“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 often surprises 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 was already having 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 your quality of life. A study on AS found that shoulder pain rarely caused disability, but those 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 in the body. 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 the development of 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 in the shoulder, as well as a 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 usually one of the first symptoms of AS, but for some people, it’s the first sign that they have the condition.

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 your joints, including your shoulder. Others find that sitting for a long time can increase the risk of side effects like shoulder pain, so they aim to get up and walk around frequently if they have to sit a lot for their jobs.

If you have shoulder pain and AS, talk to 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, the 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 that may 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 a massage, make sure you see a licensed massage therapist or physiologist who knows about your AS diagnosis. A licensed provider will know how to perform an AS-adapted massage because they understand which movements are safe for people with AS. Specific exercises recommended by a specialist are very useful if done regularly. People with AS should exercise daily for their back pain and other joint involvements to maintain their mobility.

Medications

Your doctor will likely start your shoulder pain treatment plan by recommending over-the-counter pain relievers, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) naproxen (Aleve) and ibuprofen (Advil). These NSAIDs can help relieve shoulder pain and reduce inflammation and stiffness, particularly if it’s mild or only flares up at certain times of the day.

If NSAIDs aren’t strong enough to help with shoulder pain, your provider might prescribe corticosteroids. These steroids can be taken by mouth or given as injections into a muscle, a vein, or straight into the affected joint. 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 if other treatments haven’t helped.

Your rheumatologist will determine the right dose, how the medication is given, and how often you should take it. Corticosteroids work quickly, but using them for a long time can cause serious side effects.

Injections shouldn’t be given more than three times a year. Talk to your doctor about the specific treatment plan recommended by your rheumatologist. It’s important to be aware of potential side effects and to avoid using corticosteroids and NSAIDs together.

“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 might be a good idea, as it could help with your pain by treating the spondylitis itself. These could include biologics (drugs made from living cells), disease-modifying antirheumatic drugs (used for inflammation and joint pain), or other options. Your treatment will depend on how much pain relief you need, how often you have flare-ups, and your overall health. Talk to 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. By exercising, you can improve your range of motion, boost your flexibility, sleep better, maintain good posture, and reduce pain.

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

One study of people with AS found that participating in a yoga routine over two weeks led to better flexibility, reduced AS symptoms, and a reduced need for pain medication.

Physical Therapy

Some people with shoulder pain from AS have success by taking part in a physical therapy program. 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 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 limiting your quality of life. If you have a frozen shoulder, arthritis, or another shoulder condition that surgery can help, your doctor may recommend an operation based on your specific needs.

Deciding whether to have surgery for AS shoulder pain is a personal decision. Your rheumatologist can help you understand whether you might be a good candidate for surgery and can connect you with a surgeon who can answer questions about the procedure before you finalize your 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

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 98,000 members come together to ask questions, give advice, and share their stories with others who understand life with ankylosing spondylitis.

Have you experienced shoulder pain while living with AS? How did you manage it? Comment below, or start a conversation by posting on your Activities page.