Frozen Shoulder: Stages, Timeline, and What Helps

By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published October 2026

It started as an ache in your shoulder that you thought would pass. Then reaching behind your back, fastening a bra, grabbing your seatbelt, or reaching into a cabinet became painful, and over weeks your shoulder seemed to stiffen up in every direction. Even when someone else tries to lift your arm, it won't go.

That pattern is typical of frozen shoulder, a condition that can be frustrating and slow, but that usually improves. This article explains what frozen shoulder is, its stages, how long it tends to last, who is more likely to get it, and how physical therapy can help.

Frozen shoulder is diagnosed by a physician or physical therapist after an exam, sometimes with imaging to rule out other causes. This article is general education, not a diagnosis.

The short answer

Frozen shoulder, also called adhesive capsulitis, happens when the capsule around the shoulder joint becomes inflamed, thickened, and tight, causing pain and a loss of motion in many directions. It's most common in women between 40 and 60, and people with diabetes have about five times higher odds of developing it (Ramirez, American Family Physician 2019). It's traditionally described in three phases: painful, stiff, and recovering. It often improves over one to two years or longer, though some people don't regain full motion. The APTA's guideline supports education and stretching matched to how irritable the shoulder is (APTA guideline summary). In California, you can see a physical therapist without a referral.

What is frozen shoulder?

Your shoulder joint is surrounded by a capsule, a sleeve of connective tissue that holds the ball of the upper arm in the socket. In frozen shoulder, that capsule becomes inflamed and then thickens and tightens, which limits how far the shoulder can move.

What makes frozen shoulder different from many other shoulder problems is that motion is lost in several directions, and it's lost both when you try to move your arm and when someone else tries to move it for you. Reaching overhead, out to the side, and behind your back can all become limited.

Most cases develop without a clear cause. Frozen shoulder can also follow a period of limited shoulder use, such as after an injury or surgery.

What are the stages of frozen shoulder?

Frozen shoulder is traditionally described in three phases (Ramirez, 2019):

• Painful (freezing) phase: pain builds, often worse at night, and motion starts to decrease.
• Stiffness (frozen) phase: pain may ease somewhat, but the shoulder is very stiff and daily tasks are hard.
• Recovery (thawing) phase: motion gradually returns.

The phases overlap, and not everyone follows the same pattern or timeline. Knowing which phase you're in helps guide how hard to push with stretching.

How long does frozen shoulder last?

It's usually a slow process. Historically, full resolution without treatment was expected over about one to two years. A review of studies found that without treatment, range of motion improved partially but not completely over one to four years, and that most of the improvement in pain and motion happens early (Ramirez, 2019). Some people have symptoms for years, and some never fully regain shoulder motion.

That's not meant to discourage you. It's a reason to have a clear plan, realistic expectations, and the right kind of exercise for each phase.

How can physical therapy help?

The APTA's adhesive capsulitis guideline recommends (APTA guideline summary; Kelley et al., JOSPT 2013):

• Education about the natural course of the condition and pain-free activity changes
• Stretching exercises with intensity matched to how irritable your shoulder is
• Joint mobilization, hands-on treatment directed at the shoulder joint, as part of care

The guideline also notes that corticosteroid injections combined with mobility and stretching exercises give better short-term pain relief and function than exercise alone. Injections are a decision to make with your physician.

A physical therapy evaluation may include:

• When symptoms started and how they've changed
• Shoulder motion in every direction, both active and with assistance
• How irritable the shoulder is, which guides how hard to stretch
• How the shoulder affects sleep, dressing, work, and driving
• Screening for signs that need a physician's evaluation

A typical plan may include:

• Gentle, pain-respecting motion early, when the shoulder is most irritable
• Progressively stronger stretching as irritability settles
• Hands-on mobilization of the shoulder joint
• Strengthening of the shoulder and shoulder blade muscles as motion returns
• Tips for sleeping, dressing, and daily tasks
• A home program you can keep doing on your own

Physical therapy doesn't guarantee full recovery or a specific timeline. If progress is very limited after a period of good nonsurgical care, your physician may discuss other options.

At Nova Physical Therapy in North Hollywood, shoulder recovery is one of our core services, and every plan starts with an evaluation so treatment fits what we find.

Who is more likely to get it?

Frozen shoulder affects an estimated 2% to 5% of people. Known associations include (Ramirez, 2019; Zreik et al., 2016):

• Age and sex: most common in women between 40 and 60
• Diabetes: about five times higher odds; in one analysis, about 30% of people with frozen shoulder had diabetes
• Thyroid problems: hypothyroidism was more common in people with frozen shoulder in one study
• Limited shoulder use after an injury or surgery

Having one of these doesn't mean you'll get frozen shoulder, and frozen shoulder doesn't mean you have one of these conditions. If you have risk factors and shoulder symptoms, an evaluation can help clarify what's going on.

When should I see a doctor?

Call 911 if shoulder or arm pain comes with chest pain or pressure, shortness of breath, sweating, or nausea. These can be signs of a heart attack (American Heart Association).

See a physician promptly if you have:

• Shoulder pain and stiffness after a fall or injury, especially if you can't lift your arm
• A hot, red, swollen shoulder or fever
• Unexplained weight loss, a history of cancer, or night pain that doesn't change with position
• Numbness, tingling, or weakness spreading down the arm
• Rapidly worsening pain or stiffness

We screen for these signs during every evaluation and refer you to a physician when findings call for medical assessment.

Do I need a referral for physical therapy in California?

Not to get started. California allows direct access to physical therapy. A physical therapist can evaluate and treat you without a referral for up to 45 calendar days or 12 visits, whichever comes first. After that, a physician or podiatrist needs to sign the plan of care for treatment to continue. Your insurance plan may have its own referral rules, so check your coverage.

Frequently asked questions

Will frozen shoulder go away on its own?
It often improves over time, but research shows recovery may be incomplete, and some people have symptoms for years. A structured plan helps you make the most of each phase.

Should I stretch a frozen shoulder?
Yes, but the intensity should match how irritable your shoulder is. Gentle motion is best early on, with stronger stretching as pain settles. Stretching too hard during the painful phase can backfire.

Why does frozen shoulder hurt more at night?
Night pain is common, especially in the painful phase. Supporting the arm with a pillow and avoiding lying on the affected side may help.

Is frozen shoulder the same as a rotator cuff problem?
No. Rotator cuff problems usually cause pain with certain movements, while frozen shoulder causes stiffness in many directions, even when someone else moves your arm. An exam helps tell them apart.

Does a cortisone shot help frozen shoulder?
Research shows injections combined with exercise can give better short-term relief than exercise alone. Whether an injection is right for you is a decision to make with your physician.

Can frozen shoulder come back?
It's uncommon to have it again in the same shoulder, but some people later develop it in the other shoulder.

Do I need a referral to see a physical therapist?
No, not to start. California allows direct access within the limits described above.

About Nova Physical Therapy

Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from shoulder problems, back and neck pain, sports injuries, work injuries, auto accident injuries, and knee pain, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.

Schedule an evaluation

If your shoulder is painful and stiff in every direction, an evaluation can help sort out what is going on and build a plan for each stage.

Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online

Disclaimer

This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Shoulder pain and stiffness have many causes, and only an in-person evaluation can determine what is right for you. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.

References

1. Ramirez J. Adhesive Capsulitis: Diagnosis and Management. Am Fam Physician. 2019;99(5):297–300. Link
2. Kelley MJ, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. Clinical Practice Guidelines. J Orthop Sports Phys Ther. 2013;43(5). Link
3. Guideline Central. APTA Shoulder Pain and Mobility Deficits: Adhesive Capsulitis Guideline Summary. Link
4. Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. 2016. Link
5. American Heart Association. Warning Signs of a Heart Attack. Link