The painful stiff shoulder: what it is and what to do about it

The 'stiff shoulder' might be one of the easiest self-diagnosis to make, so easy that you don't even need to consult Dr Google and thereby avoid induced anxiety that arises from many catastrophic conditions you're presented with.

Conversations around stiff shoulders start like this...

'My shoulder is stiff'.

From such simplicity however stems the need for a deeper investigation to understand what's going on and what to do about it.

What is a stiff shoulder?

The term “stiff shoulder” refers to a group of conditions where the shoulder joint loses its normal range of motion, often accompanied by pain and difficulty with daily activities.

This can develop gradually or after an injury, surgery, or prolonged immobility. While “stiff shoulder” is not a specific diagnosis, it describes a symptom commonly seen in conditions like frozen shoulder (adhesive capsulitis), post-traumatic stiffness, arthritis-related shoulder stiffness or osteosarcoma.

There is some big stuff in there and as such our recommendation if you have a stiff shoulder where your passive and active range of motion is significantly less than expected, is to seek guidance from a medical professional i.e. your GP or physiotherapist.

You can take our free shoulder assessment here which will help you to better understand your shoulder problem and what your next best step so you can move to a better place.

What Causes a Stiff Shoulder?

The reasons you might experience a stiff shoulder can be various and multifaceted. In the section below we'll provide some of the headlines but it's important that you get support in developing the right treatment strategy for you based on an individual assessment.

Frozen Shoulder: This is a condition that typically involves shoulder pain, movement restriction and a detrimental impact on quality of life. Whilst there is a base of published research frozen shoulder is a complex condition which those of us in the rehabilitation world are still seeking to understand.

There are two main classifications:

• Primary – there is no identifiable reason for the onset or association with other health concerns.

• Secondary – there could be other underlying causes such as post shoulder surgery, calcific tendinopathy, or other health factors such as diabetes or thyroid disease.

Frozen shoulder appears to have a 'life cycle' and can be categorized into distinct phases.

Clinicans have proposed the condition has a 'freezing' phase which is in inflammatory in nature, then comes the 'frozen' phase followd by 'thawing.

Jeremy Lewis offered a two phase description where pain > stiffness moving to a stage where stiffness > pain.

Regardless of the clinical classification, the time frame over which or a frozen shoulder progresses can vary significantly as can the treatment strategy.

Injury or Surgery: Trauma or immobilisation following a fracture, dislocation, or surgery can cause stiffness as tissue heals. Stiffness can occur due to capsular or soft tissue adhesions, scarring, or muscle guarding.

Osteoarthritis: Joint inflammation or degenerative changes (e.g. osteoarthritis or rheumatoid arthritis) in the glenohumeral joint leading to pain, swelling and reduced range of movement. It can be common in older adults or secondary to inflammatory conditions.

Common Symptoms of a Stiff Shoulder

• Age can be a determining factor in cases of frozen shoulder with people around or over the age of 50 being at great risk

• Stiff shoulders are generally painful that can range from mild to severe, often worsening at night.

• Reduced range of motion, especially when reaching overhead, behind your back, or across your body.

• A feeling of tightness or resistance when moving the shoulder.

• Difficulty with everyday tasks, like dressing, reaching into cupboards, or sleeping comfortably.

What Can Be Done About It?

The good news is that most people with a stiff shoulder can see significant improvement with the right approach. Treatment focuses on reducing pain, restoring movement, and improving function. Early intervention can lead to faster recovery and better long-term outcomes.

What you should look for in a comprehensive rehabilitation plan

• Education: Be intentional about understanding your condition, prognosis, and the rationale for treatments.

• Active Rehabilitation: Movement and strengthening should be prioritized over passive modalities.

• Load Management: Proper progression is essential to avoid exacerbating symptoms or inducing further stiffness.

• Multidisciplinary Approach: Collaboration between physiotherapists, surgeons, reconditioning coaches and other healthcare providers ensures optimal outcomes.

Our recommendation with stiff shoulders is that you contact your GP or physiotherapist. These conditions can require an individualised medical approach and face-to-face assessment.

Additional considerations to keep in mind. If you have a stiff shoulder and you have diabetes and/or epilepsy or seizure activity, and/or your shoulder is stiff more than painful and the stiffness lasts longer than 30 minutes in the morning, follow the recommendation above and contact your GP or physiotherapist.

If you're unsure if you are struggling with a painful stiff shoulder, take our free shoulder assessment.

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