Introduction

Frozen shoulder, medically known as adhesive capsulitis, causes progressive pain and stiffness of the shoulder. The joint capsule becomes inflamed, thickened and tight, resulting in restriction of shoulder movement. The condition commonly affects activities such as reaching overhead, dressing, combing the hair and reaching behind the back.

Exercise is an important part of rehabilitation. The programme should not be identical for every patient. During the painful stage, gentle movements and comfortable-range exercises are generally emphasized, while more prolonged stretching and strengthening can be introduced as pain decreases and mobility improves.

Goals of Exercise in Frozen Shoulder

• Reduce fear of shoulder movement.
• Maintain available shoulder mobility.
• Gradually improve restricted range of motion.
• Improve functional use of the arm.
• Stretch the tight shoulder capsule and surrounding tissues.
• Restore shoulder strength when appropriate.
• Improve performance of daily activities.
• Prevent excessive deconditioning of the shoulder.

Exercise 1: Shoulder Pendulum

Purpose

Pendulum exercises provide gentle movement of the shoulder while reducing the need for active muscle contraction. They are particularly useful when active shoulder movement is painful.

Starting position

• Stand beside a table or stable surface.
• Place the unaffected hand on the table for support.
• Lean forward slightly.
• Allow the affected arm to hang freely.
• Keep the affected shoulder and arm relaxed.

How to perform

• Gently move the arm forward and backward.
• Move it gently from side to side.
• Progress to small circular movements.
• Perform circles in both directions.
• Keep the movement relaxed rather than actively lifting the arm.

Dosage

10–20 repetitions in each direction, according to tolerance.

Exercise 2: Shoulder Rolls

Purpose

Shoulder rolls encourage gentle movement of the shoulder girdle and help reduce protective muscle tension.

Starting position

• Sit or stand comfortably with the arms relaxed beside the body.

How to perform

• Slowly roll both shoulders backward.
• Make the movement comfortable and controlled.
• Return to the starting position.
• Repeat in the opposite direction if comfortable.

Dosage

10–20 repetitions.

Exercise 3: Assisted Shoulder Flexion in Lying

Purpose

This exercise helps gradually improve shoulder elevation while allowing the unaffected arm to assist the painful side.

Starting position

• Lie on your back.
• Bend both elbows slightly.
• Hold the affected wrist or hand with the unaffected hand.

How to perform

• Slowly raise both arms toward the head.
• Allow the unaffected arm to assist the affected arm.
• Move only as far as reasonably comfortable.
• Slowly return to the starting position.

Dosage

5–10 repetitions.

Progression

• As movement improves, gradually increase the available range rather than forcing the arm to the maximum position.

Exercise 4: Table Slide – Forward

Purpose

Table slides provide an assisted method of improving shoulder flexion.

Starting position

• Sit or stand facing a table.
• Place the affected hand on a towel on the table.
• Keep the shoulder relaxed.

How to perform

• Slowly slide the hand forward.
• Allow the trunk to lean forward slightly.
• Continue until a gentle stretch is felt.
• Hold briefly.
• Return slowly.

Dosage

5–10 repetitions.

Exercise 5: Wall Slide – Forward

Purpose

Wall slides help gradually improve active and assisted overhead movement.

Starting position

• Stand facing a wall.
• Place the affected hand on a towel against the wall.

How to perform

• Slowly slide the hand upward.
• Step slightly closer to the wall if necessary.
• Continue as far as comfortable.
• Slowly slide the hand back down.

Dosage

5–10 repetitions.

Progression

• Try to increase the height reached gradually over time rather than forcing a large movement during one session.

Exercise 6: Assisted External Rotation With a Stick

Purpose

External rotation is commonly restricted in adhesive capsulitis. This exercise uses the unaffected arm to assist the affected shoulder.

Starting position

• Sit or stand upright.
• Keep the affected elbow bent approximately 90°.
• Keep the elbow close to the side of the body.
• Hold a stick with both hands.

How to perform

• Use the unaffected arm to gently push the affected hand outward.
• Keep the affected elbow close to the trunk.
• Stop when a comfortable stretch is felt.
• Return slowly.

Dosage

5–10 repetitions.

Hold

A gentle end-range hold of approximately 5–10 seconds may be used when tolerated.

Common mistake

• Do not allow the affected elbow to move away from the body excessively while performing this exercise.

Exercise 7: Assisted Abduction With a Stick

Purpose

This exercise helps improve the ability to raise the arm sideways.

Starting position

• Hold a stick with both hands.
• Keep the affected arm relaxed.
• Stand or sit upright.

How to perform

• Use the unaffected arm to assist the affected arm upward and outward.
• Move gradually into the available range.
• Hold briefly at the comfortable end range.
• Slowly lower the arm.

Dosage

5–10 repetitions.

Progression

• Increase the height of the movement gradually as shoulder mobility improves.

Exercise 8: Behind-the-Back Towel Stretch

Purpose

This exercise targets the difficulty many patients experience with reaching behind the back.

Starting position

• Hold a towel behind your back.
• The unaffected hand is positioned above the shoulder.
• The affected hand holds the lower part of the towel.

How to perform

• Gently pull upward with the unaffected hand.
• Allow the affected hand to move gradually higher behind the back.
• Stop when a gentle stretch is felt.
• Slowly relax.

Dosage

5–10 repetitions.

Exercise 9: Hand-Behind-Head Stretch

Purpose

This exercise gradually improves the combination of shoulder elevation and external rotation needed for activities such as washing or combing the hair.

Starting position

• Lie comfortably on your back.

How to perform

• Place both hands behind the head or neck as tolerated.
• Slowly allow the elbows to move outward.
• Move only within a comfortable range.
• Hold briefly.
• Return to the starting position.

Dosage

5–10 repetitions.

Exercise 10: Cross-Body Shoulder Stretch

Purpose

This exercise provides a gentle stretch around the posterior shoulder.

Starting position

• Sit or stand upright.

How to perform

• Bring the affected arm across the chest.
• Use the opposite hand to gently assist the movement.
• Keep the shoulder relaxed.
• Hold at the comfortable end range.
• Slowly release.

Dosage

5 repetitions, holding approximately 20–30 seconds if comfortable.

Exercise 11: Scapular Setting

Purpose

Scapular control helps maintain good shoulder-girdle positioning and prepares the patient for more advanced shoulder exercises.

Starting position

• Sit or stand with the neck relaxed.

How to perform

• Gently draw the shoulder blades backward and slightly downward.
• Avoid excessive squeezing.
• Keep the neck relaxed.
• Hold the position.
• Relax completely.

Dosage

5 repetitions with approximately 20–30-second holds, if comfortable.

Key point

• The goal is gentle control rather than maximal contraction.

Exercise 12: Gentle Shoulder Strengthening

Purpose

Strengthening should generally be introduced progressively when pain has settled sufficiently and shoulder movement has improved.

Example: Isometric External Rotation

• Keep the elbow at approximately 90°.
• Keep the elbow close to the trunk.
• Place the back of the hand against a wall or another stable surface.
• Gently press the hand outward against the surface without moving the shoulder.
• Hold the contraction and relax.

Dosage

5–10 repetitions, holding approximately 5 seconds each.

Progression

• Once tolerated, strengthening can progress from isometric exercises to light resistance exercises under physiotherapy guidance.

Suggested Phase-Wise Exercise Approach

Exercise Dosage Guide

• Mobility exercises: 5–10 repetitions initially; increase gradually toward 10–20 repetitions when tolerated.
• Stretching: use a gentle end-range position for approximately 5–30 seconds depending on the exercise and tolerance.
• Frequency: short, regular sessions are generally preferable to forcing one long session.
• Some NHS guidance recommends exercises 1–2 times daily, while other guidance recommends smaller amounts of movement throughout the day.

Pain During Exercise: What Is Acceptable?

A frozen shoulder can be sensitive, so more exercise is not necessarily better. A mild stretching sensation or mild discomfort can occur during mobility work. However, do not force the shoulder through severe pain, reduce the range if symptoms become excessive, reduce repetitions if pain remains increased after exercise, and stop an exercise that causes sharp or severe pain.

One NHS physiotherapy resource advises reducing repetitions or force if pain remains elevated for more than about 30 minutes after exercise.

Common Exercise Mistakes

• Forcing the shoulder: trying to force a stiff shoulder quickly into full range can aggravate symptoms.
• Exercising only once a day with excessive intensity: gentle, regular movement may be more appropriate than an aggressive session.
• Shrugging the shoulder: patients may compensate by excessively elevating the shoulder blade during overhead movement.
• Holding the breath: breathe normally during stretching and strengthening.
• Ignoring worsening symptoms: exercise should be adjusted if symptoms repeatedly worsen after the programme.

Patient

A 52-year-old woman reports gradual onset of right shoulder pain followed by increasing stiffness. She has difficulty reaching overhead, dressing and placing her hand behind her back. Night pain is also affecting sleep.

Physiotherapy assessment

The assessment demonstrates a significant restriction of active and passive shoulder movement, particularly in external rotation, elevation and internal rotation, consistent with a clinical picture of adhesive capsulitis.

Initial exercise programme

• Pendulum exercises.
• Gentle assisted shoulder flexion.
• Table slides.
• Gentle external-rotation mobility.
• Scapular setting.

The patient is advised to perform the exercises regularly without forcing painful end ranges.

Progression

• Longer-duration stretching.
• Wall slides.
• Assisted abduction.
• Behind-the-back mobility.
• Active range-of-motion exercises.
• Progressive strengthening.

Expected goal

The goal is not simply to achieve a particular range immediately. The rehabilitation programme aims to gradually improve pain, mobility, strength and functional use of the arm.