Address safety, settle excessive irritability and maintain useful movement.
What to do
Education about variable natural history and symptom-guided activity
Maintain tolerable movement; avoid forceful stretching during highly irritable phase
Coordinate medical management of pain and relevant metabolic conditions
Exercise dosage
Gentle assisted ROM: 5–10 reps, several times/day, within tolerable pain
Pendulum or supported table slides if comfortable
Progress when
Daily function is stable or improving.
No new red flags or progressive neurological deficit.
Exercise response returns to baseline by the following day.
Phase 2 — Mobility, Strength & Capacity
Restore the specific strength, mobility and control required by the condition.
What to do
Progress capsular mobility within irritability limits
Restore rotator cuff and scapular strength as ROM allows
Functional reaching and behind-back tasks graded gradually
Exercise dosage
Low-load prolonged stretch: 20–60 seconds, 3–5 reps when irritability permits
Rotator cuff/scapular strengthening: 2–3 x 8–15
Progress when
Target movement and resistance are tolerated with good quality.
Functional capacity is improving without sustained symptom flare.
Progression is based on objective performance and patient goals.
Phase 3 — Functional Restoration & Return to Activity
Rebuild real-world, occupational or sporting capacity.
What to do
Progress end-range mobility and strength
Increase overhead, dressing and occupational capacity
Maintain gains with home programme
Exercise dosage
Progress resistance 2–4 x 6–15, 2–3 days/week
Task-specific reaching practice with gradual range/load increase
Progress when
Condition-specific return criteria are met.
Full task exposure is completed progressively.
No clinically meaningful deterioration during the following 24 hours.
Manual Therapy — Role & Application
Low-grade mobilization may be appropriate in painful/high-irritability stage; stronger mobilization only when irritability is lower.
Manual therapy is adjunctive and should not provoke prolonged flare.
Modalities — Use / Avoid
Heat before mobility may help comfort.
Discuss medical options such as intra-articular corticosteroid with the treating prescriber when pain limits rehabilitation; physiotherapists should not independently prescribe.
Return / Discharge Criteria
Functional reach and dressing improved
ROM adequate for work and daily tasks
Strength and activity tolerance restored without prolonged flare
Common Clinical Mistakes
Aggressive stretching in a highly painful shoulder
Assuming every stiff shoulder is adhesive capsulitis
Ignoring diabetes/thyroid association
Promising a fixed recovery timeline
Clinical Pearls
Passive external rotation loss is a key clinical clue.
Stage and irritability should guide exercise and mobilization intensity.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
