Frozen Shoulder Treatment in Five Dock: Physio Guide

What frozen shoulder actually is

Frozen shoulder, or adhesive capsulitis, is a problem with the joint capsule rather than the muscles or tendons around it. The capsule is the sleeve of connective tissue that surrounds the ball-and-socket joint. In frozen shoulder it becomes inflamed and thickened, and the volume inside the joint drops. The result is a shoulder that hurts and, more tellingly, one that will not move even when someone else moves it for you.

That last detail is what separates it from most other shoulder complaints. If we lift your arm for you and the range is still blocked, particularly turning the arm outwards, we are looking at a capsule restriction rather than weakness or a painful tendon.

People who come to our Five Dock clinic with frozen shoulder usually describe the same early pattern. A dull ache deep in the shoulder that started without a clear injury, sharp catches when they reach behind them for a seatbelt or a back pocket, and nights broken by pain when they roll onto that side.

The stages, and why they matter for planning

Frozen shoulder is usually described in three overlapping phases.

The painful or freezing phase is dominated by pain, including at rest and at night, while range gradually falls away. The frozen or stiff phase tends to be less painful but far more restricted, and this is when the loss of external rotation is most obvious. The thawing phase is a slow return of movement.

Total duration varies widely between individuals, and published ranges run from many months to a couple of years. We will not put a date on your shoulder at the first appointment. What we can do is work out which phase you appear to be in, because it changes the plan. Pushing hard into stretch during a highly irritable painful phase often flares things for days. The same work in a stiffer, less irritable shoulder is usually tolerated much better.

Who tends to get it

The classic presentation is someone between 40 and 60. It occurs more often in women, and more often in people with type 1 or type 2 diabetes or thyroid disease. It also shows up after a period of the arm being kept still, such as following a fracture, a shoulder or breast surgery, or a long stint in a sling. Having had it on one side raises the chance of the other side being involved at some point.

For active people the frustration is rarely the pain itself. It is the inability to serve a tennis ball, reach across the body in netball, hold a barbell overhead, or swim freestyle without compensating through the neck and low back.

What assessment looks like

A first appointment at Five Dock runs one-to-one, with no double-booking, and starts with history. We want the timeline, the night pain pattern, any diabetes or thyroid history, and what you are trying to get back to.

Then we measure. We record active and passive range in flexion, abduction, external rotation and internal rotation, and compare sides. A capsular pattern with external rotation limited more than the other directions points towards adhesive capsulitis. We screen the rotator cuff and the neck too, because referred neck pain and cuff tendinopathy can look similar in the early weeks and sometimes coexist.

We use the VALD ForceFrame to test shoulder strength in fixed positions and get a number rather than a hand-held impression. Repeating that number later in the process gives us something objective to track alongside range, which matters in a condition where progress is slow enough to be hard to feel week to week.

Imaging is not needed to diagnose frozen shoulder in most cases. We will refer for it if the history suggests something else, such as a significant trauma, a possible full-thickness cuff tear, or unexplained systemic symptoms.

What treatment involves

Physiotherapy for frozen shoulder is built around range work matched to how irritable the shoulder is, plus strength work for everything that is available to load.

In practice a session may include hands-on joint mobilisation, guided stretching at end range, and loaded exercise in the large gym space at Five Dock. We work the scapular muscles, the cuff in whatever range you have, and the rest of the body, because there is no reason to lose leg and trunk strength while a shoulder settles. Home programs are usually short and frequent rather than long and occasional, which tends to suit a joint that stiffens between sessions.

Shockwave therapy is available at the clinic and is more commonly used for tendon presentations than for capsular stiffness, so we will tell you plainly whether we think it is relevant to your shoulder.

Where injections and hydrodilatation fit

Some people with a highly painful frozen shoulder are managed alongside a GP or specialist, with options such as a corticosteroid injection or hydrodilatation, where fluid is used to distend the joint capsule. These are medical procedures we do not perform. When pain is dominating and range work is not tolerable, we will write to your GP and coordinate rehab around whatever they decide, since the window after a procedure is often a useful time to progress range.

When to get it looked at

Earlier assessment gives you more options, particularly while the shoulder is still moving reasonably well. Book in if reaching behind your back has become difficult, if night pain is waking you regularly, or if a shoulder ache you assumed was minor has been trending stiffer over several weeks. We treat under private, CTP, workers' compensation, NDIS and EPC/Medicare arrangements at Five Dock, and can talk through what applies to you when you get assessed.

Read more about our shoulder services.

If you would like it assessed at our Five Dock clinic, you can book a free injury assessment.