Frozen shoulder exercises: do you have to push through the pain to loosen it?

If your shoulder throbbed even more the night after you gritted your teeth and pushed your arm up

Key points in 30 seconds

1. There's no evidence for the saying "with frozen shoulder, you have to push through the pain and force it to loosen." In a study that followed 77 people for two years, the group that exercised within a pain-free range improved more, and faster (89% vs. 63%).
2. Frozen shoulder is a condition in which the capsule around the shoulder joint thickens and sticks together, bumpy like a healing scar. If you force it apart while the inflammation is still active, you create a new wound and the inflammation sticks again.
3. Exercise differs by stage. In the painful stage, move gently so it doesn't stiffen. In the stiff stage, widen the range little by little. In the thawing stage, hold on to your range and build strength.
4. There's just one rule. A "pulling feeling" is fine. When a "stabbing pain" comes, stop. If it hurts more that night or your arm goes up less the next day, cut back one step.
5. If your arm goes up when someone else lifts it, but you can't lift it yourself, it may be a tendon problem, so get it checked before exercising.

What we often hear

• "People say with frozen shoulder you have to bear the pain and force it to move."
• "I pushed my arm up against the wall, and that night I couldn't sleep."
• "The next morning, my arm actually seemed to go up less."
• "Is it not loosening because I'm not toughing it out enough?"

"With frozen shoulder, you've got to push through the pain and force it."

You've probably heard this from people around you. So you grit your teeth, put your arm against the wall and push it up. You try hanging from a door frame, or ask a family member to pull your arm.

That night, your shoulder throbs more and you can't sleep. The next day, your arm seems to go up even less. Is it because you didn't push hard enough?

It's not because you didn't push hard enough. Frozen shoulder exercise means steady exercise within a pain-free range, and research shows better results that way.

What happens inside a frozen shoulder?

The shoulder joint is wrapped in a thin capsule. Frozen shoulder is a condition in which this capsule becomes inflamed, thickens, shrinks and sticks together.

In the exam room, we explain it like this. If you fall and scrape your knee, it doesn't heal back as smooth as before. It heals thickened and bumpy. Something similar happens inside the shoulder capsule. This sticking together is called adhesion, and it's why your arm won't go up and why it hurts.

So why not just tear the adhesions apart by force?

Here's the trap. If you force them apart while the inflammation is still active, you create a new wound. That wound heals bumpy again, and the inflammation sticks again. That's why your shoulder throbbed more on the night you pushed it.

Stretching hard vs. moving gently: a study compared them

One study divided 77 people with frozen shoulder into two approaches and followed them for two years.

• One group received intensive treatment: stretching hard, past the point of pain, and moving the joint forcefully.
• The other group exercised gently, only within a pain-free range, while being monitored.

After two years, 89% of the group that exercised within a pain-free range reached near-normal shoulder function. Of those, 64% reached that level within a year. In the group that stretched hard, it was 63%. The gentle approach did better both in results and in speed.

That said, this is a single study of 77 people. We can't go so far as to say "pushing hard is always bad." What is clear is that no result supported the belief that "the more pain you endure, the faster you heal." The results actually pointed the other way.

Exercise changes with each stage

Frozen shoulder usually goes through several stages, and each stage has a different exercise goal. What each stage looks like is covered separately in the frozen shoulder exercise article. Here, we'll give you moves to do at home.

First, in the painful stage, move gently so it doesn't stiffen. This is the stage when it throbs even at rest and wakes you up at night. Bend forward at the waist, let the painful arm hang loose, and sway your body slightly so the arm swings in small circles like a pendulum. That's enough. In this stage, managing the night pain comes before exercise.

Second, in the stiff stage, widen the range little by little. This is the stage when the pain has eased somewhat but the arm won't go up. Stand facing a wall and slowly raise your arm by "walking" your fingers up the wall. It also helps to hold a stick or towel with your good arm and use it to help lift the painful arm. A "pulling feeling" is fine. When a "stabbing pain" comes, stop there.

Third, in the thawing stage, hold on to the range you've gained and build strength. This is the stage when your range is slowly coming back. You need to strengthen the muscles around the shoulder too, so it doesn't stiffen again.

How many reps and how fast depend on which stage you're in and how far your arm goes up, so we decide together at your visit. Try them, and at the next visit we'll ask how it went.

How to tell if you overdid it

If it pulls a little during exercise and settles down soon after you finish, the amount is right.

If the pain gets noticeably worse that night, or your arm goes up less the next morning, you did too much. In that case, don't quit. Just cut back one step.

What to check before exercising

Not every stiff shoulder is frozen shoulder.

• Your arm goes up when someone lifts it for you, but you can't raise it on your own
• It started after a fall or an injury
• Your arm feels numb and weak

If any of these apply, don't push through frozen shoulder exercises. The first one in particular may mean a torn shoulder tendon (rotator cuff tear). Ways to get a rough sense of this at home are in It may not be frozen shoulder after all. In these cases, we start with an ultrasound or MRI in partnership with the radiology clinic on the 2nd floor of the same building.

How we work

First, we determine whether it really is frozen shoulder and which stage you're in. We compare how far you can raise your arm on your own and with help, and look at how it rotates outward. We always ask whether you have diabetes. With diabetes, it often lasts longer, so we give you a different expected course.

Second, if there's night pain, we deal with that first. When it hurts so much you can't sleep, exercise doesn't move forward. We first bring down the pain with acupuncture and pharmacopuncture (herbal acupuncture), and as it comes down, we widen the range with Chuna (Korean manual therapy) and exercise. Why we stick to this order is explained in detail in If shoulder pain wakes you up at night.

Third, we check with angles. Before treatment, we measure how many degrees your arm goes forward, to the side and outward, and measure again at set points. If the angles don't improve within the set period, we don't keep repeating the same treatment. We reassess.

What changes

An arm that doesn't hesitate when reaching for a bowl on the shelf. A morning when you can reach behind your back to get dressed. A pencil mark on the wall creeping a little higher every few weeks.

That's what we aim for.

The speed of recovery and the final range differ from person to person, depending on how severe the first symptoms were, how long you've had it, and other conditions such as diabetes.

Today's takeaway

Frozen shoulder doesn't loosen faster the more you endure. The rule is: up to just before a stabbing pain, a little every day.

There's just one thing to try today. Stand facing a wall and slowly walk the fingers of your painful arm up the wall. Stop just before a stabbing pain comes, and lightly mark that height on the wall with a pencil. Add the date. That's your shoulder's starting point for today.

If that mark hasn't moved in several weeks, or night pain keeps you from sleeping, bring that date and height with you. We're open until 8:30 p.m. on weekdays, and on weekends and public holidays too.

Whether frozen shoulder heals on its own, and which treatments have evidence behind them, is summarized in the director's column I heard frozen shoulder gets better if you just leave it.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.

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References

Diercks RL, Stevens M. Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. J Shoulder Elbow Surg. 2004;13(5):499-502. PMID: 15383804