Frozen shoulder, or adhesive capsulitis, is a painful, stiff shoulder that can take many months to settle. Manual therapy and exercise are commonly used for it, so this Cochrane review, one of the most respected types of evidence there is, set out to see how well they actually work.
We want to be straight with you on this one. The findings are more mixed than you might expect, and we think you deserve the honest picture rather than a tidy sales pitch.
Not every treatment is a slam dunk, and frozen shoulder is genuinely tricky. Being honest about the evidence helps you make good decisions about your care.
Hands-on mobilisation of the shoulder along with stretching and strengthening exercises, either alone or combined with other treatments.
The review compared these against options like corticosteroid injection, placebo, and combined approaches.
Here is the honest headline. In the short term, manual therapy and exercise may not be as effective as a corticosteroid injection.
In the short term, a corticosteroid injection outperformed manual therapy and exercise for pain and success rates.
Adding manual therapy and exercise to an injection did not clearly add much on top.
Manual therapy and exercise remain widely used to support movement and function during recovery.
Much of the evidence was low quality, and long-term effects were unclear.
For frozen shoulder, manual therapy and exercise did not beat a corticosteroid injection in the short term, and the overall evidence is limited. That does not mean they are useless, but it does mean they are best seen as part of a broader plan rather than a stand-alone answer.
We would never oversell what hands-on care can do for a frozen shoulder. What we can honestly say is that manual therapy and exercise are commonly used to help you keep as much movement and function as possible while the condition runs its long course, and to support you through a frustrating recovery.
For many people the sensible path is a team approach, where your doctor considers options like injection and we help with movement, function and coping strategies alongside. Frozen shoulder often improves with time, and good support can make that time more bearable.
Supports a supportive role in maintaining movement and easing tension, as part of a broader plan rather than a stand-alone cure.
Backs manual therapy and exercise as supportive care, ideally coordinated with medical options like injection.
Reinforces gentle soft-tissue work to ease the muscle tension that builds around a stiff, guarded shoulder.
May help associated muscle tension, again as support rather than a primary treatment.
Much of the evidence in this area is low quality, and the trials were quite varied, which makes firm conclusions hard. Long-term effects were unclear, and no trials compared manual therapy and exercise against no treatment at all, so there is genuine uncertainty here.
This Cochrane review found that manual therapy and exercise may not be as effective as a corticosteroid injection in the short term for frozen shoulder, with limited overall evidence. The honest takeaway is that hands-on care has a supportive role to play, best delivered alongside your doctor as part of a bigger plan.
Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Page MJ, Green S, and colleagues. Cochrane Database of Systematic Reviews. Please confirm the full citation at the source before publishing.
