Shoulder Pain: Is It Frozen Shoulder or Bursitis?

Key Takeaways

• Frozen shoulder and bursitis are two of the most common causes of shoulder pain, but they have different causes, timelines, and treatment approaches.
• Frozen shoulder develops gradually and restricts movement in all directions. Bursitis tends to cause pain in specific positions, particularly overhead.
• Getting the diagnosis right is the most important first step. The wrong treatment for the wrong condition will not work, and can sometimes make things worse.
• Both conditions respond well to physiotherapy. The approach differs significantly depending on which one you have.
• Shoulder pain affects up to 36 percent of the population at some point. You are not alone, and the outcomes with the right treatment are genuinely positive.

Quick note: this article is here to help you understand the topic, not replace professional advice. Everyone is different. Please speak with your physio or doctor about your specific situation.

Table of Contents

• What is frozen shoulder?
• What is shoulder bursitis?
• How to tell the difference
• What causes shoulder pain?
• Should I see a physio for shoulder pain?
• How physiotherapy helps shoulder pain
• What you can do while you wait
• FAQs

A lot of people come into our clinic worried about this

Shoulder pain can be genuinely disabling. When it hurts to lift your arm, get dressed, reach behind your back, or sleep through the night, it affects everything. And because frozen shoulder and bursitis can feel surprisingly similar on the surface, a lot of people spend months treating the wrong thing and wondering why they are not improving.

I want to help you understand the difference, what to look for, and how physiotherapy can help with both.

What Is Frozen Shoulder?

Frozen shoulder, known clinically as adhesive capsulitis, is a condition where the capsule surrounding the shoulder joint becomes inflamed, thickened, and progressively tighter over time. The American Academy of Orthopaedic Surgeons describes it as a condition characterised by stiffness and pain in the shoulder joint that develops gradually, worsens over time, and typically resolves over one to three years. That timeline is one of the things that makes it so frustrating to live with.

What makes frozen shoulder different from most shoulder conditions is that the restriction is not just about pain. The joint itself becomes structurally stiff. In a healthy shoulder, the capsule is loose enough to allow full movement in every direction. In frozen shoulder, it contracts and tightens, physically limiting how far the joint can move regardless of pain.

What Frozen Shoulder Feels Like

Frozen shoulder typically develops in three overlapping stages:

• The freezing stage: pain increases, often significantly, and movement starts to become restricted. Night pain is common and can be severe. This stage can last six weeks to nine months.
• The frozen stage: pain may ease slightly but stiffness reaches its peak. Activities like reaching overhead, fastening a seatbelt, or getting dressed become very difficult. This stage can last four to twelve months.
• The thawing stage: movement gradually returns, usually over five to twenty-four months.

The hallmark signs of frozen shoulder include:

• Deep, aching pain across the whole shoulder, sometimes referring down the upper arm
• Loss of movement in all directions, particularly overhead and behind the back
• Night pain that disturbs sleep regardless of which position you try
• Gradual onset with no clear injury or incident
• Difficulty with everyday tasks like reaching a high shelf, putting on a jacket, or doing up a bra strap

Risk factors include diabetes, thyroid conditions, and cardiovascular disease. It is most common in people aged 40 to 60 and slightly more prevalent in women. Previous shoulder injury or a period of immobilisation (for example, using a sling after a fracture) also increases risk.

What Is Shoulder Bursitis?

The shoulder has a small fluid-filled sac called the subacromial bursa that sits between the rotator cuff tendons and the bone above them. Its job is to reduce friction and allow smooth movement. When this bursa becomes irritated and inflamed, it is called bursitis.

The Cleveland Clinic notes that shoulder bursitis is one of the most common causes of shoulder pain, and is often associated with rotator cuff weakness, repetitive overhead activity, or a specific loading incident such as a fall or a heavy lift.

What Shoulder Bursitis Feels Like

Unlike frozen shoulder, bursitis tends to be positional. The pain is typically worse in specific movements rather than constant across all directions.

Common signs include:

• Sharp or pinching pain at the front or side of the shoulder, especially when lifting the arm past 90 degrees
• Pain at night, typically worse when lying on the affected shoulder but often relieved by changing position
• Tenderness when pressing on the upper arm or top of the shoulder
• Difficulty reaching behind the back
• Pain that often came on after a specific activity, period of overuse, or incident

Bursitis does not typically cause the global stiffness that frozen shoulder does. Movement may be painful in certain positions, but the joint itself usually retains a reasonable range of motion. Weakness in the rotator cuff muscles is often a more prominent feature.

How to Tell the Difference

This is where it gets a bit nuanced, because the two conditions share some common features. Night pain, difficulty reaching behind the back, and pain with overhead movement can all occur in both. But there are some key distinguishing features.

These distinctions help guide diagnosis, but the honest truth is that shoulder conditions can overlap. Rotator cuff tears, AC joint issues, and referred pain from the neck can all mimic these conditions, which is why getting assessed by an experienced physio early makes such a difference.

Our physiotherapy team at Physio Club assesses shoulder presentations every week. The most common thing we hear from people who have been managing shoulder pain on their own is that they were not sure what they were dealing with. That uncertainty ends with a good assessment.

Not sure what is going on with your shoulder? That is exactly what we are here for. Book in with our team at Sutherland or Engadine and we will give you a clear picture.

What Causes Shoulder Pain?

Shoulder pain is one of the most common musculoskeletal complaints we see, affecting up to 36 percent of the population at some point. Beyond frozen shoulder and bursitis, other common causes include:

• Rotator cuff tears: partial or full thickness tears of the rotator cuff tendons, often from overuse, age-related degeneration, or acute injury
• Rotator cuff tendinopathy: degeneration or irritation of the rotator cuff tendons without a full tear, very common in people who do repetitive overhead work or sport
• AC joint sprain or arthritis: pain at the top of the shoulder, often with a visible bump, common after falls or contact sport
• Referred pain from the neck: cervical spine problems can refer pain into the shoulder region and are surprisingly easy to confuse with primary shoulder conditions. Our head and neck physiotherapy page covers this in more detail.
• Shoulder instability: a feeling of the shoulder slipping or giving way, often following dislocation or in hypermobile individuals

One of the most important reasons to see a physio early is exactly this: the shoulder region has a lot going on, and the right diagnosis determines everything about the treatment approach.

Should I See a Physio for Shoulder Pain?

Yes, and the earlier the better.

One of the most common patterns we see in clinic is people who have been managing shoulder pain for three to six months with rest, heat packs, or generic stretches they found online. Often by the time they come in, the problem is more entrenched than it needed to be.

The Australian Physiotherapy Association recommends physiotherapy as first-line management for most shoulder conditions before considering imaging, injections, or surgery. That recommendation is backed by strong evidence.

Shoulder pain that is affecting your sleep, limiting your work, or not improving after a week or two of self-management is a good reason to get assessed. You do not need a referral to see a physio in Australia.

There are also some symptoms that should prompt you to seek care sooner rather than later:

• Significant trauma, such as a fall onto an outstretched arm or a direct blow to the shoulder
• Sudden loss of strength or inability to lift the arm
• Pain, tingling, or numbness that travels down the arm into the hand
• Shoulder pain accompanied by chest tightness or shortness of breath (seek emergency care immediately)

If you have neck pain or headaches alongside your shoulder symptoms, it is worth reading our blog on vertigo and dizziness as referred pain from the cervical spine can present in overlapping ways.

How Physiotherapy Helps Shoulder Pain

Physiotherapy for shoulder pain is not a one-size-fits-all approach. Treatment is built around your specific diagnosis, your lifestyle, and what you are trying to get back to.

At Physio Club, a shoulder assessment typically involves a detailed history, movement and strength testing, neurological screening where relevant, and a hands-on assessment of the joint and surrounding structures. From there we build a treatment plan specific to what we find.

Treatment for Frozen Shoulder

Frozen shoulder has a natural course, but that does not mean there is nothing to do. Physiotherapy can significantly reduce pain, preserve movement during the freezing stage, and accelerate recovery during the thawing stage.

Treatment typically includes:

• Education about the stages and realistic timeline, which reduces anxiety and helps people manage their expectations
• Exercise therapy to maintain and progressively recover range of motion throughout all stages
• Manual therapy for symptom relief and to support joint mobility
• Load management: understanding which activities to modify and which to continue

Research published in PMC confirms that physiotherapy combined with corticosteroid injection in the early painful stage can provide meaningful short-term relief, but that physiotherapy and exercise remain essential for restoring long-term function. The injection alone is not enough.

Treatment for Shoulder Bursitis

Bursitis generally responds well to physiotherapy, particularly when treatment addresses the underlying reason the bursa became irritated in the first place.

This typically means:

• Identifying and modifying the activities or loads that are aggravating the bursa
• Strengthening the rotator cuff and shoulder stabilisers to reduce impingement and offload the bursa
• Improving control of the shoulder blade and thoracic spine, which directly affects how well the shoulder joint moves
• Manual therapy and soft tissue techniques to reduce pain and restore movement
• A progressive return to full activity, including sport or overhead work

If your bursitis is related to sport or overhead loading, our sports physiotherapy team at Physio Club has specific experience managing these presentations and getting athletes back to full training safely.

What You Can Do While You Wait for Your Appointment

If you are in pain right now and waiting to get assessed, here are some things that tend to help:

• Keep moving gently. Complete rest and immobilisation is rarely the right answer for shoulder pain. Gentle movement within a pain-free range is generally better than stopping altogether.
• Modify, not stop. If a particular activity is aggravating your shoulder, try adjusting how you do it rather than stopping completely. Avoid the positions that provoke sharp pain.
• Sleeping position. Try sleeping on your back with a pillow supporting the affected arm, or on the unaffected side with a pillow between your arms to reduce shoulder strain.
• Short-term pain relief. Ice or heat can both help manage discomfort in the short term, depending on what feels better for you. Anti-inflammatories may also help if appropriate, but check with your doctor or pharmacist first.
• Avoid overhead aggravation. In the early stages, heavy lifting overhead or sustained positions that provoke pain are best avoided until you have been assessed.

Shoulder Pain Treatment in Engadine and Sutherland

We see a lot of shoulder presentations at Physio Club, and it is one of those areas where getting the diagnosis right early really pays off. The difference in recovery time between someone who comes in at four weeks versus someone who waits four months is significant.

Our team will assess your shoulder thoroughly, explain what is going on in plain language, and build a treatment plan that fits your life and your goals. Whether you are trying to get back to sport, sleep through the night, or just reach the top shelf without wincing, we want to help you get there.

We have two clinics in the Sutherland Shire:

• Physio Club Engadine: 53 Station Street, Engadine NSW 2233  |  (02) 9520 6067
• Physio Club Sutherland: 39 East Parade, Sutherland NSW 2232  |  (02) 8417 2978

Ready to get your shoulder sorted? Book online here, or reach out to our team at Physio Club Sutherland or Physio Club Engadine. If you have questions before booking, get in touch and we will point you in the right direction.

FAQs

How long does frozen shoulder last?

Frozen shoulder is a self-limiting condition, meaning it does resolve on its own over time. The total duration is typically one to three years across all three stages. However, physiotherapy during this time makes a significant difference to how much pain and restriction you experience while you wait for the thawing process to complete. Some people do not achieve full recovery without active treatment.

Can shoulder bursitis go away on its own?

Mild cases of bursitis can settle with rest and activity modification. However, if the underlying cause (usually rotator cuff weakness or a biomechanical issue with how the shoulder moves) is not addressed, symptoms are likely to return as soon as you resume the aggravating activity. Physiotherapy addresses the root cause, not just the symptoms.

Is it okay to exercise with frozen shoulder or bursitis?

In most cases, yes, with guidance. Appropriate exercise is actually a key part of treatment for both conditions. The type, intensity, and range of exercise matters enormously though. Aggressive stretching of a frozen shoulder in the freezing stage, for example, can worsen pain without improving outcomes. Your physio will prescribe exercises specific to your stage and presentation.

Can shoulder pain be related to neck pain?

Yes, absolutely. Referred pain from the cervical spine is one of the most commonly missed causes of shoulder symptoms. The nerves that supply the shoulder originate in the neck, and irritation or compression of those nerve roots can produce pain, tingling, and weakness that feels like it is coming from the shoulder. Our head and neck physiotherapy team assesses for this routinely as part of every shoulder examination.

Can I play sport with shoulder bursitis?

It depends on the severity and the sport. Low-impact activities may be fine to continue with modification. High overhead sports like swimming, tennis, or basketball are more likely to aggravate bursitis and may need to be temporarily reduced or modified. Our sports physiotherapy team can help you work out what to keep doing and what to dial back during your recovery.

What is the difference between shoulder bursitis and a rotator cuff tear?

Both conditions can cause shoulder pain and difficulty with overhead movement, but they are different injuries. Bursitis involves inflammation of the bursa sac. A rotator cuff tear involves damage to the actual tendon fibres. The two can coexist. Rotator cuff tears tend to produce more significant weakness and often come on after a specific incident, whereas bursitis is more commonly an overuse or gradual-onset condition. A clinical assessment, and sometimes an ultrasound, is the most reliable way to distinguish between them.

Is cortisone injection a good treatment for frozen shoulder or bursitis?

Cortisone injections can provide meaningful short-term pain relief, particularly in the freezing stage of frozen shoulder and in acute bursitis flare-ups. However, they should be used alongside physiotherapy, not instead of it. Evidence consistently shows that physiotherapy and exercise are essential for restoring long-term function. For bursitis in particular, repeated injections without addressing the underlying biomechanical cause tend to produce diminishing returns.

References and Further Reading

The following sources were referenced in this article.

• American Academy of Orthopaedic Surgeons (OrthoInfo): Frozen Shoulder
• Cleveland Clinic: Shoulder Bursitis
• PMC: Frozen Shoulder: Overview of Clinical Presentation and Review of Evidence Base for Management (2020)

Related reading from Physio Club:

• Can Sciatica Be Cured?
• What to Expect After Knee Replacement Surgery
• Vertigo and Dizziness: Causes, Symptoms and How Physiotherapy Can Help
• Best Stretches for Tight Hip Flexors
• Corked Muscle: What It Is, How to Grade It, and the Best Way to Treat It
• Physiotherapy at Physio Club
• Sports Physiotherapy at Physio Club

This article is intended as general information only and does not replace professional medical advice. If you are experiencing shoulder pain, please speak with a qualified physiotherapist or healthcare provider.

Tom Hol  |  Director at Physio Club  |  Meet the Physio Club team