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Living with a frozen shoulder can be incredibly frustrating. Simple things like reaching up to comb your hair or grab a cup from a shelf become painfully difficult. You might have tried rest, medications, or months of regular physiotherapy, yet your shoulder is still stiff and aching. If this sounds familiar, you’re not alone – and there may be another option worth considering. Shockwave therapy (a non-invasive treatment using acoustic energy) has emerged as a promising approach for stubborn cases of frozen shoulder. In this article, we’ll explore what frozen shoulder is, why it can linger for months, and how shockwave therapy compares to other non-invasive treatments. We’ll dive into the scientific evidence, explain in plain language how shockwave therapy works, and outline what you can expect from treatment. Most importantly, we’ll keep it realistic – no miracle “cures,” just evidence-based possibilities (with appropriate disclaimers that results may vary). If you’re tired of the cycle of trying everything and feeling no improvement, read on. Shockwave therapy might be the missing piece in your frozen shoulder recovery plan.
(Disclaimer: The information below is educational and not a substitute for professional medical advice. Always consult a qualified healthcare provider for personal guidance.)
Frozen shoulder, medically known as adhesive capsulitis, is a condition where the shoulder’s joint capsule becomes thick, inflamed, and tight, leading to pain and severely restricted motion. It often develops gradually and has classically been described in three phases:
Freezing (Painful) Phase: Shoulder pain gradually increases and range of motion starts to decrease. This phase can last anywhere from 6 weeks up to ~9 months. Pain is often worse at night, and everyday activities become challenging.
Frozen (Stiff) Phase: Pain may slightly diminish, but the shoulder remains very stiff. Reaching overhead or behind your back can be nearly impossible. This phase often lasts about 4–12 months.
Thawing (Resolution) Phase: Slow, gradual improvement in mobility occurs. This phase can take another 6–18 months (in severe cases up to ~42 months total from start to finish). Even then, some patients never regain full pre-frozen range of motion, especially without proper treatment.
Frozen shoulder affects roughly 2–5% of the general population and is more common in women (especially between ages 40–60). Certain factors increase risk – for example, diabetes (about 10–20% of diabetics develop frozen shoulder), thyroid disorders, or prolonged shoulder immobilization after injury can all predispose someone to this condition. Often, however, it happens “out of the blue” (idiopathic) with no clear cause.
What makes frozen shoulder so frustrating is not just the pain, but the persistent stiffness and duration. Many people try the usual recommended remedies – rest, anti-inflammatory medications, stretching exercises, perhaps corticosteroid injections – and still find themselves stuck months later with an immobile shoulder. In fact, without effective intervention, a frozen shoulder can take 1–3 years to fully “thaw,” and some people are left with lingering limitations. During this time, daily life is impacted: sleep gets disrupted by pain, simple self-care tasks are difficult, and it’s easy to become discouraged.
Traditional treatments for frozen shoulder usually start conservatively. Doctors often recommend oral NSAIDs (like ibuprofen) for pain and inflammation, along with physiotherapy focusing on gentle mobilization and stretching of the shoulder. Physical therapy modalities such as heat, ultrasound, or TENS, and exercises (e.g. the classic pendulum exercise) are commonly used to maintain some mobility. If progress is very slow, a doctor may offer a corticosteroid injection into the shoulder joint to reduce inflammation; this can provide short-term relief and improve range of motion for a few weeks in some cases. However, steroid injections don’t always lead to long-term improvement in frozen shoulder and repeat injections carry risks (like weakening of tendons or elevated blood sugar in diabetics). Other non-surgical options include hydrodilatation (injecting fluid to stretch the joint capsule) or nerve blocks for pain relief. When these measures fail and the shoulder remains “stuck,” more invasive steps such as manipulation under anesthesia (forcibly breaking up the adhesions while the patient is asleep) or arthroscopic capsular release surgery may be considered. Understandably, patients often want to avoid surgery due to the costs, risks, and rehab involved.
It’s no wonder people with a prolonged frozen shoulder feel trapped in a cycle of failed treatments. By the time someone has had shoulder pain and stiffness for 3+ months with little improvement, it’s officially a chronic problem. This is the point where exploring alternative treatments like shockwave therapy might be worthwhile – especially if standard exercises and injections haven’t led to recovery. Shockwave therapy is completely non-surgical and aims to accelerate the body’s natural healing processes in the shoulder. But does it actually work for frozen shoulder? Let’s examine what the research says.
Shockwave therapy, formally known as extracorporeal shockwave therapy (ESWT), involves sending high-energy acoustic pulses into affected tissues. It’s a well-established treatment for certain tendon and ligament conditions (like plantar fasciitis and tennis elbow), but its use in frozen shoulder is more recent. Because frozen shoulder is a capsular fibrosis and inflammation issue, the idea is that shockwaves might help by stimulating tissue repair, breaking up adhesions, and improving shoulder mobility. Over the past decade, a number of scientific studies – including randomized controlled trials – have investigated ESWT for frozen shoulder (adhesive capsulitis). Here are some key findings:
Shockwave vs. Sham (Placebo): In a blinded 2014 clinical trial, 36 patients with frozen shoulder were split into two groups – one received true shockwave therapy weekly for 4 weeks, the other got sham (placebo) treatment. After 4 weeks, the shockwave group showed significantly greater improvements in shoulder pain and disability scores (measured by SPADI questionnaire) compared to placebo. They also had larger gains in range of motion (specifically in flexion, abduction, and external rotation). Internal rotation was the only movement that didn’t significantly differ. The shockwave-treated patients reported a quicker return to daily activities and better quality of life. In short, this study concluded that ESWT had positive effects on frozen shoulder recovery versus no real treatment.
Shockwave vs. Standard Physical Therapy: A 2015 trial in Korea compared shockwave therapy to regular physiotherapy exercises in 30 frozen shoulder patients. One group received ESWT twice a week for 6 weeks (along with basic rehab), while the control group received conservative physiotherapy sessions for 6 weeks. Both groups improved to some degree (as one would expect with time and exercise), but the shockwave group improved significantly more. Their pain levels (VAS scores) dropped further and their shoulder function scores increased more than the exercise-only group. The authors concluded that shockwave therapy is an effective intervention for reducing pain and improving function in patients with adhesive capsulitis.
Shockwave vs. Corticosteroid Injection: One noteworthy 2021 randomized trial focused on diabetic frozen shoulder patients – a group that often doesn’t respond as well to treatment. Fifty patients with diabetes and frozen shoulder were randomized to either 1) an intra-articular steroid injection or 2) a course of shockwave therapy (12 sessions); both groups also did prescribed shoulder exercises. After the treatment period, both groups showed improvement in pain, disability, and range of motion, but the shockwave group’s gains were significantly greater. Shoulder pain scores and disability scores improved more in the ESWT group than in the steroid group (p = 0.001), and shoulder flexion and abduction range of motion increased more as well. Additionally – a notable point for diabetic patients – the shockwave group saw improvements in blood glucose control, whereas steroid injections can transiently raise blood sugar. The researchers concluded that shockwave therapy provided a more effective and safer treatment for frozen shoulder in diabetic patients than steroid injections.
Shockwave as an Adjunct to Other Therapy: Because most frozen shoulder treatments are not mutually exclusive, some studies have looked at adding shockwave to standard care. A comprehensive systematic review and meta-analysis published in 2022 pooled data from 20 studies of ESWT for frozen shoulder. The meta-analysis found that when shockwave was used in addition to routine treatments (like exercise therapy), patients had better outcomes than routine therapy alone. In particular, shockwave produced greater short-term pain relief (significantly lower pain scores) and improved shoulder function (measured by standard scales) in the weeks and months following treatment. Improvements in external rotation range of motion were also noted, though there was some variability between studies. The authors’ conclusion was that ESWT appears beneficial for frozen shoulder by reducing pain and improving function, and that it can be a valuable adjunct therapy in a conservative treatment plan. They did caution that the quality of some studies was variable and long-term effects beyond a few months are less clear – so while shockwave helps in the short to medium term, more research is needed on long-term outcomes.
Overall, the evidence – including multiple RCTs and reviews – indicates that shockwave therapy can help “thaw” a frozen shoulder faster than it might with standard therapy alone. Patients receiving shockwave often experience significant pain reduction and improved shoulder mobility over a series of treatments, whereas those without shockwave may improve more slowly or plateau. It’s important to note that in most studies, shockwave was not a magic bullet on its own – it was typically combined with exercise or physical therapy for best results. But compared to exercises alone or medication alone, adding shockwave tends to accelerate relief. And compared to corticosteroid injections, shockwave may yield more sustained improvement without the side effects of steroids.
How can sound waves possibly loosen up a frozen shoulder? It sounds a bit like sci-fi, but the mechanism of shockwave therapy is rooted in some fascinating biology. When the high-energy acoustic pulses from the device are delivered into the shoulder tissues, they create a form of micro-trauma (tiny physical stresses) that stimulate the body’s healing responses – a process called mechanotransduction. Essentially, the mechanical energy is converted into cellular activity. Research suggests shockwaves trigger a cascade of effects in the treated area, including:
Increased Blood Flow and New Vessel Formation: Shockwaves cause a surge of blood circulation and the growth of new capillaries in tissues (a process called angiogenesis). For a frozen shoulder, which often has poor synovial fluid flow and scarring, this improved blood supply can promote tissue repair and wash out inflammatory substances.
Collagen Remodeling and Tissue Breakdown: The pulses can help break up abnormal collagen fiber crosslinks and adhesions in the stiff joint capsule. Think of it as helping to “soften” and remodel the scar tissue that is restricting your shoulder.
Reduction of Inflammation and Pain Mediators: Studies have found shockwave therapy reduces levels of inflammatory cytokines and can even decrease unmyelinated nerve fibers (which transmit pain) in the targeted area. Patients often report pain relief fairly soon after treatment, potentially because shockwaves trigger the release of Substance P (a neuropeptide) and other factors that modulate pain signals and inflammation.
Stimulation of Cellular Repair Processes: Perhaps most intriguingly, shockwaves prompt the release of growth factors and the activation of local stem cells. This means the therapy kick-starts your body’s natural regeneration capabilities – encouraging the generation of new healthy tissue to replace or repair the damaged, fibrotic tissue in the shoulder. Over several weeks post-treatment, this can lead to strengthened tendons and restored range of motion.
In simpler terms: shockwave therapy “wakes up” the healing system in an area that has been stuck in a rut. Frozen shoulder often involves a stalled healing process – the body laid down scar tissue and the normal recovery stalled out, leaving chronic pain and stiffness. Shockwaves send a message to restart healing: increasing circulation, cleaning up inflammation, and stimulating fresh repair. Patients typically feel a bit of soreness after a session (similar to having worked the shoulder out), but then gradually notice pain decreasing and mobility improving as these biological changes take effect over the ensuing days and weeks.
If you decide to try shockwave therapy for a frozen shoulder, what can you expect in terms of sessions and results? Protocols vary, but in studies and clinical practice, it’s common to undergo a series of weekly treatments. Each session usually lasts only about 10–20 minutes of actual shockwave application to the shoulder (often with additional time for evaluation, stretches, etc.). The shockwave applicator delivers focused pulses to various points around the shoulder joint – it’s somewhat uncomfortable but generally tolerable; the intensity can be adjusted to your tolerance (more on this in our FAQ “Does shockwave therapy hurt?” below).
Most research trials used between 4 and 12 sessions in total for frozen shoulder. Real-world clinics report that a typical patient might need around 3–6 sessions, spaced about a week apart, to achieve substantial improvement. At our clinic, we’ve found many people start to notice positive changes after 2 or so treatments, and often achieve considerable relief by the 4th or 5th session. Of course, every individual is different – factors like how severe your frozen shoulder is, how long you’ve had it (the chronicity), and your overall health (e.g. diabetes or other issues) can impact healing time. Some patients may require a few additional sessions, or an occasional follow-up treatment down the line, especially if gains start to plateau.
It’s crucial to set realistic expectations: Shockwave therapy is not an overnight miracle, but rather a jump-start to a natural recovery. Typically, you won’t walk out of one session with a full range of motion – but you might feel some immediate pain relief or slight loosening. More noticeable changes in mobility usually accumulate over several weeks as the biological effects (like new blood vessel growth and tissue remodeling) take place. In one study, the maximum benefits of shockwave were observed around 3 months after treatment, aligning with the body’s timeline for tissue regeneration. This is actually relatively fast given that frozen shoulder without intervention could linger for years.
Importantly, shockwave therapy is most effective when combined with movement. You’ll still need to do your prescribed stretching and range-of-motion exercises for the shoulder, to take advantage of the tissue changes that shockwave is inducing. Think of shockwave as reducing the biological barriers (pain, fibrosis) so that you can stretch more and move better; doing so will reinforce the improvements. Clinical guidelines often recommend continuing physiotherapy or gentle exercises in between shockwave sessions. The good news is that as pain decreases, you’ll likely find it easier to do those exercises that were too painful before.
Lastly, while evidence is positive, we must emphasize no treatment works 100% for everyone. Some patients respond only modestly to shockwave therapy. The 2022 meta-analysis noted variability – some studies’ patients had dramatic improvement, others more mild. If you have significant osteoarthritis or other shoulder pathologies in addition to frozen shoulder, results can vary. That said, because shockwave therapy is low-risk and non-invasive, it’s generally worth a try before considering aggressive options like surgery. Let’s look next at how our clinic integrates shockwave therapy into a comprehensive approach for treating frozen shoulder.
At Unpain Clinic, shockwave therapy isn’t an add-on or last resort – it’s often a central component of our treatment plans for chronic shoulder issues, including frozen shoulder. Our approach starts with a thorough assessment of why your shoulder froze in the first place. As our founder Uran Berisha often says, we don’t just ask “Where does it hurt?” — we ask “Why does it hurt?” (and often, the answer involves more than just the shoulder joint). Frozen shoulder can sometimes be linked to systemic factors (like metabolic health in diabetics) or compensations from other areas of the body. For example, neck nerve compression or even old surgical scars on the trunk can contribute to shoulder movement dysfunction. So, our first step is a whole-body assessment: looking at your posture, spine, other joints, and medical history to identify any root causes or contributing factors to your shoulder problem.
After the assessment, if you’re a suitable candidate for shockwave therapy, we design a tailored program. A typical shockwave therapy session for frozen shoulder at Unpain Clinic involves:
Targeted Shockwave Application: We use advanced shockwave devices (including true focal shockwave and radial pressure wave) to deliver pulses to the shoulder capsule, rotator cuff tendons, and surrounding tight tissues. We often treat not just the immediate shoulder area but also relevant trigger points in the neck, upper back, or chest if they’re impacting shoulder mechanics.
Manual Therapy and Mobility Work: In the same visit, our therapists may perform gentle joint mobilizations, soft tissue release techniques, or guided stretching after the shockwave treatment. Shockwave’s effect of breaking down adhesions and increasing blood flow makes manual therapy more effective immediately afterward. By retraining the muscles and shoulder blade movement (scapular motion), we help ensure that newfound range of motion is used and maintained.
Whole-Body Focus: True to our name, Unpain Clinic looks at the whole body during treatment. We might address a stiff upper back, a tight elbow, or even fascia in the opposite shoulder or hips – whatever our assessment indicates as a contributor to your frozen shoulder. Shockwave therapy can be applied to fascial chains and scar tissue in other areas that might be affecting your shoulder movement (for instance, treating an old abdominal surgery scar that is limiting overhead arm reach).
Education and Exercise: We empower you with specific exercises to do at home, such as pendulum swings, gentle pulley stretches, or table slides that match your current phase of recovery. We also advise on simple lifestyle modifications (like how to avoid straining the shoulder during daily tasks, proper heat application before stretching, etc.). This holistic strategy means you’re getting shockwave therapy in context – not just “zapping” the shoulder in isolation, but integrating it into a broader plan.
One of the reasons we emphasize shockwave therapy is that we’ve repeatedly seen it break the cycle of chronic pain where other methods haven’t. Shockwave can penetrate up to ~12 cm into tissues, reaching deep into the shoulder joint capsule and rotator cuff – areas that hands or needles often can’t fully target. Many patients who come to us have “tried everything” (physio, massage, injections) and still couldn’t lift their arm; but after a few shockwave sessions combined with our rehab approach, they start to see real changes. We’ve had clients with frozen shoulder who regained significant mobility in a fraction of the typical time. (For example, one of our YouTube video case stories shows a patient who suffered with frozen shoulder for years and experienced rapid improvement after shockwave therapy – going from barely lifting her arm to nearly normal movement within a short period.)
Another advantage is that shockwave therapy has minimal downtime. After a session, you might feel a bit sore or “worked out,” but there is no incision, no anesthetic, and no significant recovery period needed. You can generally continue using your arm gently in normal activities. In fact, we encourage staying active (within pain-free limits) to keep the shoulder from tightening up. Most patients tolerate shockwave well – if something is too intense, our therapists adjust the settings to keep you within a moderate discomfort (it should hurt so good, not truly painful!). We also prioritize patient education during the process; as you see improvements, we explain what’s changing in your body (e.g. “We’ve broken up some scar tissue here, so now let’s strengthen this motion.”).
Throughout care, we track your progress – measuring improvements in range of motion and pain scores. If you plateau, we re-evaluate and might modify the plan (occasionally adding a steroid injection or other modality if truly needed, or referring to a specialist if something unexpected arises). But generally, by using shockwave as a core treatment, we are often able to avoid the need for more invasive interventions. One internal review at our clinic noted that a majority of chronic shoulder pain patients (including adhesive capsulitis cases) reported significant relief and increased motion within 3–5 shockwave sessions – with very few side effects beyond temporary soreness. We love shockwave therapy because it tends to produce rapid results with minimal side effects or downtime, allowing our clients to get back to living their lives.
(Note: While we’re enthusiastic about shockwave, we always ensure it’s appropriate for you. If you have certain conditions – e.g., a bleeding disorder or you’ve recently had a cortisone injection – we might delay or avoid shockwave in those cases for safety. Your therapist will discuss any contraindications with you. Safety is a top priority.)
To illustrate how shockwave therapy fits into a frozen shoulder recovery, let’s walk through a hypothetical example. Meet Jane – a Fifty-year-old office administrator, who developed a frozen shoulder after a minor shoulder strain that seemed to just get worse instead of better. By the time she visits Unpain Clinic, she’s had 8 months of shoulder pain and stiffness. She’s tried physiotherapy exercises and one steroid injection. The injection helped her pain for a few weeks, but the stiffness remained and her gains plateaued. Jane still struggles to lift her arm to shoulder height, can’t hook her bra in back, and wakes up at night anytime she rolls onto that shoulder. She’s frustrated and starting to wonder if she’ll ever get back to normal without an invasive procedure.
Initial Assessment: At her first visit, our therapist evaluates Jane and finds she’s in the “frozen” phase – moderately less pain than a few months ago, but very limited motion (external rotation and abduction are especially restricted). We also notice Jane has a history of diabetes (a risk factor for frozen shoulder) and some myofascial tightness in her neck and chest muscles. We explain that a whole-body approach is needed. We outline a plan including weekly shockwave therapy sessions, plus some targeted stretches and posture exercises for Jane to do daily. We also educate her on the importance of blood sugar management and anti-inflammatory nutrition (since diabetes can make connective tissues more sticky).
Shockwave Treatment Sessions: Jane begins coming in once a week. In Session 1, we apply shockwave pulses to her shoulder capsule and around the rotator cuff tendons. It’s a bit tender (she describes it as a 5 out of 10 discomfort during treatment), especially over the front of the shoulder, but she tolerates it well. Afterward, we do gentle mobilizations – and she notes her shoulder feels “looser” immediately on the table. That night, she has some soreness, but by the next day, her resting pain is lower. Over the next two sessions, we progressively increase the shockwave intensity as she tolerates more, and start breaking up adhesions in her upper shoulder blade area too. By Session 3, Jane reports she can reach her arm overhead enough to almost touch the top of her head – something she couldn’t do for months! She’s also sleeping better. We incorporate more active stretching now that her motion has improved.
By Session 5, Jane has regained about 90% of her shoulder range of motion. Her SPADI (Shoulder Pain and Disability Index) score, which was 70/100 at baseline, has dropped to 20/100 – indicating much less pain and disability. She can fasten her bra and even returned to her aqua-fit exercise class (with minimal discomfort). We decide to space out to bi-weekly sessions for the next two visits. After a total of 7 shockwave treatments, Jane essentially “graduates” – she has a mostly pain-free, functional shoulder. We advise her to continue home exercises and check back in 6 weeks. At her follow-up, she’s maintained her motion and is thrilled that she avoided surgery. This kind of outcome – while individual results vary – shows how a structured plan with shockwave therapy can potentially speed up frozen shoulder recovery dramatically. (Remember, without treatment, many frozen shoulders would still be in a painful phase at 7–8 months, whereas Jane was able to move on with life).
Disclaimer: The above story is a composite example for illustrative purposes only. Every patient is unique; not everyone will achieve the same results or in the same timeframe. We share this to demonstrate possibilities, not guarantees.
Managing a frozen shoulder isn’t just about in-clinic treatments – what you do at home plays a huge role in recovery. Here are some simple, safe tips to complement your shockwave therapy or other treatments:
Keep It Moving – Gently: Total rest can actually worsen a frozen shoulder. You want to gently move the shoulder within your pain-free range to prevent further stiffness. Pendulum exercises are a great starting point: Lean forward and let your affected arm dangle, then slowly sway your body to make the arm circle like a pendulum. This uses gravity to mobilize the joint with minimal pain. Perform pendulums for a few minutes each day. Also practice mild stretching – for example, use your good arm to lift the affected arm in front of you or to the side as far as comfortable, hold 10–20 seconds, repeat a few times. Note: Only stretch to a point of mild discomfort, not sharp pain. Overly aggressive stretching can trigger inflammation – slow and steady progress is better.
Heat and Warm-Up: Many frozen shoulder sufferers find that applying heat before exercise helps. A warm shower or heating pad on the shoulder for 10–15 minutes can increase blood flow and tissue flexibility. After warming up, do your gentle stretches/exercises. (Save ice packs for after exercise if you experience soreness, but in general frozen shoulders respond well to warmth due to the tight capsule.)
Posture and Shoulder Blade Mobility: Pay attention to your posture during the day, especially if you work at a desk. Scapular (shoulder blade) movement is key to shoulder function. Practice gently pinching your shoulder blades back and down (as if tucking them into your back pockets) – this can relieve some strain on the shoulder joint. Avoid slouching or hunching which can make shoulder movement harder. You might be given specific scapular retraction exercises or doorway pectoral stretches by your therapist – these can be done at home to keep the surrounding musculature flexible.
Don’t Ignore the Other Shoulder: With one frozen shoulder, people tend to overuse the opposite arm – which can sometimes lead to strain on that side. Try to be mindful of symmetry: perform gentle range-of-motion exercises on your good shoulder too, and practice some general arm/shoulder stretches on both sides. This can prevent secondary problems and also keeps your body balanced.
Pain Management: It’s okay to use some pain relief aids to stay comfortable. Over-the-counter anti-inflammatories (like ibuprofen or naproxen) or acetaminophen can be used as directed, especially on days you’re doing more activity. Topical analgesic creams or patches might offer mild relief for aching muscles around the shoulder. These don’t speed up the thawing of a frozen shoulder, but they can make you more comfortable so you can stay active, which does help recovery. Always follow dosage guidelines and consult your doctor if you’re unsure about medications.
Know When to Rest (and When to Seek Help): While movement is good, there will be times your shoulder feels particularly painful – perhaps after an intense therapy session or a day of heavier use. It’s fine to rest it more on those days. You can immobilize in a sling for short periods if absolutely needed for pain, but remove it frequently to gently move the joint so it doesn’t stiffen further. Most importantly, listen to your body’s limits. If you experience any red-flag symptoms – such as sudden severe pain that’s unrelenting, fever or redness (could indicate joint infection, which is rare but serious), or symptoms of another condition (like chest pain radiating to the shoulder or arm – which could be heart-related) – seek prompt medical evaluation. Those are likely unrelated to simple frozen shoulder and need a doctor’s attention.
(Another disclaimer: These at-home tips are general and may not be appropriate for everyone. Always follow the specific advice given by your healthcare provider, as they know your individual case. When in doubt, consult a professional before trying new exercises.)
By staying proactive with home care and partnering with your therapist, you can maximize the gains from shockwave therapy or any treatment. The goal is to gradually reclaim your shoulder’s mobility and maintain those improvements. It takes patience – you might measure progress in weeks, not days – but each degree of motion regained is a small victory on the road to recovery.
Yes, for the vast majority of patients, shockwave therapy is considered safe for frozen shoulder. It is a non-invasive treatment – no injections, no incisions – and it has a good safety profile with minimal systemic side effects. The energy from shockwaves is focused on the shoulder region and does not require anesthesia. Clinical studies have reported no serious adverse events when treating adhesive capsulitis with shockwave. Most people experience only temporary local soreness or redness. However, there are a few exceptions and precautions. We typically avoid shockwave therapy (or postpone it) in certain situations: for example, if you are pregnant (especially near the shoulder area, as a precaution), if you have a bleeding/clotting disorder or are on blood thinners, if you’ve had a corticosteroid injection in that shoulder within the past 6 weeks, if there’s an active infection or tumor at the shoulder, or if you have a pacemaker or nerve implant in the area. These contraindications are mostly out of caution, not because shockwave is inherently dangerous. A trained provider will screen you for these conditions. When applied by a qualified professional, shockwave therapy is generally very safe for treating frozen shoulder.
The number of sessions can vary per individual, but typically a short course of treatment is used. Most patients need somewhere around 3 to 6 sessions of shockwave therapy, spread out over several weeks, for frozen shoulder. In our experience at Unpain Clinic, we often start with a package of 3 sessions (once per week) and then re-evaluate – many people show noticeable improvement by the third visit (in terms of pain reduction or a bit more range of motion). If progress is continuing, we might do 1-2 more weekly sessions, usually totaling about 5. Very few patients need more than 6-8 sessions for a frozen shoulder, unless the case is exceptionally severe or there are multiple areas being treated. Scientific studies reflect this range: some used 4 sessions, others 6 or 8, and one protocol for diabetics used 12 very low-dose sessions. It’s not an indefinite therapy – if it’s helping, you should know within a few treatments. We also build in rest periods; after a cycle of weekly treatments, we often pause to let the body fully respond (since shockwave’s regenerative effects continue unfolding for weeks). For example, one guideline is 3-5 sessions about 1 week apart, then a break of 4-6 weeks to “heal,” then follow-up to assess if more is needed. Remember, shockwave is triggering your body to heal, and that healing takes time – so doing more and more sessions back-to-back isn’t always better beyond a point. Your clinician will tailor the plan to your progress. The good news is that many frozen shoulder patients don’t require a long course of treatment; significant improvements are often achieved within a month or two of starting shockwave therapy.
This is a common concern. The short answer is there can be some discomfort, but it’s generally tolerable and short-lived. During the treatment, as the shockwaves are delivered, you might feel a tapping or pounding sensation on the shoulder. Most patients rate the discomfort as mild to moderate – perhaps a 3–5 out of 10 on a pain scale. It often feels like deep vibrations or quick little “thuds.” Areas with less soft tissue padding (like a bony front of the shoulder) may feel more tender. Interestingly, many people find that after the first few seconds, the sensation becomes less noticeable – your nervous system starts to accommodate to it. Our therapists will always work within your tolerance: we start at a lower intensity and ask for your feedback. If it’s too intense, we can dial it down to keep you comfortable. After the session, you might experience some soreness in the treated area – akin to muscle soreness after exercise – and perhaps a bit of redness on the skin. This post-treatment soreness can last a few hours or, at times, a day or two, but it’s usually easily managed (a warm bath or a Tylenol can help if needed). Serious pain is not typical; in fact, many patients feel relief soon after the treatment as pain-mediating chemicals in the tissue are reduced. To put it in perspective: You won’t need any anesthesia or painkillers to get through a shockwave session, and most people leave saying “that wasn’t bad at all.” So yes, there may be some discomfort, but it’s a sign that the therapy is stimulating the tissue – and it’s generally a small price to pay for the potential gain in mobility and pain relief you get afterward.
Absolutely – even if your frozen shoulder has been lingering for a long time, shockwave therapy may still provide benefit. In fact, many of the cases we treat are chronic, stubborn frozen shoulders that haven’t resolved on their own after a year or more. By definition, a frozen shoulder that lasts beyond 12–18 months is chronic, and often the body has kind of accepted a “new normal” of limited movement. Shockwave therapy attempts to disrupt that stagnant state and provoke a fresh healing response. Clinical research included patients with long-duration symptoms; for example, one study’s average patient had about 6–7 months of frozen shoulder symptoms and still saw improvement with shockwave. We’ve treated patients who were 2+ years post-onset and had tried other therapies without success – and they achieved significant motion gains with shockwave. It might take a few extra sessions or a multi-modal approach (we might combine shockwave with more aggressive stretching under therapeutic guidance), but improvement is possible. It’s also worth noting that frozen shoulder can sometimes partially “unfreeze” on its own after several years, but the goal of therapy is to expedite that and not leave you waiting indefinitely. Shockwave therapy has been reported to shorten the duration of the frozen phase, even in chronic cases. Keep in mind, every case is unique: if your shoulder has underlying arthritis or rotator cuff tears, those issues can also limit recovery. But even then, shockwave often helps by reducing pain and promoting whatever mobility is achievable. In summary, yes – having a frozen shoulder for years does not disqualify you from shockwave therapy; in fact, you might be exactly the kind of person who finds this treatment beneficial when everything else has failed to get you “over the hump.”
While shockwave therapy is safe for most people, there are a few groups who should avoid or postpone it (as touched on earlier). You should not have shockwave therapy on your shoulder (or any area) if:
You are pregnant – particularly over or near the uterus. For a shoulder problem, pregnancy is a relative contraindication (since the shoulder is away from the womb, some clinicians might still treat with caution), but generally we err on the side of avoiding shockwave during pregnancy.
You have a known blood clotting disorder (like hemophilia) or you are on strong anticoagulant medications. The concern is a slightly increased risk of internal bleeding or bruising in the treated tissues. Similarly, if you have a clot (deep vein thrombosis) or vascular condition, we’d be cautious.
You recently had a cortisone injection in that shoulder (within the last 4–6 weeks). We don’t combine steroid shots and shockwave in the same immediate timeframe because the steroid can weaken tissue temporarily and shockwave could, in theory, cause tissue stress. We usually wait a full 6 weeks after a steroid injection before starting shockwave.
There is an active infection or open wound at the shoulder. Shockwave could irritate infected tissue or spread infection, so we’d treat the infection first.
There is a tumor or cancer in the treatment area. If you have a known malignancy in or near the shoulder, shockwave is contraindicated over it. (Having had cancer elsewhere in the past isn’t necessarily a contraindication; it’s specific to treating directly over a tumor site.)
You have certain implanted devices. For example, a pacemaker or spinal cord stimulator – we wouldn’t apply shockwave very close to electronic implants to avoid interference. Also, areas with metal hardware (plates, screws) can often be treated, but it depends on depth – we avoid direct treatment over metallic implants if there’s concern about vibration on the hardware.
Lastly, if you are under 18 and still have growing bones (epiphyseal plates), shockwave is generally not used over growth plates as a precaution.
Your provider will screen for these factors. If you fall into one of these categories, it doesn’t mean you have no options – it just means shockwave might be off the table, and we’d consider alternatives. Fortunately, most frozen shoulder patients do not have these contraindications. And even if you do (say you just had a cortisone shot), we can simply wait a few weeks and then proceed. Always be open with your healthcare team about your full medical history so they can determine if shockwave is appropriate for you.
Insurance coverage for shockwave therapy varies widely. In Canada, for instance, provincial health plans (like Alberta Health Care) typically do not cover shockwave therapy when done in a private clinic, because it’s considered an elective advanced therapy (similar to how they don’t cover massage or many physio modalities). However, if you have extended health benefits or private insurance, you may have coverage for shockwave therapy under the umbrella of physiotherapy or chiropractic care. Many insurance plans will reimburse physiotherapy sessions up to a certain limit, and if shockwave is administered by a licensed physio or chiropractor as part of treatment, it can be billed as such. At Unpain Clinic, our physiotherapists and chiropractors provide shockwave treatment, so we can issue receipts that indicate those services. It’s best to check your individual plan: ask if physiotherapy with shockwave or chiropractic with shockwave is covered. Some plans might require a doctor’s referral or have a dollar cap per year. As for workers’ compensation or motor vehicle accident insurance, coverage for shockwave is case-by-case. Generally, you should be prepared that you might have to pay out-of-pocket, at least partially. The good news is that the number of sessions is usually limited (not an endless weekly therapy forever), and many clinics offer package deals. When compared to the cost of something like surgery and postoperative rehab, shockwave is relatively affordable. Our clinic’s administrative team can help check your insurance if you’re unsure. And even without coverage, consider that the investment in a faster recovery is often worth it – getting back to work, sports, or just living pain-free sooner can save money in the long run.
Shockwave therapy side effects are generally mild and temporary. The most common ones include: localized soreness, bruising, or aching in the treated area, and sometimes redness or minor swelling on the skin. For instance, after treating a frozen shoulder, you might feel that deep achy feeling in the shoulder for a day, as if you did an intense workout. This is normal and usually subsides within 24–48 hours. Bruising is not very common with proper technique, but if you have sensitive skin or were on blood thinners, you might see a small bruise. Some patients report feeling a bit “tingly” or numb in the area for a short time after – this is due to shockwaves temporarily affecting nerve endings (often in a good way that helps pain). An interesting side effect can be a feeling of fatigue or being “washed out” later in the day – likely because your body is spending energy initiating healing responses; staying well-hydrated and resting after a session can help if this occurs. Serious side effects are exceedingly rare. Unlike surgery or injections, there’s no risk of infection from shockwave, and no risk of allergic reaction (since nothing is injected). There have been rare reports in other conditions of tendon rupture after very high-intensity shockwave, but in the context of frozen shoulder, that’s not a concern because we’re treating the capsule area and not directly shocking a weight-bearing tendon at high power. Our clinicians are very mindful of dosing – we use settings that are effective but safe. We will also warn you about any unusual things to watch for. For example, if you experienced severe pain or swelling after a session (beyond the typical soreness), you would let us know – but this is uncommon. Overall, the vast majority of patients tolerate shockwave well with minimal side effects, which is one of its big advantages. It’s always good to communicate with your provider about what you feel during and after treatment so they can adjust as needed. And remember: a little temporary soreness is often a sign that your body is responding and will lead to improvement in the days ahead.
Frozen shoulder can truly test your patience – it’s a condition known to “come and go on its own,” but waiting it out for years is not a pleasant prospect. Fortunately, modern therapy options like shockwave therapy offer a way to potentially speed up the thawing process without surgery. To recap, frozen shoulder (adhesive capsulitis) causes thickening of the shoulder capsule, pain, and stiffness that can last for months or years if untreated. Traditional non-invasive treatments (pain meds, physiotherapy exercises, steroid injections) help many people, but some cases remain stubborn. Shockwave therapy has emerged as a promising non-surgical treatment that may jump-start healing in a frozen shoulder by improving blood flow, breaking up adhesions, reducing pain, and stimulating tissue regeneration. Research – including randomized trials and a meta-analysis – suggests that shockwave therapy can reduce shoulder pain and improve range of motion significantly more than standard therapy alone. It’s not a magic cure, but it can be a powerful catalyst for recovery, especially when combined with holistic care (exercise, manual therapy, whole-body assessment of causes).
If you’re a good candidate (no contraindications like those discussed in the FAQ), shockwave therapy offers a relatively low-risk, time-efficient path to relief. It might help you avoid more invasive measures and get back to daily activities sooner. Of course, individual results vary – some shoulders respond quicker than others. That’s why at Unpain Clinic we personalize the approach: using shockwave as a tool within a comprehensive plan that addresses the “why” behind your pain. We’ve seen many frozen shoulders finally loosen up after patients thought they were stuck with it for good – and that kind of life-changing result is why we’re passionate about this therapy.
If your shoulder has been “frozen” in pain and limited movement, and you’re looking for a non-surgical, evidence-backed solution, shockwave therapy may be worth considering. Especially for those who haven’t found success elsewhere, it can offer hope of regaining mobility and comfort. Always consult with a qualified healthcare provider to determine if it’s appropriate for your specific situation. You don’t have to just endure the frustration of frozen shoulder – there are options that can help move your recovery forward. Shockwave therapy might just be the pulse of energy your shoulder needs to finally thaw out.
Ready to take the next step? At Unpain Clinic, we are experts in shockwave therapy and integrated rehab for conditions like frozen shoulder. We’d be happy to assess your case and guide you towards lasting relief. Remember, you don’t have to settle for “permanently frozen” – with the right approach, you can get back to moving freely again.
Book Your Initial Assessment NowAt Unpain Clinic, we don’t just ask “Where does it hurt?” — we uncover “Why does it hurt?”
If you’ve been frustrated by the cycle of “try everything, feel nothing,” this assessment is for you. We take a whole-body approach so you leave with clarity, not more questions.
✅ What’s Included
Comprehensive history & goal setting
Orthopedic & muscle testing (head-to-toe)
Motion analysis
Imaging decisions (if needed)
Pain pattern mapping
Personalized treatment roadmap
Benefit guidance
🕑 Important Details
60 minutes, assessment only
No treatment in this visit
👩⚕️ Who You’ll See
A licensed Registered Physiotherapist or Chiropractor
🔜 What Happens Next
If you’re a fit, we schedule your first treatment and start executing your plan.
🌟 Why Choose Unpain Clinic
Whole-body assessment, not symptom-chasing
Root-cause focus, not temporary relief
Non-invasive where possible
No long-term upsells — just honest, effective care
🎯 Outcome
You’ll walk out knowing:
What’s wrong
Why it hurts
The fastest path to fix it
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
1. Vahdatpour B. et al. (2014). Efficacy of Extracorporeal Shockwave Therapy in Frozen Shoulder. Int J Prev Med, 5(7):875-881. PMID: 25104999.
2. Elerian AE. et al. (2021). Effectiveness of Shock Wave Therapy versus Intra-Articular Corticosteroid Injection in Diabetic Frozen Shoulder: RCT. Applied Sciences, 11(8), 3721. DOI: 10.3390/app11083721.
3.Park C. et al. (2015). The effects of extracorporeal shock wave therapy on frozen shoulder patients’ pain and functions. J Phys Ther Sci, 27(12):3659-3661. PMID: 26834326.
4. Zhang R. et al. (2022). Extracorporeal Shockwave Therapy as an Adjunctive Therapy for Frozen Shoulder: A Systematic Review and Meta-analysis. Orthop J Sports Med, 10(2):23259671211062222. PMID: 35141337.
5. Unpain Clinic Podcast – Episode #2: “Learn how to cure and relieve your chronic shoulder pain!” (June 21, 2021)
6. Unpain Clinic YouTube – “How Frozen Shoulder Unfroze. Rapid Recovery with Shockwave Therapy After Years of Stubborn Pain.” (2019)
7. Unpain Clinic – Physiotherapy for Shoulder Pain Relief in Edmonton. Unpain Clinic website article.
8. Unpain Clinic – Shockwave Therapy in Edmonton & Summerside. Unpain Clinic webpage.
