Chapter 16 · Shoulder
Frozen Shoulder (Adhesive Capsulitis) protocol
For stiffness and pain with restricted range (adhesive capsulitis). No soft tissue work—range of motion first, long low-load stretches next, and strength as soon as range allows.
AMBER — get assessed before starting rehab
Screen for red flags before starting any protocol (safety check). Progress by symptoms and function, not by the calendar: > 3/10 pain → start phase 1; < 3/10 → phase 2 (PDF p. 205).Follow this programme to treat
- Shoulder joint stiffness and pain
- Shoulder range of motion restriction
- Adhesive capsulitis
Conditions in this protocol
- Frozen shoulder (adhesive capsulitis) PDF p. 420
Why these exercises · PROM with a dowel stretches further than active movement can and may ease pain; the table slide adds relaxed flexion; isometrics limit atrophy.
Good for
- Improving shoulder range of motion
- Building early tendon strength
- Warm-up for phase 2 and 3 exercises
Guidelines
- Perform every day
- Tool: dowel
- Add phase 2 when you have no pain at rest and no more than mild pain (3/10) with the exercises
Avoid / modify in this phase: Prolonged immobilisation
Mobility exercises (PROM → AAROM)
▶ 3 × 10–15; to a moderate stretch, not severe pain; pause 2–3 s at end range
top view · red = working arm
Internal/external rotation PROM/AAROM (dowel)
Restore rotation—the first direction lost in frozen shoulder.
PDF p. 425
side view · red = working arm
Shoulder flexion PROM/AAROM (dowel)
Restore overhead range while the injured muscles stay relaxed.
PDF p. 425
front view · red = working arm
Shoulder abduction PROM/AAROM (dowel)
Restore sideways and overhead range passively.
PDF p. 426
side view · red = working arm
Table slide (flexion)
Gain overhead range with the arm relaxed.
PDF p. 427
Isometric exercises
▶ 4–5 reps × 30–45 s; ≤ mild pain
Progress to the next phase when: No pain at rest and no more than mild pain (3/10) with the exercises
Why these exercises · Low-load, long-duration static stretches (3 × 30–60 s, building to 2–5 min) in the restricted directions, then shoulder flexion eccentrics to build overhead control.
Good for
- Improving shoulder range of motion with increased mobility demands
Guidelines
- Perform every day, 2 or 3 times per day
- Tools: towel, dowel, dumbbell
- Add phase 3 when you can do the exercises with no more than mild pain (3/10)
LLLD stretches
▶ 3 reps × 30–60 s holds, working up to 2–5 min
top view · red = working arm
Shoulder external rotation stretch (door frame)
Regain external rotation—the first direction lost in frozen shoulder.
PDF p. 429
side view · red = working arm
Shoulder flexion stretch (wall slide)
Regain overhead range.
PDF p. 430
top view · red = working arm
Horizontal adduction stretch (cross-body)
Stretch the back of the shoulder.
PDF p. 431
front view · red = working arm
Shoulder abduction stretch (side wall slide)
Regain sideways elevation.
PDF p. 432
side view · red = working arm
Shoulder internal rotation stretch (towel)
Improve hand-behind-back reach.
PDF p. 433
Eccentrics
▶ 2–3 × 10–15
Progress to the next phase when: Exercises performed with no more than mild pain (3/10)
Why these exercises · Start strengthening as soon as range allows—even partial range—because muscles decondition during the long course; phase 3 of Shoulder Pain can be used for a fuller programme.
Good for
- Strengthening the shoulder and surrounding muscles
- Maintaining shoulder range of motion and mobility
- Preventing shoulder pain and injury
Guidelines
- Perform 3 or 4 days a week
- Do 3 sets of 10–15 reps
- Push sets to fatigue
- Tools: resistance tube band, towel, dumbbell
- All banded exercises can be done using a cable machine
- You can also follow phase 3 of the Shoulder Pain protocol for a more comprehensive shoulder strengthening program
Resistance exercises
kneeling-banded-single-arm-row
side view · red = working arm
Kneeling banded single-arm press
Light pressing to balance pulling work.
PDF p. 437
top view · red = working arm
Side-lying dumbbell external rotation
Strengthen the external rotators of the cuff.
PDF p. 437
top view · red = working arm
Banded internal rotation
Strengthen the subscapularis—the only cuff muscle that rotates the arm inward.
PDF p. 438
top view · red = working arm
Banded external rotation
Strengthen external rotators standing.
PDF p. 439
Source: Rehab Science · Ch 16 · PDF pp. 420–431· 4 original research citationsshow sources ▾
Also cited by the book on these pages:
- [Ch 16·13] de la Serna D, Navarro-Ledesma S, Alayón F, López E, Pruimboom L. A comprehensive view of frozen shoulder: a mystery syndrome. Front Med (Lausanne). 2021;8:663703. find original ↗
- [Ch 16·14] Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. Br J Sports Med. 2011;45(1):49-56. find original ↗
- [Ch 16·15] Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. Published 2020 Dec 1. find original ↗
- [Ch 16·16] Dempsey AL, Mills T, Karsch RM, Branch TP. Maximizing total end range time is safe and effective for the conservative treatment of frozen shoulder patients. Am J Phys Med Rehabil. 2011;90(9):738-745. find original ↗
Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.