Frozen Shoulder

Knowing how to treat a frozen shoulder first depends on making the correct diagnosis. The familiarity of the term can often lead to over diagnosis. Frozen shoulder is not treated the same as other types of shoulder pain by a physiotherapist, so what sets it apart?

Shoulder Pain
A possible park runner on Crosby Beach – Other beaches and park runs are available (but are not as good).

The Pain

The nature of frozen shoulder pain is different for every patient. It’s commonly a developing pain (sometimes described as gnawing or aching), which is always there and worsens with reaching or stretching movements – such as putting on a coat. The pain is often described as much worse at night with some relief using anti-inflammatory medication. This is due to the inflammatory nature of the condition.

Shoulder Stiffness

This is where frozen shoulder takes it’s name and it’s possibly the most important feature of the frozen shoulder when making the diagnosis. If the shoulder is progressively becoming more limited in its range of motion it could well be a frozen shoulder. The role of the physiotherapist is to interpret the type of movement restriction to see if this is consistent with the pattern of frozen shoulder. But essentially, you will notice a loss of elevation, external rotation (taking the hand out to the side while keeping your elbow against your side) and the ability to reach your hand behind your back – reaching for your bra strap for example.

The Person

There are a number of factors which make the diagnosis more or less likely; age, gender, medical history and general fitness all have a role to play in building up the picture. For example women are more commonly affected, as are those with a history of diabetes. There are a lot of features related to the condition that are still under investigation by researchers, but physiotherapists are trained to recognise clusters of features which can help to make the diagnosis.


The first line of treatment for a frozen shoulder is appropriate pain relief via the GP or pharmacist. This is a very painful condition and having enough pain relief to allow you to sleep and start exercising early can be crucial to a better long term outcome. The next stage is physiotherapy. Physio is dependent upon the level of pain control. I often say to patients you can’t bully a frozen shoulder better with hard stretching in the early stages. The skill is to find the movements you can manage and gradually increase them with physio exercises. Sometimes hands on techniques to give relief from the associated muscle aches and pains can be useful. For example, it’s common to get associated neck pain which may respond to hands on treatment. But the core evidence based treatment is graded and proportionate physio exercises and this shouldn’t be distracted from.

Failure to get the shoulder moving may result in more limited function and stiffness in the later stages when pain has died down.


Your physiotherapist can give you advice about the need for a steroid injection. There is very good evidence that these can be effective especially in the early phases of the condition. They are less effective at later stages but this must be considered on an individual basis. There is also a injection procedure know as hydrodilatation which involves pressure and steroid under imaging guidance. Not everyone can be treated with steroids so other pain relief options can be considered through discussion with your physio or doctor.


Thankfully few cases of frozen shoulder get to this stage if managed well in the early phases. However there are options such a the capsular release procedure that help to get a frozen shoulder moving again and restore function. This is usually a last resort when intensive physiotherapy and strengthening have failed to return a functional range of motion.

I hope you have found this article useful. Please remember that this is not a substitute for a proper medical assessment and individual care advice. If you suspect you have a frozen shoulder please report to your GP or you can book in for a physiotherapy assessment here at our clinic in Crosby Leisure Centre.

Ben Watkins BSc Hons MCSP HCPC

Chartered Physiotherapist – Blundellsands and Crosby Physio

Ben worked as an NHS clinical specialist in shoulders in Yeovil District General Hospital before moving into private practice. He also has a special interest in treating;

  • Rotator Cuff Tears
  • Shoulder Tendinopathy/Tendonitis
  • Shoulder Instability (Dislocations)
  • Shoulder Arthritis and Joint Problems
  • Nerve Injury
  • Chronic Shoulder Pain
  • Sporting Shoulder Complaints

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Physio for Climbers

Climbers are a unique bunch. Throwing themselves at indoor walls, cliffs and boulders to get their weekly fix. Even getting to the best locations can be injurious, clambering over rough terrain and hiking for hours in inhospitable weather. The climbers body needs to be flexible, versatile and above all robust! Suffice to say as physios we love the challenge climbing injuries present.

Climbing injuries

Climbing injuries often do not fit neatly into the textbook, they can be a combination of injury from a sudden trauma or repeated loading injuries which build up gradually over time. Hand and shoulder injuries are common due to the obvious demands of the activity, but injury to the knee, hip or ankle can be equally problematic.

Getting the correct physiotherapy advice early can prove invaluable, while a failure to fully appreciate the injury can compound problems making things harder to resolve further down the line. Unsurprisingly prevention is 100% better than cure, so prehab and specific conditioning can pay dividends. Knowing what to do is the tricky part.

Blundellsands and Crosby Physio

Here at the clinic we have experience working with the military population and all the adventure training and climbing injuries that go with it. We understand the need for robustness and the demands of climbing on the body. We also know how important it is to box clever when the problems begin to arise. What we mean by that is getting fast expert opinion and guidance. A lot of places may claim expertise in certain sports but we know when to go to the next level. That’s why we work with Sam Corbett, a leading specialist in climbing injuries, physiotherapist and mountaineer from Adventure Fitness Consultants.

Sam conducts online video consultations and climbing specific screening programs for our patients. He works closely with climbing specific strength coaches and even takes his patients out on expeditions to complete their rehabilitation. Suffice to say we think he’s a true expert in this area and that’s why we work with him when patients need next level support.

We work together

Thankfully many of the usual climbing injuries and conditions can be treated face to face in the clinic. But if we have something that needs more climbing specific knowledge, we call in Sam and you get the best expert screening assessment and advice in the field of UK climbing rehab, combined with localised face to face clinic treatment delivered by an experienced chartered physio. The result being; saved time, money and getting you back out there faster.

Tele medicine working at its absolute best!

So to start your rehab journey today book an appointment or call us.

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A handy way to use ice

The use of ice is something that I’m often asked about in the clinic. While there is controversy around what ice actually does to the bodies inflammatory process, it is clear to me that its use for temporary pain relief is safe and effective for a great many people. I think one of its most useful side effects can be to help reduce the use of pain killers.

There are a great many ways to apply ice to any injury, from the bag of frozen peas to very expensive cryotherapy machines. I wanted to use this quick post to share a product that I think is excellent for it simplicity and ease of application.

The Ice-it-Away!

Ice it Away

The ICE-it-away was developed by Claire Robertson who is a physio specialists in the treatment of knee pain. You can purchase an ICE-it-away directly from her website for £19.99 via the button below.

Please note that this is not something I sell here at the clinic or have any investments in. I own one for my own personal use and I am confident to recommend it to my patients, often getting great feedback when I do.

Please note this blog does not constitute medical advice on how and when to use ice safely. For more information please read product instructions in full or to discuss your own case please book in for a consultation.

Thanks for reading!

Learning Disability Physio

Exercise For All

Did you know that men and women with a learning disability in the UK live on average 14 and 18 years less than those without a learning disability. That’s a shocking statistic. A person with a learning disability is also more likely to suffer with physical or mental health problems. Often barriers to healthcare services contribute to this but its not the only problem. Poor service design in areas such as transport, education and skills training all contribute to this health inequality.

A lack of access and inclusion when it comes to exercise and physical activity is also a problem. It’s for this reason that one of the key objectives that Blundellsands and Crosby Physio has set itself is to make services as accessible for people with a learning difficulty as possible. We truly believe that a healthy lifestyle with exercise and physical activity at its core is vital for everyone. Having ready access to physiotherapy treatment and advice when injured or in pain is just one small part of that.

Playing Our Part

So what can a physiotherapy practice do? Well, we want to start by getting the basics right. For example taking extra time to facilitate communication for treatment and care in the clinic, making sure support workers and carer’s feel welcome at appointments and taking onboard the feedback to help us build care around additional needs. We can offer physio supported exercise programs in the gym in Crosby Leisure Centre, helping to build confidence and independence when exercising in that space. It’s a work in progress and we want to learn and progress in this specialist area of care.

Learning Disability Education for Therapists

The first step on this road is therapist education. Clinic Physio Ben Watkins has arranged for a Learning Disability Specialist Physiotherapist Alistair Beverley @theLDphysio to teach a course in Liverpool on the 12th Feb 2022 via physiotherapy course provider My Therapy Network. This will be open for physios and other health care providers working in clinics who want to improve their care for those with a learning disability. The course will teach communication skills, legal responsibilities, clinical skills in Learning Disability Physio and discuss case studies for improving practice and clinic set up.

Interview with Learning Disability Specialist Physio

In preparation for the course Ben spoke with Alistair to find out more about his work and experiences. You can watch this video below via YouTube. If you are a member of the local community living with a learning disability please get in touch. We would love to speak with you about how we can improve our service at the clinic going forward and ensure exercise & physio is truly for ALL!

How to Treat Back Pain

Back pain is the most common problem we treat at Blundellsands and Crosby Physio. It’s a common, painful and frustrating problem and at some point we will all experience it.

Physio Assessment

The first thing that needs to be done is a careful assessment. The vast majority of back pain is not dangerous, but there are signs and symptoms that might mean your particular pain episode requires further investigation. Poor management and confusing explanations can lead to a lot of extra stress.

Assessment is important for every case but there are also special considerations for pregnancy related back pain, back pain in old age, chronic lower back pain, back pain with sciatica and for children with back pain. Essentially you shouldn’t begin a course of treatment until you have given a detailed history to your physio and been fully assessed. For this reason we insist on 45mins for new assessments at our clinic. It allows us to assess fully and begin treatment on day one. In some complex cases we may recommend 60 minutes. Please email us to discuss this in advance.

Scans for Lower Back Pain

“My pain is terrible, do you think I need a scan?”

Scans are good at doing two things when back pain is present. 1) Identifying specific or serious diagnosis, such as a fracture or cancer of the spine, and 2) helping to confirm a target for a surgical intervention. If either of these two scenarios are warranted following detailed assessment we can write a supporting letter to the GP.

We do not request scans directly from this private practice, however if you bring reports to an appointment we can help to explain the confusing medical terms often used. Scans are not good for the vast majority of back pain as pain does not show up on a scan. A scan can even be harmful as we often have normal variations and changes in our spine as we age unrelated to pain. However once you have been told they can lead to anxiety and fear of movement impacting some patients for years to come.

Treatment for back pain

“What are the best treatments for my back pain?”

The best treatment is actually the reassurance that comes from good assessment. Once things have been explained the fear factor can pass. This in turn leads to a more relaxed and positive outlook which can ease pain further. Returning to normal movements as soon as possible is a priority. Good physio is about finding the right prescription of exercise taking into consideration your ability and pain levels to help you get moving again. It can often be as simple as getting you to start walking again or performing a simple movement exercise for the spine.

Hands On Treatment

“Will you treat me hands on?”

Some people will want a hands on approach from their physio. A common phrase we hear is; “The last person didn’t even touch my back”. Well the truth is for the vast majority of back pain hands on treatment isn’t required to make a full recovery. Your previous therapist was most likely trying to help you self manage and avoid becoming dependent on them. It’s an approach we fully respect. However in a private physiotherapy clinic we believe that patients should be able to request hands on treatment for the relief of symptoms such as muscle tension and spasms if they wish.

As well as soft tissue massage for pain relief we offer a form of manual therapy know as the Mulligan Concept. This is a form of therapist directed joint mobilization combined with active patient movements. These techniques can allow a patient with a painful movement to move without pain often instantly. It does not put joints “back in” or “realign” a person. These are inaccurate descriptions of what manual therapy can actually do. We use manual therapy to ease pain and muscle tension and build your confidence by showing you that a painful movement can quickly become eased. These techniques are part of a package of care that we offer with exercise rehabilitation and advice at its core.

Session frequency

“How many sessions will I need?”

This is very much dictated by you the patient. Many will only need to be seen once if they feel they have the information and reassurance to self manage. That’s great, job done. Some people want to be seen a couple of times a week for some hands on symptom relief or to check in and keep their exercises on track. We can support that approach if needed. We don’t use aggressive marketing strategies or follow up targets, its all about getting good outcomes and passing the friends and family recommendation test.

Exercise for Lower Back Pain

Will I get exercises?

Exercise is the main expertise of physiotherapists. Here at Blundellsands and Crosby Physio we use an exercise prescription application called Rehab My Patient and email you exercises with videos. Usually a maximum of 3 exercises is optimal for a pain problem. This will always be discussed and agreed with busy lives taken into account.

For more information before booking an appointment, please feel free to enquire by email via