“Anyone else suffering from neck pain and shoulder pain?” one MySpondylitisTeam member asked. Another member responded, “I have severe shoulder pain.” Ankylosing spondylitis (AS) most commonly causes back pain, but it can also lead to discomfort in other areas, which may surprise some people with the condition.

Here’s a look at how common shoulder pain is among people with AS — also called radiographic axial spondyloarthritis (r-axSpA) — and what you can do about it.

How Is Ankylosing Spondylitis Linked to Shoulder Pain?

About 33 percent of people with AS have inflammation in the hips or shoulders. In fact, shoulder pain is often linked with AS-driven hip pain. The authors of one study even recommended that healthcare providers check the shoulders of anyone with AS who already had pain in their hips to determine whether discomfort was in both locations.

Your shoulder pain may be on both sides or could affect just one shoulder. Although shoulder pain in AS is usually described as mild, it can interfere with quality of life. A study on AS found that shoulder pain rarely caused disability, but participants with shoulder problems had more pain than those without shoulder symptoms.

AS usually starts with pain and stiffness in the spine or pelvic area, but it can also affect other joints. As the disease progresses, the pain can spread to the heels, hands, ribs, and shoulders. This pain can start months or even years after diagnosis, depending on how active the disease is.

Other Causes of Shoulder Pain

Another potential cause of shoulder pain could be adhesive capsulitis — also known as frozen shoulder. This condition is more common in people with AS than in the general population because AS causes ongoing inflammation in the shoulders. Adhesive capsulitis causes pain and reduced range of motion, which can strike quickly and get worse over several weeks or months.

In addition, you may experience shoulder pain due to enthesitis — inflammation of an area where tendons or ligaments directly attach to a bone. Shoulder pain isn’t typically among the first symptoms of AS, but for some people, it can be the earliest sign of the disease.

You may also have shoulder pain due to the way you hold your body to compensate for AS pain. Some people develop a hunched-over posture, which can strain the joints, including the shoulder. Others find that sitting for a long time can contribute to shoulder pain, so they aim to get up and walk around frequently if their job requires a lot of sitting.

If you have shoulder pain and AS, talk with your rheumatologist. They can help you pinpoint the root cause of your pain and find the most effective treatment.

How Do You Treat Ankylosing Spondylitis in the Shoulder?

Choosing the right method of ankylosing spondylitis pain management depends on what’s causing your pain, which medications you take, and your overall health. Your rheumatologist can help you choose the best treatment. Your treatment options might include medications, home remedies, or even a regular exercise plan to help ease your symptoms.

Home Remedies

If your shoulder pain isn’t severe, home remedies may help. MySpondylitisTeam members have shared some of their methods:

• “I have pain between my shoulder blades and neck — trying naproxen and a hot water bottle.”
• “I find heat and gentle stretches help.”
• “I was given a massage on my shoulder — it helped a bit.”
• “I swim four times a week and do self-care.”
• “Mindfulness training and deep breathing exercises really do help with pain relief.”
• “I had a hot stone massage and can’t recommend it enough. I’ve been pain-free in my neck, shoulders, and lower back.”

If you want to try massage, be sure to see a licensed massage therapist or physical therapist who knows about your AS diagnosis. A licensed provider will know how to safely perform an AS-adapted massage. Specialist-recommended exercises are most effective when practiced regularly. People with AS are encouraged to exercise daily to help manage back pain, support affected joints, and maintain mobility.

Medications

Your doctor will likely start your shoulder pain treatment plan by recommending over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs can help relieve shoulder pain and reduce inflammation and stiffness, especially when symptoms are mild or tend to flare at certain times of the day.

If NSAIDs aren’t enough to relieve shoulder pain, your provider may prescribe corticosteroids. Steroids can be taken by mouth or delivered as injections into a muscle, a vein, or the affected joint itself. An intra-articular shot, which targets a joint to reduce pain and inflammation, may be a good option if only one joint is affected or other treatments haven’t helped.

Your rheumatologist will determine the right dose, the method of delivery, and how often you should take the medication. Corticosteroids work fast, but using them for a long time can cause serious side effects.

Injections shouldn’t be given more than three times a year. Talk with your doctor about the specific treatment plan recommended by your rheumatologist. It’s important to understand the potential side effects and talk with your doctor before combining corticosteroids and NSAIDs.

“Had a shot in the shoulder, and I’m feeling pretty good for a change,” one MySpondylitisTeam member wrote. “My legs and feet are still in pain, but my shoulder feels good.”

Exploring different AS medications may help relieve pain by targeting the disease itself. Options may include biologics (made from living cells), disease-modifying antirheumatic drugs (DMARDs), or other treatments that reduce inflammation and joint pain. Your treatment will depend on how much pain relief you need, how often you have flare-ups, and your overall health. Talk with your healthcare provider to learn more about potential treatments.

Exercise

Although it may seem overwhelming to exercise when you’re already in pain, moving your body can help you manage your AS symptoms. Exercise can help:

• Improve range of motion
• Boost flexibility
• Promote better sleep
• Support good posture
• Reduce pain

Talk with your rheumatologist about which types of exercises might work best for you. They may suggest you start with stretching exercises or consider gentle movements like walking, swimming, yoga, or tai chi. The National Axial Spondyloarthritis Society offers online exercises designed for people with AS.

A 2021 study of people with AS found that participating in a two-week yoga routine improved flexibility, reduced symptoms, and lowered the need for pain medication.

Physical Therapy

Some people with shoulder pain from AS have success with physical therapy. By working with a physical therapist, you can perform targeted exercises and movements to build strength and increase flexibility in your shoulder joints.

“I finished physical therapy and feel pretty good,” one MySpondylitisTeam member reported. Another said, “I’m having trouble with shoulder mobility, and I’m doing as much physical therapy as possible.”

Surgery for Ankylosing Spondylitis

Although surgery is rare as a treatment for AS, it may be recommended if your shoulder pain is severe or lowers your quality of life. If you have frozen shoulder, arthritis, or another shoulder condition that may benefit from surgery, your doctor may recommend an operation based on your specific needs.

Deciding whether to have surgery for AS shoulder pain is a personal choice. Your rheumatologist can help you understand if you’re a good candidate and connect you with a surgeon who can answer questions before you make a decision.

“I had a shoulder joint replacement,” one MySpondylitisTeam member wrote. Another replied, “My surgery was over two years ago now — I’m definitely thankful that I had it!”

Talk to Your Doctor

Managing shoulder pain with AS can be challenging, but there are many ways to find relief. Medications, physical therapy, and simple home treatments can help ease pain and keep your shoulders moving. If your pain is getting in the way of daily life, talk to a doctor about what might work best for you. Finding the right treatment and moving as much as you’re able can make a big difference.

Find Your Team

On MySpondylitisTeam, people share their experiences with spondylitis, get advice, and find support from others who understand.

Have you experienced shoulder pain while living with AS? How did you manage it? Let others know in the comments below.