What is Frozen Shoulder? Understanding Adhesive Capsulitis
- 2 days ago
- 7 min read
Hi, I’m Dr. Patrick Walsh from Walsh Chiropractic and Physical Therapy of Hagerstown. Today I want to walk you through a condition I see fairly often and that tends to confuse a lot of people: frozen shoulder, also known as adhesive capsulitis.
In the video below, I use visuals to explain this, and in this blog, I want to put it all together in a way that makes sense, especially if you are dealing with shoulder pain, stiffness, or loss of motion.
Read the Full Video Transcript Here
Today we're going to talk about frozen shoulder adhesive capsulitis. So in the next couple minutes we're going to go over a quick overview. The shoulder joint is kind of complicated. This condition isn't very complicated, but it's weird. My name is Dr. Walsh. I'm over here at Walsh Chiropractic and Physical Therapy in Hagerstown.
Frozen shoulder is an inflammation of the shoulder capsule. And this is the shoulder capsule. You can see where it's not inflamed and the inflammation right there. Uh it's so well depicted in the drawing. It's a joint. The shoulder is not truly a great joint. Actually, if you remember the seven simple machines in physics, the lever is one of them. This is the reason why the lever works, and it's why the shoulder becomes so vulnerable. Because if you remember in a lever stick, right, the load is here, the fulcrum, you need less force. Well, the problem is the fulcrum is next to the load. In the shoulder, the fulcrum is next to the force. So what it actually does is multiply what's in your hand on the shoulder joint. That's why it's very vulnerable.
So that's why proper posture and proper form are very important in any physical activity. Okay. So with the shoulder joint, you have rotator cuff muscles, four of them, and they attach and help hold it in. You've got a labrum. They make up the capsule. You've got different ligaments and tendons in there all trying to keep that bone in that socket, right? Because if you take a look at the glenoid fossa, it's very flat. Very flat. And you’ve got this front. They call it a ball joint, but it's very flat. It's the soft tissue that holds it all together.
And this is an inflammation of the connective tissue that holds that joint. So what happens is basically that becomes inflamed. It's very painful to move the joint itself. You have very limited range of motion, but it does have typically its own cycle in which it heals. In about two years, if you do nothing, in about two years it should improve. It should go away, supposedly. Okay? I don't know if it ever truly totally goes away. Every patient that I've had, it's never the same totally. And that's because of the fact that you didn't do some of the work after. You did nothing different. You just let it run its course.
Because it is connective tissue, it means it's avascular. Now what happens with avascular tissue? It doesn't have a direct blood supply. Therefore, the nutrients in blood for healing are not direct. It has to get its nutrients through diffusion through whatever it's attached to that is vascular, bone or muscle. Okay. In ligaments, there is no muscle. It's all bone. And for it to diffuse to the injured area, it has to go through every cell in between the connection and the injury, and they've got to become saturated before it can pass on nutrients. It takes time. Uh this is roughly two years if you do nothing. Typically, you can improve on that.
Chiropractic, what we do is we adjust the joints. Uh we do a couple right off the bat. First stage, the critical stage, you don't do too much. Whenever tissue, muscle, ligament, tendon, connective tissue, fascia is torn, you don't want to go directly into exercise. Even though some say go ahead and do some, no, I don't. And you’ve got to watch the stretching too because it's already torn, right? So if you stretch torn tissue, what can happen? You can tear it more. So don't do that.
Typically, what we want to do in the critical phase is we want to get you out of discomfort as quickly as possible. So we do some soft tissue work. We adjust. We could do dry needling. We can do some electric stim. Now, I like dry needling even though it's a soft tissue technique just like ART, IMJT, different types of even therapeutic massage. They're all the same thing. What you're actually doing is you're going in there and tearing tissue.
What makes dry needling different is that you're not tearing any tissue. You're eliciting the healing response. Right? Because when you're tearing tissue up, there's two things that are happening. So, I’ve got tight muscles. You go to a massage therapist or IMJT chiropractor, it doesn't matter, and you're doing soft tissue techniques. What you're doing is you're loosening up that tissue. And sometimes loosening up that tissue, you're going to tear it. And that's okay as long as you don't over-tear it. Then you get over-injured and you actually have deep bruises. But that little tearing helps free up the tissue. And for healing, it's going to bleed more. So you're going to get more blood to the area for healing.
Dry needling doesn't tear. You put in these little needles, acupuncture needles. You're not moving the tissue. Though some techniques you can move tissue under with the needle in it, but you're poking little holes in it, which elicits the same healing response with less damage than a lot of those other techniques. Okay. So that's why I like dry needling. Dry needling, at least clinically what I have seen, is by far the best soft tissue technique.
The problem with dry needling is the fact that insurance companies quit paying for it in March 2020, and now that's all out of pocket. And you know, just like any other expense, or what patients look at as an expense. But nothing happens overnight. Everybody wants to heal quick, tomorrow. It's not going to happen. The injury can happen that quick, but the healing from that injury takes time. And everybody's different.
I always say it's a roller coaster. You're not going to go straight up the slope of that roller coaster. You're going to have good days, bad days. Good days, bad days. And the more you do it, the less intense and the shorter the bad periods become.
But as far as frozen shoulder, this basically is the joint capsule that becomes inflamed and limited motion. What you're going to see is a decrease in motion at first, then an increase in pain, then you can't move it past a certain degree. And that's going to be for a while. And then hopefully, eventually, it can work itself out. And the given time is about two years.
What Is Frozen Shoulder?
Frozen shoulder is an inflammatory condition of the shoulder joint capsule. The capsule is the connective tissue that surrounds the shoulder joint and helps hold everything together. When this tissue becomes inflamed, thickened, and tight, the shoulder becomes painful and extremely limited in motion.
This is not primarily a muscle injury. It is a connective tissue problem, and that distinction matters a lot when it comes to treatment and recovery.
Why the Shoulder Is So Vulnerable
The shoulder joint is one of the most complex joints in the body. It is often described as a ball and socket joint, but the socket, called the glenoid fossa, is actually very shallow. It relies heavily on soft tissue to stay stable.
From a physics standpoint, the shoulder functions like a lever. The problem is that the fulcrum is positioned in a way that multiplies force at the joint. That means whatever weight or force you are holding in your hand creates significantly more stress at the shoulder joint itself.
This is why posture, form, and mechanics matter so much, and why the shoulder is more prone to injury than people realize.
What Structures Are Involved?
The shoulder joint is held together by a combination of soft tissues, including:
The rotator cuff muscles
The labrum
Ligaments and tendons
The joint capsule itself
The glenoid socket is very flat, so it is the soft tissue, not the bone, that provides stability. Frozen shoulder occurs when the joint capsule becomes inflamed and restricted, limiting movement and causing pain.
Common Frozen Shoulder Symptoms
Frozen shoulder tends to follow a predictable pattern. Patients often experience:
Gradual loss of shoulder range of motion
Increasing pain with movement
A firm stopping point where the shoulder simply will not move further
Difficulty with everyday activities like reaching overhead or behind the back
Over time, motion becomes more restricted, and pain can become persistent.
How Long Does Frozen Shoulder Last?
If you do absolutely nothing, frozen shoulder often follows a long natural course, sometimes lasting up to two years.
While symptoms may improve over time, I rarely see shoulders return to normal without proper care. Many patients tell me the shoulder never quite feels the same afterward, and that is often because no corrective work was done during or after the condition.
Frozen shoulder affects connective tissue, which is largely avascular, meaning it does not have a direct blood supply. Healing happens slowly through diffusion from nearby tissues like muscle and bone. That is why this condition takes time and why proper treatment matters.
Why Stretching Too Early Can Make Things Worse
One of the biggest mistakes I see is trying to stretch aggressively during the early stages of frozen shoulder.
When connective tissue is inflamed or injured, forcing it to stretch can actually create more damage, not less. This is especially true early on when the tissue is already irritated.
In the critical phase, the goal is not to push range of motion. The goal is to reduce discomfort and calm the tissue down first.
How We Approach Frozen Shoulder Treatment
At Walsh Chiropractic and Physical Therapy of Hagerstown, our approach is staged and intentional.
Early on, care is focused on reducing pain and inflammation. This may include:
Gentle joint adjustments
Soft tissue techniques
Modalities such as electrical stimulation
Dry needling when appropriate
I use dry needling frequently because it elicits a healing response without tearing tissue. Unlike aggressive soft tissue work that can cause additional micro-tearing, dry needling stimulates circulation and healing with less collateral damage.
As symptoms improve, we gradually progress care. Nothing is rushed. Healing connective tissue takes time, and everyone heals at a different pace.
I often tell patients that recovery feels like a roller coaster. You will have good days and bad days. Over time, the bad days become shorter and less intense if things are done correctly.
Final Thoughts on Frozen Shoulder
Frozen shoulder is not just shoulder soreness. It is a condition involving the joint capsule itself, leading to pain and significant loss of motion.
If you are noticing stiffness that keeps progressing, pain that limits movement, or a shoulder that simply will not move past a certain point, it is important to have it evaluated properly somewhere like Walsh Chiropractic and Physical Therapy of Hagerstown.
With the right approach, we can often reduce discomfort, improve function, and help the shoulder heal more effectively than just waiting it out.
