Why Is My Shoulder Getting Stiffer and Harder to Move? A Physical Therapist Answers

“My shoulder has gradually become stiff. I struggle to reach behind my back, put on a jacket, and lift my arm. Is this frozen shoulder, and can physical therapy help?”

Progressive shoulder pain and stiffness may be associated with frozen shoulder, also called adhesive capsulitis. It is characterized by restriction of both active movement (when you lift your own arm) and passive movement (when someone else gently moves it). However, arthritis, rotator cuff problems, previous injury, and other conditions can cause similar complaints. A medical assessment and physical therapy examination can help clarify the appropriate next steps. Conservative rehabilitation often focuses on pain management, tolerable movement, and gradual restoration of shoulder function.

Frozen shoulder is a condition in which the shoulder joint capsule becomes painful and less flexible, making movement increasingly restricted. The shoulder may become difficult to rotate outward, lift overhead, or move behind the back. The American Academy of Orthopaedic Surgeons (AAOS) describes a pattern of pain and loss of both active and passive range of motion. Symptoms alone cannot confirm a diagnosis, and not every stiff shoulder is adhesive capsulitis.

Dressing, fastening a seat belt, washing hair, and reaching a back pocket require combinations of shoulder rotation, elevation, and movement control. When the shoulder becomes painful and restricted, these everyday movements can feel disproportionately difficult. Some patients compensate by twisting their trunk or shrugging the shoulder. Rehabilitation should address the activities that matter to the patient rather than focusing only on a number measured with a goniometer.

The precise cause is not always known. Frozen shoulder can develop without an obvious injury or after a period of limited shoulder movement, including following an injury or surgery. Diabetes and thyroid conditions are associated with higher risk. The 2025 clinical practice guideline also identifies dyslipidemia as a risk factor. Having one of these conditions does not mean a person will develop frozen shoulder, and a physical therapist should not assume the cause without appropriate clinical evaluation.

Frozen shoulder is often described using three broad phases: a painful phase with increasing stiffness, a period in which stiffness predominates, and a gradual recovery phase. These descriptions are useful for patient education, but the phases do not follow an exact timetable for everyone. The AAOS notes that recovery may take months to years, and some individuals retain movement limitations. Treatment should be guided by current symptoms and tolerance rather than forcing a patient into a rigid stage-based protocol.

Yes. Physical therapy can help many people manage movement limitations and functional problems associated with a stiff, painful shoulder. Depending on examination findings, care may involve education, gentle range-of-motion exercises, appropriately dosed stretching, progressive strengthening, and selected joint or soft-tissue techniques. A home program can support consistency between visits. Early in a highly painful presentation, aggressive stretching may increase irritability; later, progressive mobility and strengthening may be better tolerated. Learn more about Nova Physical Therapy’s outpatient rehabilitation services.

A clinician may select supported shoulder flexion, gentle external rotation, table slides, pendulum movements, or gradual strengthening when appropriate. The exact exercise, dosage, and progression depend on irritability, medical history, and movement findings. Exercises should not be forced through sharp or escalating pain. Following surgery or fracture, the treating surgeon’s precautions and healing restrictions take priority. The aim is consistent, tolerable practice rather than trying to regain all shoulder motion in one session.

A 2025 evidence-based clinical practice guideline reviewed nonsurgical care for primary frozen shoulder. It found that manual therapy combined with range-of-motion exercise may improve function and motion, while acknowledging that the certainty of evidence is often low. The guideline also discusses self-stretching and strengthening as individualized options. It recommends considering intra-articular corticosteroid injections, sometimes alongside physical therapy, through an appropriate medical professional. The AAOS patient guidance similarly emphasizes restoring motion and function with conservative care. These sources do not establish that one exercise or technique is universally best.

A physical therapist may ask about symptom onset, previous injuries or operations, sleep, daily limitations, medical conditions, and goals. The examination can compare active and passive shoulder motion, strength, movement control, and relevant neck or upper-extremity findings. The therapist may document functional tasks such as reaching a shelf or fastening clothing and screen for findings that warrant physician evaluation. Imaging is not always required, but a physician may recommend it to investigate alternative causes. In California, physical therapists evaluate and treat movement impairments within their licensed scope and refer for medical assessment when indicated.

Arrange medical evaluation for persistent or progressive shoulder stiffness, especially if the diagnosis is uncertain or daily function is significantly affected. Seek urgent assessment for severe pain after trauma, visible deformity, a hot or markedly swollen joint, fever or systemic illness, sudden major weakness, or persistent numbness. Shoulder or arm discomfort accompanied by chest pressure, shortness of breath, sweating, or faintness requires emergency evaluation. Do not assume all shoulder pain is frozen shoulder.

2. Why does my shoulder hurt more at night? Night pain can occur with frozen shoulder, but it is not specific to that condition.

3. Can I have frozen shoulder without an injury? Yes. It may develop without an obvious triggering event.

4. Can physical therapy restore shoulder motion? Rehabilitation may improve mobility and function, although the degree and timing of recovery vary.

5. Should I stretch through severe pain? No. Exercise intensity should reflect symptoms and clinician guidance.

6. Is shoulder strengthening helpful? It may be useful when appropriately introduced and tolerated.

7. Do I need an MRI? Not necessarily. Imaging decisions depend on the medical evaluation and suspected alternative causes.

8. Can diabetes affect frozen shoulder? Diabetes is associated with increased risk and may influence recovery.

9. How long does frozen shoulder last? Symptoms can persist for months or longer, and recovery varies substantially.

10. Are injections part of physical therapy? Injections are medical procedures performed by appropriately licensed clinicians, not routine California PT treatment.

11. Can I continue using my arm? Usually, comfortable movement is encouraged, but activity should respect symptoms and any medical restrictions.

12. When should I see a physical therapist? When pain or stiffness limits daily activities or persists, an evaluation may help determine appropriate rehabilitation or referral.

If shoulder stiffness is affecting your ability to reach, dress, sleep, or work, consider a medical assessment and individualized physical therapy evaluation. Contact Nova Physical Therapy in North Hollywood to learn about appointment options, or review our physical therapy services.

This article is for general education and does not establish a medical diagnosis or replace an examination by a qualified clinician. Not all shoulder stiffness is frozen shoulder. Physical therapy interventions must be individualized and provided within the Physical Therapy Board of California’s scope-of-practice requirements. No specific recovery time or outcome is guaranteed.

2. Lee BC, et al. Clinical Practice Guidelines for Diagnosis and Non-Surgical Treatment of Primary Frozen Shoulder. Ann Rehabil Med. 2025;49(3):113–138. DOI: 10.5535/arm.250057.

3. NHS. Frozen shoulder.

4. Physical Therapy Board of California. Physical Therapy Practice Act.