HEALTH-FITNESS
Health and Wellness: New research changing how we treat frozen shoulder
Carrie Jose
Special to Seacoast Media Group
Aug. 21, 2026, 7:52 a.m. ET
Frozen shoulder, also known as adhesive capsulitis, affects roughly 2% to 5% of the population, with women between the ages of 40 and 60 most likely to develop it. It occurs when the capsule surrounding the shoulder joint becomes inflamed, thickened and stiff, making everyday tasks such as reaching overhead, fastening a seat belt or simply getting dressed surprisingly painful
But despite how common frozen shoulder is, not every painful, stiff shoulder is actually frozen shoulder. And even when it is, new research suggests we’ve been thinking about it all wrong
For decades, frozen shoulder was viewed as a simple musculoskeletal problem. The prevailing theory was that the capsule around the shoulder tightened for reasons we didn’t fully understand, so treatment focused on stretching it, injecting it with cortisone or, in more severe cases, forcing it to move under anesthesia
Emerging research, however, suggests frozen shoulder is far more than a stiff shoulder. It appears to be an immunometabolic condition, influenced by inflammation, hormones, immune function and overall metabolic health
In other words, what’s happening throughout your body may have as much, if not more, to do with your frozen shoulder than what’s happening inside the joint itself
This new understanding helps explain several things that have puzzled clinicians for years. People with diabetes are significantly more likely to develop frozen shoulder, while thyroid disorders, obesity and elevated inflammatory markers also increase risk. Frozen shoulder affects women more often than men, particularly during their 40s, 50s and early 60s, which further supports the potential role of hormones and metabolic changes.
Rather than the shoulder simply “freezing” on its own, researchers now believe the capsule responds to a biochemical environment that promotes inflammation and fibrosis. That’s an important distinction because it changes how we should think about helping it heal
If frozen shoulder is driven by more than just tight tissue, it’s not surprising that many traditional treatments fall short. Cortisone injections may temporarily reduce pain, but they don’t address the underlying biological processes fueling the condition. Manipulation under anesthesia can restore motion temporarily, but it also carries risks, including capsule tears, rotator cuff injuries, fractures and nerve irritation.
While these interventions certainly have a place for select patients, they should not automatically be considered the first or only option
The encouraging news is that frozen shoulder almost always improves with time. In the vast majority of cases, the shoulder will gradually “thaw” on its own without surgery or invasive procedures
The downside is that “eventually” can mean several months and sometimes as long as two or even three years. For active adults who want to golf, garden, lift weights, play with grandchildren or simply sleep comfortably again, that’s a long time to put life on hold
This is where regenerative therapies such as Shockwave Therapy (ESWT) and EMTT can play a valuable role. They don’t force the shoulder to heal or magically eliminate frozen shoulder overnight. Instead, they create physiological changes within the tissue that help support and accelerate the body’s natural healing process
Shockwave Therapy helps stimulate circulation and healthier tissue remodeling, while EMTT works at the cellular level to help calm inflammation and support tissue repair. Combined with the right mobility exercises at the appropriate stage of recovery, these treatments can help many people move through the painful phases more comfortably and potentially recover faster than simply waiting for nature to take its course.
As inflammation begins to subside and the capsule becomes more responsive, targeted mobility and strengthening exercises become much more effective. Instead of trying to force movement through an irritated, resistant shoulder, you’re creating a healthier environment for recovery and movement. Essentially, you’re working with your body’s biology rather than fighting against it
But here’s where the story takes another important turn: Not every painful, stiff shoulder is actually frozen shoulder
One of the biggest mistakes I see is people accepting a frozen shoulder diagnosis without ever receiving a thorough mechanical examination. Rotator cuff injuries, arthritis, labral tears and certain mechanical problems originating from the shoulder, or even the neck, can all mimic frozen shoulder, especially early on
For example, a rotator cuff injury can make reaching overhead or behind your back painful and restricted, while a mechanical problem in the neck can refer pain into the shoulder and alter how it moves, sometimes without causing any neck pain at all
In fact, published case reports have shown that some patients diagnosed with adhesive capsulitis instead had a mechanical shoulder problem that responded quickly to specific corrective movements, resolving pain and restoring motion in just a handful of visits. That’s not how a true frozen shoulder behaves
That’s why getting the diagnosis right matters just as much as choosing the right treatment. If you truly have frozen shoulder, understanding the biology behind it can help you avoid unnecessary procedures and make smarter decisions about your recovery
But if your shoulder pain is coming from a mechanical problem instead, the right evaluation could save you months, or even years, of unnecessary treatment
Either way, don’t settle for simply being told you have frozen shoulder. Make sure you understand why your shoulder hurts in the first place and that you’re doing everything possible to support your body’s natural healing process
Dr. Carrie Jose, a physical therapy specialist and mechanical pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or to request a copy of her free guide for neck and shoulder pain, visit cjphysicaltherapy.com or call 603-380-7902
