Frozen Shoulder (Adhesive Capsulitis): what is the primary rehabilitation strategy?

• A. Pain-free AROM and compensation until it thaws naturally.
• B. Complete immobilization for several weeks
• C. Aggressive strengthening from day one
• D. Surgery to release the capsule

Answer: (D)

In adhesive capsulitis, the priority is to preserve and gradually restore shoulder motion with pain-free range-of-motion exercises rather than immobilizing the joint or pushing for strength too early. The goal is to keep the capsule from becoming more stiff while the inflammatory process resolves and the range begins to return. Early on, this means gentle, pain-free movements—often starting with passive or active-assisted ROM and manual techniques within a tolerable pain level—followed by progressive active ROM as comfort allows. Over time, as movement improves, stretching and scapular-stabilizing work are added, with a careful progression to strengthening once a solid ROM is established. Aggressive strengthening from day one can provoke pain and swelling and hinder recovery, and complete immobilization tends to promote further stiffness. Surgery to release the capsule is not a first-line rehabilitation strategy; it’s considered only after conservative treatment has failed over an extended period. Understanding the pattern of motion loss—external rotation most limited, followed by abduction and then internal rotation—helps guide the targeted ROM plan.