Frozen shoulder syndrome (FSS), also known as adhesive capsulitis, affects an estimated 2% to 5% of the general population. The painful and debilitating condition most often affects people between the ages of 40 and 65, with a slight female predominance. The condition is dramatically more common in people with diabetes: reported prevalence in diabetic populations ranges from approximately 10% to 30%, and people with diabetes have roughly three to four times higher odds of developing frozen shoulder than those without.
Despite how common it is, frozen shoulder remains one of the most poorly understood shoulder conditions, with its cause and underlying disease process still debated. All we know is that it is defined as “a condition characterised by functional restriction of both active and passive shoulder motion for which radiographs of the glenohumeral joint are essentially unremarkable.”
Functional restriction hardly captures the experience of FSS though. Essentially, the connective tissue surrounding the shoulder joint becomes thick, stiff, and inflamed. It causes severe pain and a progressive loss of both active and passive range of motion in the joint
Clinicians distinguish two forms of the condition. Primary (idiopathic) frozen shoulder arises without any identifiable illness, presenting as shoulder pain of at least one month’s duration with progressively severe limitation of both active and passive glenohumeral movement in all ranges, and with normal radiographs. Secondary frozen shoulder is clinically identical but occurs alongside an identifiable condition (such as thyroid disease, Parkinson’s disease, or after shoulder injury or immobilisation such as rotator cuff tears or calcific tendonitis).
The condition classically progresses through three stages. In the “freezing” (painful) stage, lasting roughly 2 to 9 months, diffuse, severe shoulder pain develops gradually and often worsens at night. In the “frozen” (adhesive) stage, lasting roughly 4 to 12 months, pain begins to subside but the shoulder progressively loses flexion, abduction, and internal and external rotation. Finally, in the “thawing” stage, range of motion gradually returns over approximately 5 to 26 months. Although frozen shoulder is often self-limiting  (typically resolving within 1 to 3 years) symptoms can persist well beyond that, with lingering pain the most common complaint.
All of this represents a significant impact on quality of life, and ability to undertake daily tasks, when even sleep is impacted by pain and movement loss. So then, with treatment options as vague as the epidemiology of the condition, what can we do about it? A recent chiropractic case report showed a positive incident of chiropractic management of FSS. While it is one case alone, and there is a paucity of literature when it comes to any other cases, it is something that we should perhaps be keeping a closer eye on.
A New Case Report: Chiropractic Care and Applied Kinesiology
A recently published, peer-reviewed case report in the Asia-Pacific Chiropractic Journal by Dr Adam S. McBride describes the resolution of right frozen shoulder symptoms in just two visits using chiropractic care and Applied Kinesiology (AK) based techniques.
The patient was a 30-year-old male surfer who presented with one month of right shoulder pain radiating into the right upper trapezius, rated 3/10 at presentation and aggravated by reaching and left cervical lateral flexion. Examination revealed positive Mazion’s Shoulder Manoeuvre and Apley’s Scratch tests on the right (findings supportive of frozen shoulder) along with postural distortions and segmental dysfunction at C1, C5, L1, L5, and restricted thoracic segments.
Over just two visits in November 2022, care combined several approaches: Diversified high-velocity, low-amplitude spinal adjustments guided by AK manual muscle testing, sacro-occipital technique blocking, Activator instrument adjusting, and acupuncture meridian point work. By the second visit, six days after the first, the patient reported his shoulder pain had completely dissipated. He performed Apley’s Scratch and Mazion’s tests without discomfort, and had returned to lifting furniture and surfing between visits.
The fact that the condition resolved so quickly, and with just two sessions of chiropractic and applied kinesiological care is a dramatic departure from the normal course for FSS. That is, essentially, what makes this case remarkable. Again, its just one case and we have to do more research in order to understand why it occurred this way, but it offers hope to other people who may not have considered chiropractic for FSS.
Where this sits in the literature
Put simply, there isn’t much research out there when it comes to chiropractic and frozen shoulder, so all we have to compare this case report to is other manual therapies that do no employ the same specific adjusting methods that chiropractic uses. Nevertheless, manual therapy and exercise are widely used first-line approaches for frozen shoulder, and the evidence base offers some useful guidance, though it is not authoritative.
A 2014 Cochrane review by Page and colleagues examined manual therapy and exercise for adhesive capsulitis. It found moderate-quality evidence that six weeks of manual therapy and exercise produced less short-term improvement in pain and function than glucocorticoid injection, with a similar rate of adverse events. This is consistent with a 2020 network meta-analysis in JAMA Network Open (Challoumas et al.), which found intra-articular corticosteroid injection associated with greater early benefit than other interventions, with effects lasting up to about six months. They found combining injection with physiotherapy or exercise may be of some benefit.
Systematic reviews of joint mobilisation specifically have reported moderate evidence that mobilisation techniques improve pain, range of motion, and function, with high-grade glide mobilisations (Maitland and Kaltenborn approaches) showing benefit for external rotation and abduction. Randomised trials by Bergman and colleagues found that adding manipulative therapy to usual medical care accelerated recovery of general shoulder complaints, though these trials were not specific to frozen shoulder. Current guidance, including NICE recommendations, supports a stepped approach beginning with physiotherapy and exercise before escalating to injection or surgical options such as manipulation under anaesthesia.
Where does chiropractic sit in all this? The honest answer is that the evidence is thin. As the McBride report acknowledges, the literature on chiropractic adjustments specifically for shoulder complaints consists of one small pilot study, a qualitative study, and a number of case reports, including a retrospective case series of 50 frozen shoulder patients by Murphy and colleagues reporting improved range of motion and reduced pain following a cervical-focused adjusting technique.
Its important to remember that lack of evidence is not evidence of lack. It simply means we haven’t done the studies yet. That’s why cases like these are important, as they show how quickly a case has resolved in the past, and thus why we need to do more research to understand it.
A Call to Action: Our Patients Deserve Better Evidence
Frozen shoulder touches the very population chiropractors serve every day;middle-aged adults, people with diabetes, workers and athletes whose lives are disrupted for months or years by pain and stiffness. Case reports like McBride’s are valuable: they document real clinical encounters, generate hypotheses, and show what may be possible. But case reports cannot tell us what works, for whom, or why.
That’s all work that needs to be done. If chiropractic care can genuinely shorten the course of frozen shoulder — even for a subset of patients — that would matter enormously for a condition this common, this painful, and this prolonged. The only way to find out is to do the research. For the sake of the patients in our waiting rooms, it is time we did.
References
- McBride AS. Resolution of Adhesive Capsulitis following Chiropractic care and Applied Kinesiology (AK): A case report. Asia-Pac Chiropr J. 2026;7.1. https://www.apcj.site/McBrideAdhesiveCapsulitis.pdf
- Adhesive Capsulitis (Frozen Shoulder). StatPearls, NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK532955/
- Zreik NH, et al. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. https://pmc.ncbi.nlm.nih.gov/articles/PMC4915459/
- Page MJ, Green S, Kramer S, et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014;(8):CD011275. https://www.cochrane.org/evidence/CD011275_manual-therapy-and-exercise-frozen-shoulder-adhesive-capsulitis
- Challoumas D, et al. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2020;3(12).
- Therapeutic effects of mobilization in alleviating pain and improving shoulder mobility in adhesive capsulitis – a systematic review. Journal of Musculoskeletal Surgery and Research. https://journalmsr.com/therapeutic-effects-of-mobilization-in-alleviating-pain-and-improving-shoulder-mobility-in-adhesive-capsulitis-a-systematic-review/
- Murphy, et al. Chiropractic Management of Frozen Shoulder Syndrome Using a Novel Technique: A Retrospective Case Series of 50 Patients. J Chiropr Med. 2012;11(4):267–272.
- Bergman GJD, Winters JC, et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Ann Intern Med. 2004;141(6):432–9.
