in reply to Sarah Chapman) Reply
        • Sarah Chapman

          Hi Penny,
          I’m glad you’ve fond something helpful here.The freezing stage is miserable isn’t it? I really hope you notice some improvement soon.
          Best wishes,

          Sarah Chapman / (in reply to Penni) Reply
  6. Avatar

    Joint replacement is worst decision individuals will make, there are other better treatments available such as regenerative medicine.

    R3 Stem Cell / Reply
    • Avatar

      This is my 2nd frozen shoulder. First one cortisone worked, this time no. I take lyrica for the damn nerve pain and do the exercises. It will take 2 years like the other. I wish they’d figure this out

      Kay Izzard / (in reply to R3 Stem Cell) Reply
  7. Avatar

    Good read, I have secondary frozen shoulder, post heavy-duty double surgery in my right shoulder:- 1. Bicep tenodesis and 2. SLAP tear repair with four anchors.

    I damaged my labrum (grade 4+ tear) a decade prior whilst in the gym in my late 20s. 41 when I finally took the plunge to get it fixed given the sorry state it was in. I nicknamed my surgeon “the butcher” because that’s what he did; hacked, poked, prodded and drilled away, leaving my shoulder in a rather traumatic state so much so that it froze solid. I wasn’t even aware there was a risk of this, that this was a thing until I experienced it.

    I’m three months in to the healing process and the pain is almost negligible now, I’m also able to sleep again without a bottle of sleeping pills each night, even lie on it for brief periods of time without it feeling like an elephant’s just landed on it. What I can’t do however, is raise it past 100+ forward flexion, even worse stats side abduction.

    “Adhesive Capsulitis” thus makes logical sense given the amount of trauma I suffered during the operation. I suspect it’s my body’s way of saying “get stuffed brain, you’re not moving this joint in any serious plane of motion anytime soon, until such time it heals enough so that we can release it ready for action again”.

    From what I understand, the underlying mechanism involves lots and lots of inflammation and scarring. The hardening of the shoulder joint capsule is central to this condition, the result of scar tissue around the capsule. Undertaking physio in my case heavily promoted by my surgeon mere weeks post-surgery, made absolutely no sense to me whatsoever, but hey, he’s the surgeon and I’m the patient. (I just happen to be a trained physicist, so I like the “physics framework” for thinking, it comes in quite useful when doing, learning new things). I say it made no sense because:- 1. My physio was an absolute psycho of atoms and 2. I arrived at the conclusion after reasoning by first principles, conducting extensive research etc., that attempting to move my arm when my body said it’s not ready to move it would simply prolong the runaway inflammatory processes involved when we’re actually attempting to break the cycle and reduce it. We’re aiming for a negative inflammatory feedback loop rather than a positive one. I thus decided to stop all physio and yes, as painful as it sounds, do nothing, a strategy in its own right.

    I now suspect that the capsular swelling around the joint has turned into scarring because the pain has subsided but restriction in ROM remains. With the subsequent passage of an unknown amount of time, normal daily use etc., I fully expect the scarring around the capsule to stretch enough, to breakdown gradually so that my ROM returns.

    Once again, this is a runaway inflammatory condition, the capsule is inflamed and sore, so logically, anything that stretches or pulls on it will aggravate it further. As such, during the inflammatory phase, it’s counterintuitive but physio and exercise likely doesn’t help, in fact, it may actually make things worse. The aim, the goal of recovery, is to break the inflammatory cycle NOT to exacerbate it. It is a mystery why this cycle once ramped up, continues unabated for a prolonged period of time. I suspect it’s because we’re told to move and stretch it etc. It’s also quite hard not to use your shoulder during day-to-day living, even for those with rather mundane lives. The only anti-inflammatory solutions short of corticosteroids I can think of is rest-over-time. The idea that less is actually more, do not use your shoulder etc. can seem like a rather difficult pill to swallow when physio is rammed down your throat into your shoulder joint.

    Dan Hood / Reply
    • Avatar

      Hi there, your story is fascinating as it is exactly the train of thought Ive had with my treatment. My story is after a fall which dislocated my shoulder and had to be put back in under anaesthetic and then a sling for a week. By the time I saw a specialist and had an mri and xrays 3 weeks later it was already freezing up, however I just thought it was the injury…..I had now been informed of a large labrum tear bicep tendonosis and a cracked humeral head. At one month after the fall my surgeon declared frozen shoulder and put surgery to repair the instability issues on the backburner. He wasn’t keen to go in and cut away scar tissue and tighten/ repair the rest when atm the frozen shoulder was actually ironically keeping my shoulder from redislocating. Anyway 5 months in now I have been religiously to my physio who does a great massage but is reluctant to do much else because of the underlying injury. I have no pain unless I push past the the ‘stuck’ positions. I am aware I use my shoulder muscles rather than moving the joint whenever I reach or stretch my arm out. My range is very limited, hardly any external abduction, i can now touch the top of my head and put something in my back pocket.
      I hear what u r saying tho. If i do my physio exercises, its sore and achy. If I dont then its not and I swear the range of movement hasnt benefited or been restricted by either. I wish someone knew exactly what is going on inside, it seems like a lot of guess work. Can scar tissue release itself, I’m sure mine must be mainly that due to the initial trauma. Do I get the instability repair surgery and risk further more painful frozen shoulder as it will be 6 weeks in a sling. I just dont know what to do. I haven’t had any cortisone as I dont have any pain. I manage day to day life quite ok. Can drive and do my job with hardly any issues. But it is the little things like washing hair and doing up a bra plus many more that the frustration creeps in.
      Where to go from here…

      Tiff / (in reply to Dan Hood) Reply
  8. Avatar

    Is it normal for physiotherapist to let me do exercises with her help,that really are very painful?She tells me I have to pass my pain for my fs to heal…

    Marlene / Reply
  9. Avatar

    This was such a helpful read. Thank you for posting and starting the thread. I had frozen shoulder about eight years ago and I am now experiencing it for the second time but this time in the opposite shoulder. It’s been about 9 months since the initial discomfort started. I’ve tried exercises and am seeing a physical therapist which has not given any relief or improvement of the pain but perhaps increased ROM slightly.
    Due to gastritis I can’t take NSAIDs so am on Tylenol and now sometimes have to take oxycodone because the pain is too intense and it’s been going on for months. Between Covid prevention and chronic pain I feel like my life has gotten so small and there’s no fun anymore. I feel depression nipping at my heels and it’s requiring a lot of inner emotional and spiritual strength not to succumb to despair and resignation. (Current events here in the U.S. aren’t helping either…)

    Anyway, it was just comforting to read other peoples posts and feel less alone in this miserable predicament. My sympathies go out to everyone here, and I hope folks are feeling improvement or that they are starting to thaw. In the meantime, it was validating to read your descriptions which lifted my spirits a bit.

    And having been through it before, I know for sure it will resolve eventually. Phew!

    Lizzy / Reply
  10. Avatar

    I’ve currently had FS for almost 2 years. It first started in July 2018 after we just moved and I thought I did something while lifting and carrying boxes into our new home. I’m now 39 and male so this happened very young. I’m a type 1 diabetic and had thyroid cancer (fully recovered). I used to be very active, ran, played basketball, weights, yoga, the whole 9 yards. So to say this was frustrating is an understatement. I finally got a cortisone shot 6 months ago in November 2019. It definitely helped with the pain and increased my overall movement, but my blood sugars increased dramatically for 2 weeks. I’m now at the state where I just try not to move it too much each day. I can run a little before it starts hurting, and bike. Nice to read everyone’s account and know I’m not the only one going through this horrible thing. Best of luck to everyone.

    Chris Cole / Reply
  11. Avatar

    Reading all of these posts makes me feel like I’m not alone or crazy with the FS symptoms I have. I had shoulder surgery for a torn bicep muscle, PT was going well after surgery until FS hit me about 10 weeks into PT. I think I’m in the frozen stage…the sudden movements followed by intense pain is the worst. I too, can’t sleep at night because of pain, the pillow for my right arm seems to be the only way to get some comfort. I will be starting my second wave of therapy tomorrow since finding out I now have FS. By the way the surgery went well and the bicep is doing fine😊….and yes I am over 50 and female.

    Tracy / Reply
  12. Avatar

    I had suffered from cfs for several months before seeing my gp, I was unable to throw a tennis ball for my dog when I did sever pain in my right shoulder would stop my arm from moving for around 4o second before I could use it again. Physio was unhelpful and the pain during the treatment was almost unbearable. Gp referred me to a sports medical service who over 12 months gave 3 Hydrodilatation injections into the capsule. I received no benefit from the injections and was referred to a Shoulder specialist and subsequently had surgery to cut adhesion’s, no immediate relief or range increase occurred. It took about 3 years after surgery before this arm showed a significant change in both pain and movement range. That was 2o years ago, recently I had open heart surgery and when I woke, I had chronic pain in my neck and top of left arm. Follow up x-rays and ultrasound suggested Frozen shoulder ( I was told shoulder injury not uncommon after Heart surgery) Advised by new specialist Hydroilatation was still best option despite my previous experience. So new injection into joint, instant pain relief for about 3 days (good night’s sleep). After pain meds wore off back to pain physio provided limited relief. As I work for myself I have no option but to push on, I’ve had to learn to compensate to use my right arm for more work and realize that the left arm is basically useless.
    The only hope I have is that overtime my right arm came good on its own.

    Will Bee / Reply
    • Sarah Chapman

      That sounds miserable. We really need some good evidence to inform our treatment choices.
      I hope you get some good improvement soon.
      Best wishes,
      Sarah Chapman

      Sarah Chapman / (in reply to Will Bee) Reply
  13. Avatar

    I was diagnosed with FS by my chiropractor. He thought he would be able to “break” it loose but has been unsuccessful and is now suggesting I go to an orthopedic doctor. My FS developed over the summer but I did not know it wasn’t just a soft tissue issue until October. My chiropractor tells me due to me being over 50, menopausal, I was a prime candidate. I wish my OB/GYN would have mentioned this. Otherwise, I am active, very busy, slim and eat fairly healthy. My dilemma is, the chiro says due to my age, it needs treated differently than in younger people. He says if I exercise it and do stretches I find on internet or that someone else was told to do for the condition, that my body will be triggered to create even more scar tissue as it will see these things as more trauma that need protecting. I want to try to help this along, I’m willing and disciplined to do the work, I just don’t want to make it worse. If anyone can offer experience on this, it would be greatly appreciated. Thank you. 12.03.19

    SJ / Reply
    • Avatar

      Your chiro is flat out wrong. Just because you’re older it does NOT mean your body will see stretches differently than when you were younger. Stretches are good for the body, especially as we age, because they help keep muscle flexible and strong. What you don’t want to do at any age are painful, even agonizing, stretches of short duration. What you want are near painless stretches of long duration. That means stretching just until it becomes a bit uncomfortable (but not painful) and holding it for a long period of time.

      Judy / (in reply to SJ) Reply
  14. Avatar

    I’m also suffering from a FS. At this moment I’m in about 14 months. Took a steroid shot, have been dry-needled, had Shockwave therapy and I’m still trying to do some exercises in the gym. There’s nothing that helps me, neither with the pain, nor the ROM. By now the pain during the day is okay, as long as I don’t make unexpected moves. At night I am able to sleep, even when I roll over. I do wake up slightly, but it’s bearable. But the ROM is terrible
    It’s so bloody annoying. Since a few days I started using Glucosamine / Chrondoitin / MSM since I’ve read some pretty amazing reviews about MSM with FS injuries. Hope it will help. I’ll keep you posted if it does.
    (Sorry for my English, I’m not a native speaker)

    Alex / Reply
    • Avatar

      I’ve had a FS for about 5 or 6 months. I guess you could say I’m at the thawing stage, which is good. Thanks Sarah for this article. It’s helpful also to read about other people’s experiences in the comment section. I have recently started seeing a physiotherapist and she’s given me an exercise regime to follow and she has performed two dry needling treatments which I HATE. What I really want to know is: what is the difference in the outcome if I A do nothing B just exercise or C exercise plus dry needling.
      I am at the point where I can do a lot more now than I could, for eg I can brush my hair and dressing and undressing is easier. I can’t put my bra on in the conventional way though and I feel a long way from achieving that.
      What I have learned here is that swimming may be helpful and that makes sense. We have an outdoor pool in the townhouse strata that I live but it’s closed because of Covid…haha. Never mind. Thanks again Sarah and Cochrane.

      Louise McElhill / (in reply to Alex) Reply
      • Sarah Chapman

        Dear Louise,
        You’ve reminded me just how debilitating frozen shoulder is and that I should be giving thanks every time I put my bra on without difficulty (always now)!
        You’ve hit the nail on the head with those questions and of course the equivalent can be applied to treatment decisions much more widely. Good questions to take to a doctor, physio or other healthcare professional. What happens if I do nothing or treatment A or treatment B? What are the potential benefits and harms of each? This reminds me of the blog I wrote with geriatrician Kit Byatt, who helped me think through treatment choices for my mother. I found it so useful, we wrote it up.
        Let’s hope the Cochrane Reviews will be updated with better evidence.
        I hope you can soon swim again and that it helps.
        Best wishes,

        Sarah Chapman / (in reply to Louise McElhill) Reply
  15. Avatar

    I’m a few months into my second frozen shoulder. First time I tried physiotherapy, dry needling and a steroid injection. I don’t believe any of these treatments made any difference whatsoever. After 18 months, I fully recovered. Three years on and now my other shoulder is frozen.
    I’m two weeks into four week course of Prednisolone, 30mg daily. I’m having a few side effects, including fluid retention but it is definitely providing relief to that constant intense ache, especially at night. It’s made no difference to the pain experienced from a jerking movement though, still need to breathe through that! Unfortunately the treatment is only available short term.

    Julie / Reply
    • Avatar

      From a former frozen shoulder patient to everyone in this forum. Please look into trigenics OAT procedure, it is the only viable solution for this horrible condition. I had it done and have my arm back. all the best.

      Maree / (in reply to Julie) Reply
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    I have had both of my shoulders frozen. First with cortisone shot and 5 months of therapy. The second I did nothing but treat the symptoms and they healed almost the same. The first one I did have a bit more range of motion but the time of freezing and thawing were the same. I also had these back to back. As soon as the first was healed, the next started right away. It was about a year apart or so. I now have it in my hip harder because you have to put all your weight on your hip when you walk around. It seems to be just like the shoulder where it starts stiffening and I’m about 4 months into a painful hip. I’m assuming at some point it will start thawing! So frustrating every year I have something frozen. I am assuming next year it will be my other hip! I noticed this starting when I hit perimenopause. I also have had other issues that say it’s due to an autoimmune disease? Has anyone one else had it in their hip?

    Melissa / Reply
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    I would be interested to know from my fellow frozen shoulder suffers, how many of you also suffer with poor circulation? My feet and hands seem to be almost always cold (particularly in winter), I also notice that my skin is often cool to touch on my upper arms. The reason I’m asking is I recently read a paper which discussed blood flow disturbance to the shoulder joint as a possible link with frozen shoulder. I’m just curious to know whether others suffer with blood circulatory problems. Thank you!

    Louise / Reply
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      I have been dealing with my second frozen shoulder since a March. I think I have cried every day for the last 5 months. The pain is terrible. I don’t understand why there is no effective treatment for this condition. I have been told this could be an emotional hold. I did have some very sad events happen early this year. Not sure how to release any pent up emotions to help with this pain and lack of movement. I do suffer with winter blues. I told my husband the year has come and going by so fast. I haven’t got to enjoy anything this year. And winter is coming again very fast. Hoping to beat this soon. It is enough to cause depression on its own. I would like to start living again!

      Pam / (in reply to Louise) Reply
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        So sorry to hear this Pam. Its strange you should mention the emotional hold. At the time I began to develop my FS symptoms it was after my husband had had an accident requiring surgery. It had also been a stressful six months having moved home and encountering various unexpected problems with the new property. I do hope you start to feel better soon.

        Louise / (in reply to Pam) Reply
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        Hi Pam, it will get better. It’s very frustrating and can absolutely affect your mental state. I am very upbeat and this gave me a bit of depression. The good news is, it will get better. The pain will lesson and you will get your shoulder back. Hope you start to feel better soon!

        Melissa / (in reply to Pam) Reply
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        I hear you. It is definitely not just a physical toll but also a mental one. Very stressful experience all in all. Wishing everyone well.

        cher / (in reply to Pam) Reply
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      Yes i have horrible circulation! Im 2 years in surgical menopause! I have osteoporosis an arthritis. My feet, hands an shoulders are cold. Winter time i feel like a tin man, ps i live in Kansas! Im 31 years old. My cancer dr-breast surgeon thinks it could be related to double bilateral mastectomy with lymph node under left arm! Frozen Left shoulder! Low range of motion an horrible pain.

      Lacey G Kelly / (in reply to Louise) Reply
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      Hello Louise,

      I also suffer from cold hands and feet; and my skin is always cold to the touch. This is my third episode with frozen shoulder.

      Nan / (in reply to Louise) Reply
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    Thanks for posting this Sarah. I first began experiencing symptom in about March/early April this year. By May I’d noticed that my left arm had begun to stiffen so I went along to see a private physiotherapy who diagnosed frozen shoulder.

    Since then I have been referred to an NHS physiotherapist and have been given a set of exercises. So far I’ve managed to maintain some range of movement, although I’m not sure whether I am still in the painful freezing stage and whether I am going to loose my range of movement as times goes by.

    I am taking Naproxen for the pain, which helps a little, but not greatly. I’m particularly intrigued to read how avoiding the prescribed exercises for a few weeks improved your pain/range of movement. I have read a few patient accounts which seem to echo this. I’m considering avoiding the stretches for a few days/a week to see if this makes any difference. Thanks again for posting. It really helps to read other experiences.

    Louise / Reply
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      Hi Deborah
      Ice pack at night can help and during the day. I bought a large one on amazon for about £15. I took Naproxen 500mg twice daily for a fortnight which took out some of the pain when it was horrendous. I also bought a med-fit ultrasound device that relieves pain a lot. They come up second hand on eBay sometimes for around £50 and hold their value once you’re done with it or if it doesn’t help. I use that a couple of times a week around the front of the shoulder capsule and down my biceps and also around the back of my shoulder where I lift my arm and it’s tight. I find it relieves pain and increases movement quite a bit.
      I’ve been going for physio for about 10 weeks and have been doing some exercises. You can get a lot of exercises on you tube etc.
      It’s improved a lot from before I started where I had shooting pains down my arm and could hardly lift a bag or put a top on, or get my arm around my back. I have a much greater range of movement, far less pain but it’s a stubborn condition for sure and you have to be persistent to alleviate it.

      Jane / (in reply to Louise) Reply
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    I have just been told I have frozen shoulder, I cope ok during the day but night time the pain takes over and sleep is just not possible, can anyone tell me what pain relief they took, my doctor has me on Valium, panadiene forte, and palexia and nothing is giving me any relief. This is only my second week and I’m struggling, lack of sleep isn’t helping.
    To make matters worse I’ve just had major hip surgery. I’m normally a strong person but this is unbearable, if anyone can help with advice I would really appreciate it
    Thank you

    Deborah / Reply
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      I took OTC NSAIDs for pain but my dr switched me to acetaminophen due to concerns about kidney damage because I was taking well above the max dose to relieve some of the pain. Sleep is fleeting but I found putting a soft pillow under the arm with the sore shoulder helped relieve some pain. Can get to sleep but wake up as soon as I move. This is 2d shoulder to be frozen. I bought this sleeve on Amazon that holds packs that can be heated or frozen. Applying the sleeve with frozen packs 3-4 times per day helped tremendously and I could still work at my computer. ActiveWrap Shoulder Ice Therapy Wrap BAWSH10 – Ice Pack Included

      Betsy Holmes / (in reply to Deborah) Reply
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      I know this post has been out a while but I’m experiencing frozen shoulder as well. I injured my shoulder in May. My neurologist ran MRI scans, nerve tests, muscle tests and xrays. When he got the results he sent me to an orthopedic surgeon. I saw them today. They diagnosed me with frozen shoulder. They want me to try physical therapy for 3 to 4 weeks. If that doesn’t improve my range of motion they said there is a surgery that can help. My pain was really bad at night also. I’m on Lyrica and Naproxen. It seems to help. I also take bromelain for inflammation and cbd oil.

      Renee / (in reply to Deborah) Reply
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      I’ve had frozen shoulder for 7 months. What finally helped me with the pain was acupuncture.

      Kristin Parks / (in reply to Deborah) Reply
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    I have frozen shoulder for about 8 months now. I went to a doctor, but they didn’t even suggest I may have this condition. I had to google and find out myself, but unfortunately It was too late and my shoulder froze. I believe I am at the beginning of the thawing stage now, sudden jerking motion doesn’t cause excruciating pain anymore and I can sleep to some extent on my shoulder for an hour at least. What worries me is that I am starting to develop it in my other shoulder although I’m not sure if it isn’t just sore because I sleep on it a lot more than usual. I try to do exercises and stretches sometimes but they seem to aggravate the pain.

    Petry / Reply
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    Great read. I have been trying to work out whether the exercises are helping or whether it is just a time thing. I don’t do the exercises regularly it has been close to year now & I can feel a little bit of improvement, I can now just tie up my hair again. it took a long time to get to a see a physio, I have only been at the physio for the last 2 months & now only seeing them once a month. My exercises are very inconsistent, I’ve never been good at self discipline for exercising! I can totally relate to Kirk comments in that painful stage of jerking your arm. The scary thing is I am starting to feel twinges in my other arm, so I think that is about to go as well. How long did it take for your shoulder to come right?

    Amber NZ

    Amber / Reply
    • Sarah Chapman

      Oh yes that pain when moving your arm suddenly. Flushing the loo was a tricky thing for me for a while! I do hope you won’t develop problems in the other shoulder… Hard to remember how long it took for mine to resolve but it was quicker than the 18 months I’d been told I might have to expect; maybe a year.
      Best wishes,
      Sarah Chapman

      Sarah Chapman / (in reply to Amber) Reply
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      A few years ago I developed a frozen shoulder on my right side. It resolved in less time than was predicted – I think it was two years overall from the very start to the finish, rather than the three I had expected. Then I started, like you say you are experiencing, getting twinges in my left arm and I am now in the first, painful stage of having another frozen shoulder. The zingers! I don’t honestly believe people actually understand how excruciating these are. All I can think of is to say in response to your post, is that, having already had it once, you’ll know what it is like (what you can expect, what you can and can’t do etc) AND that there is light at the end of the tunnel because it WILL eventually resolve. Hoping we both get through this with this in mind. x

      Shelley / (in reply to Amber) Reply
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      Hi amber, I see your post was in June. I hope you don’t mind me asking, but have you gone onto develop fs in the other shoulder? I’m still in the frozen stage, but getting twinges and mild pain in my right shoulder. I didn’t think it was impossible to get it in both shoulders simultaneously, but it seems that I might. Feeling very low and frustrated with it as I haven’t had a break.

      Thank you.

      Louise / (in reply to Amber) Reply
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    Hello! Just wanted to add my experience here as well. I had a proximal humorous fracture in two spots…yeah, not good. Fortunately, I didn’t have to have surgery – diagnosis was 6-8 weeks in a plastic cast/sling. It was never suggested to me to ‘get moving’ with circulation. I was super diligent about keeping my arm in the bent ‘casted’ position even when I slept. When I finally got my cast off and started PT, I quickly realized I had zero range of motion in my arm/shoulder…after two weeks of regular PT, I was diagnosed with ‘adhesive capsulitis – frozen shoulder.’ It literally took me 8 weeks PT (dry needling, exercises, heat therapy etc.) before I could raise my arm to the point I could wash my own hair. I’d say a good 4 months until I had somewhat normal range of motion back! Here I am … almost a year later to the date of my break and I’d say I’m 97% back to normal. I still have some uncomfortable pain when I roll over on my arm during the night but pretty much normal range of motion back. Still slightly cautious using it in some instances (just out of fear) but, other than that all good!
    As mentioned above – it does get better in time…although it may seem like forever! Hope my input can help someone! Best wishes on your healing journey!

    PC / Reply
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    I spent the last year suffering from a frozen shoulder and it played out pretty much as my physical therapist said it would.
    -The first two to three months were pure agony as the shoulder froze into place. Exercises had no effect, other than causing more pain. The therapist even said that it was pretty fruitless to exercise until the first stage was over.
    -Next, the shoulder was frozen for three months which meant limited movement but the pain wasn’t as bad. Exercising during this stretch seemed to help a little bit.
    -Then the thawing began which meant my range of motion slowly improved and the pain subsided. Exercising was helpful during the unfreezing process. It’s been a year since I first had symptoms and I’d say my arm is at 80-90%.
    I have a few suggestions for those suffering:
    -avoid doing things that could lead to your arm jerking suddenly. Like removing a plug from an outlet or taking the top off of a marker. The pain from jerking my arm suddenly was nearly unbearable and embarrassing (I yelped a few times in public).
    -This sounds weird but I would consider sleeping without a top sheet or blanket during the initial freezing stage. Every night in my sleep I would eventually either pull the covers up or push them away and this arm motion always caused excruciating pain and sleep loss.
    -hot showers and Tiger Balm! You will smell like an old man but so what!

    Hope this helps. It does get better!

    Kirk / Reply
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    Hi Sarah
    How are you getting on now? I’m in a similar boat trying to way up whether I should have a capsular release procedure. I am an osteopath too so doubly frustrated that I can’t find the right ‘way in’ to get this treated effectively. Some colleagues and I are exploring the Niels Asher techniques. I can keep you posted if you would like. Best wishes Jos

    Jocelyn Drew / Reply
    • Sarah Chapman

      It’s really difficult to know what might work, isn’t it? Frustrating, I agree! I am delighted that mine has almost completely resolved, but really don’t know what is responsible for the quicker-than-expected improvement! I hope you find that something works for you soon.

      Sarah Chapman / (in reply to Jocelyn Drew) Reply
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    Thanks for sharing this blog. Frozen shoulder is really an adverse condition one could have and you mentioned the it perfectly what one should do while suffering from it.

    John Smith / Reply
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    I usually take bath with warm water it helps in some way

    Susan George / Reply
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    This is great. I sent it to a friend I haven’t seen for a while who was suffering from this years ago, having steroids, wasn’t working, not sure what to do etc. etc.. I had a go at looking at a few Cochrane reviews for her but it was difficult to piece together any evidence-based advice for her. And to be frank, my authority as a Cochranite rather than a proper doctor or physio was fairly low – much as she loves me as a person. So I left her to the tender mercies of the NHS who I hope did a good job for her. I don’t want Sarah to have to go through any more health issues for our benefit. Is there a way for Cochrane to reach out to patients and carers of people with other common conditions to enable them to write equally useful round ups based on their experience, and the best available evidence? Or team patients and carers up with science communicators to produce them? And yes, someone should definitely do a study on swimming Anges. I remember you from EQUATOR Publication School 2015 – let’s design a trial!!

    Caroline Struthers / Reply
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    Swimming cured my frozen shoulder:no waiting list and cost is minimal. Somebody should do a study on it

    Agnes Ayton / Reply
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      I’m dealing with this frozen shoulder diagnosis but I’m uncertain where it’s at stage wise. I can wash my hair gently and reach high enough to hang laundry but pulling up a tight swimsuit or getting a bra on solo is not something I can do. I have begun swimming which helps with pain but not sure it’s improving my range of motion. It’s the hardest physical thing I’ve had to deal with. 😫

      Amy / (in reply to Agnes Ayton) Reply
      • Sarah Chapman

        Sorry you are living with this Amy – I know what this is like! I am back to normal now – hope you make a really good recovery too.

        Sarah Chapman / (in reply to Amy) Reply
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          Thank you Sarah for your well wishes and glad to hear you’ve recovered. A month past my comment to you and at least the zingers have gone, so that is the good news and I can do an increased arm span in a breast stroke but not getting anywhere yet with raising arm up towards my head or behind my back, that has remained the same limited ROM. Curious did you end up continuing with the eccentric muscle exercises for your frozen shoulder? I’d like to look into that because not sure the pendulum or wall finger crawl, etc has done much. I also wonder how much hormones and possible auto-immune issues may play a role in frozen shoulder? It sure is a long and mysterious health issue!

          Amy / (in reply to Sarah Chapman) Reply
          • Sarah Chapman

            Hi Amy, I’m glad you’re seeing some progress. I didn’t continue with the exercises for very long… I think I still have slightly reduced movement but not so much as to be a nuisance and no pain – I’ll take that! Hope things improve some more for you soon.

            Sarah Chapman / (in reply to Amy)
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      My shoulder started freezeing in early April 2019 and completely froze on May 7, 2019. I saw an sports medicine doctor on June 11th and was diagnosed with frozen shoulder. I’ve been stretching, lifting and swam yesterday for the first time. It’s been 21 days since I started stretching and 19 since I started lifting. The lifting has definitely helped improve ROM and strength. Swimming yesterday though seemed to very quickly improve my ROM. No matter what you do it’s going to be painful – whether you do nothing, get a shot, stretch, lift, swim. But since I started lifting I’ve gained s lot of strength back and a fair amount of ROM. This allowed me to swim yesterday. I started off with a half ass breast stroke to a nearly normal one after just a few mini laps. Lifting exercises I started with were seated slightly inclined machine chest presses, flies, reverse one a flies, seated machine lateral rows, seated cable rows, lateral dumbbell raises. At first I was using the lightest weight the machine had or 10 lb dumbbells. Now after less than 3 weeks I can use about 70% of what I used to do plus added tricep push downs, bicep curls, flat dumbbell chest presses, etc. I never stopped doing legs, lumbar machine for lower back or abs. It all hurts – a lot but at least I’m able to do way more, pain free than I could 3 weeks ago.

      I’m a big believer in lifting plus yoga to stay strong, flexible and improve mood and mind. It can only help you to be strong and fit.

      Mark Wutz / (in reply to Agnes Ayton) Reply
      • Avatar

        I’ve been suffering from severe frozen shoulder for a year. The initial freezing stage lasted 9 months and was so painful that I could not do many basic tasks (drive, wash my hair, dress myself), let alone exercise. The pain subsided 3 months ago, but my ROM was close to zero despite daily physical therapy, exercises, acupressure…Indeed, my orthopaedic specialist said it was one of worst case he had ever encountered.

        Finally, out of desperation, I tried swimming. Or rather, forcing myself to do a dog-paddle/breast stroke across the pool and – like you – noticed a remarkable improvement in ROM after a few laps. Perhaps a kind of “muscle memory” was triggered (I swam almost daily most of my life until this happened ) and my shoulder started to loosen up. I can now swim 25-30 breast stroke laps normally, albeit slowly, but my ROM decreases as soon as I get out of the pool and I’m often very sore the next day.

        Final take-way: swimming and yin yoga are the only effective therapies I’ve found to improve mobility. It is a very slow, frustrating process.

        Marie Gomariz / (in reply to Mark Wutz) Reply
        • Avatar

          Thank you for all your comments, ideas and stories.

          I started my FS when I was pregnant last June and by this June it started to give real trouble. I’m assuming this is the frozen stage. I can’t put my seat belt or bra strap on. Sudden jerks and movements create so much pain I have to wait a minute or two till it goes away.

          Nights are bad mornings the arm feels heavy and painful. I’m about to get a hydrodilation jab or steroid jab. But I see comments here saying they are not effective.

          I would like to know if anyone has tried acupuncture?

          Nirasha Silva / (in reply to Marie Gomariz) Reply
          • Avatar

            Nirasha – I am so sorry you are dealing with this, and likely with a little baby. I have had FS for 7 months. 2 steroid injections under image, 1 course of oral steroids, 6 months of physical therapy, weekly targeted massage, and 4 months of acupuncture. Lots of ice and heat throughout the day. NSAIDs and muscle relaxants. I have modestly improved range of motion, but pain is still there. I think I am seeing other benefits from acupuncture, but I don’t think it has helped FS. Other people have sworn by it, though. I am in the U.S., so our treatment protocol may be different from U.K. — I am being strongly urged to schedule surgery, which would be a “closed” full range of motion push to break up all adhesions, etc, followed by arthroscopic clean out of shoulder joint. Followed by another at least 4 months of recovery. This is all so exhausting and disheartening. Sleep is terrible (from pain) and I miss being active – playing tennis, doing yoga … not viewing driving my kids around as a monumental task! Sorry – this has turned into a vent. The short answer to your question is that acupuncture hasn’t cured my FS. :( Best of luck to you — Jessica

            JessicaD / (in reply to Nirasha Silva)
    • Avatar

      Please tell us more about your swimming:
      – how bad was your shoulder when you started swimming?
      – what type of swimming did you use? I can only swim breaststroke but it’s really difficult at the moment as cannot complete the movement properly without pain
      – how often did you swim, and how did it improve your condition? Did it relieve pain? How fast did it evolve?

      Thanks for any additional information. This condition is draining both physically and emotionally. I have been developing FS since May, and have been off my usual exercise schedule for a couple of months and it’s just getting worse. I feel “normal” exercise might hold the solution for me.


      Elinor / (in reply to Agnes Ayton) Reply
  29. Avatar

    Interesting. I had a pretty bad frozen shoulder which developed after breaking my wrist because of a fall playing tennis. It was put in a plaster, but no-one said anything about keeping it mobile, and the frozen shoulder came on with a vengeance. I couldn’t sleep on it and it was giving me a lot of pain. Normal excercises did absolutely nothing for it. What cured it in the end, after about 3 weeks of continuous discomfort, – and almost instantly – was going back to playing tennis. The serving action was really difficult at first and very painful, but it got easier as I played. By the next day, although it felt a tender, the pain was gone and I could sleep on it again. Three or four days and it was completely in the past. Circumstantial evidence – perhaps, but I am convinced it would not have gone without the tennis. It was just so instant! The serving action puts quite a lot of stress and traction on the joints. If the problem was due to adhesion, I suspect that this sorted it out.

    David Ellis / Reply
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      I believe normal exercise should fix mine too, though cannot imagine playing a tennis shot (even less a serve). Was the pain not excruciating?

      Elinor / (in reply to David Ellis) Reply
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        I have developed FS after surgery from a broken collarbone. The pain is worse than breaking a bone.

        Robert Louis / (in reply to Elinor) Reply

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