The Musculoskeletal Syndrome of Menopause
- Dr. Jess
- Feb 3
- 3 min read
Understanding Frozen Shoulder, Menopause, and a Smarter Path to Recovery
Why Frozen Shoulder Deserves a Different Conversation
Why Frozen Shoulder Deserves a Different Conversation
In October 2024, Dr. Vonda Wright and colleagues published research introducing the Musculoskeletal Syndrome of Menopause. The paper highlights a pattern many women recognize, but few have had explained: joint pain, tendon issues, and conditions like frozen shoulder often emerge during the menopause transition.
The research suggests that up to 70 percent of women experience musculoskeletal symptoms during this phase of life. Historically, these issues were treated in isolation, without addressing a shared underlying contributor: declining estrogen levels. Despite years of physical therapy education and continuing education, this connection was rarely discussed until recently.
What Frozen Shoulder Actually Is
While physical therapy remains essential, outcomes are often best when care is coordinated with medical providers who specialize in women’s health and hormonal care.
What Frozen Shoulder Actually Is
Frozen shoulder, medically known as adhesive capsulitis, involves thickening and tightening of the capsule that surrounds the shoulder joint. This capsule must glide and adapt as the shoulder moves. When adhesions develop, movement becomes restricted and pain increases.
Frozen shoulder is defined by a specific pattern of motion loss, known as a capsular pattern. Identifying this pattern allows a physical therapist to differentiate frozen shoulder from other causes of stiffness such as rotator cuff tendinopathy, bursitis, labral injury, joint irritation, or pain referred from the neck.
Because the shoulder is complex, accurate diagnosis is critical. Each condition requires a different treatment approach, and incorrect treatment can delay recovery.
Why Frozen Shoulder Disproportionately Affects Women
Frozen shoulder occurs far more often in women between the ages of 40 and 60. Emerging research suggests that estrogen receptors may be more concentrated in the shoulder capsule, making it particularly sensitive to changes in estradiol levels during menopause.
Historically, frozen shoulder was labeled idiopathic, meaning no known cause. It has also been associated with diabetes, particularly in men. Clinically, most cases occur in women during the menopause transition, with few cases seen before age 40 unless triggered by trauma.
This understanding changes how patients should be educated and treated.
The Three Stages of Frozen Shoulder
Frozen shoulder progresses through three distinct stages:
The freezing stage involves increasing stiffness with minimal pain.
The frozen stage includes significant pain and marked loss of motion.
The thawing stage is characterized by improving pain but persistent stiffness.
Treatment decisions should be based on identifying the current stage. Early intervention can significantly reduce symptom duration.
When frozen shoulder is identified early, steroid injections may help reduce inflammation and slow progression. Later stages may require other interventions such as capsular distension, nerve blocks, or manipulation under anesthesia, guided by an orthopedic specialist.
Hormones, Inflammation, and Whole-Body Health
Estrogen loss increases systemic inflammation, which can worsen musculoskeletal pain. Many clients benefit from discussing menopausal hormone therapy with a qualified provider, especially when progress has stalled.
Frozen shoulder is also seen more frequently in individuals with thyroid autoimmune conditions and metabolic dysfunction. A comprehensive medical evaluation may include thyroid panels, fasting insulin, glucose, A1C, and inflammatory markers.
Lifestyle factors matter. Nutrition that supports blood sugar regulation, adequate protein intake, quality sleep, and stress management all influence healing capacity.
How Physical Therapy Should Change by Stage
Physical therapy must adapt to each stage of frozen shoulder.
In early stages, aggressive stretching and joint mobilization can worsen symptoms. Treatment focuses on pain management, maintaining current range of motion, scapular control, thoracic mobility, and nervous system regulation.
In later stages, gentle joint mobilizations may be introduced to reduce pain. Only in the thawing stage is more aggressive mobility work appropriate.
Throughout recovery, maintaining safe physical activity is essential. Rest alone is not the answer. The goal is to modify movement while respecting tissue healing.
Why The Right Care Matters
Frozen shoulder is rarely a short process. Even with optimal care, recovery often takes close to a year. Guidance throughout each phase helps prevent setbacks, adjust treatment appropriately, and maintain overall health.
Having a knowledgeable provider during this process can significantly improve outcomes and confidence.
If you have more questions about our approach to treating frozen shoulder or any other questions for us, please don’t hesitate to reach out at 913-396-9726 or click the "Free Consultation" button above!