Why Shoulders Get Stiff and Hurt with Age
As we get older, many people notice their shoulders become less flexible and more painful. Often, this pain is more related to stiffness and restricted movement than to rotator cuff tears or bursitis, even if these show up on imaging.
1. Soft Tissue Changes with Age
Muscle and Tendon Adaptation:
Rotator cuff tendons and surrounding muscles gradually lose elasticity and strength.
Tendons may become thicker and less flexible, limiting smooth shoulder movement.
These changes can make lifting, reaching, or rotating the arm more difficult and sometimes painful.
Joint Capsule Stiffening:
The capsule surrounding the shoulder joint can thicken and lose flexibility over time.
Stiffness in the capsule often contributes more to pain and restricted movement than minor rotator cuff tears or bursitis.
Reference: Hand GC, Athanasou NA, Matthews T, Carr AJ. Pathophysiology of frozen shoulder. J Bone Joint Surg Br. 2007;89-B:1157–1162. PubMed2. Bony Adaptations
Cartilage Wear and Osteoarthritis:
Gradual cartilage wear reduces smooth motion and can make certain movements feel stiff.
Bone Shape Changes:
Minor bone spurs or shape adaptations may develop over time, contributing to mechanical stiffness.
Reference: Riley G. Tendon pathology and adaptation. Best Pract Res Clin Rheumatol.2004;18(6):899–921. PubMed3. Why Pain is Often Not from Rotator Cuff Tears or Bursitis
Many older adults have rotator cuff tears or bursitis on imaging without symptoms.
In clinical experience, pain is frequently due to stiffness and restricted movement rather than structural tears.
Tight muscles, shortened tendons, and a stiff capsule create mechanical stress during movement, triggering discomfort.
Key Point: Imaging findings do not always correlate with symptoms—shoulder stiffness is often the primary driver of pain.
4. Risk Factors That Promote Stiffness
Prolonged inactivity: Avoiding movement after injury or during illness allows tissues to tighten.
Systemic conditions: Diabetes, thyroid disease, or metabolic issues increase stiffness risk.
Previous shoulder injuries: Old injuries or surgeries can create compensatory movement patterns that limit mobility.
Age-related tissue changes: Gradual loss of elasticity in tendons, muscles, and capsule tissue contributes to stiffness.
Reference: Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg. 2002;11(5):445–450. PubMed 5. How Soft Tissue Treatment and Heat HelpSoft Tissue Treatment (Massage, Myofascial Release):
Helps relax tight muscles and fascia surrounding the shoulder joint.
Reduces abnormal tension that contributes to stiffness and pain.
Improves blood flow, which can support tissue healing and mobility.
Heat Therapy:
Increases tissue elasticity, making stretching and mobilization more effective.
Reduces discomfort, allowing greater range of motion during exercise.
Can calm muscle spasms, improving overall comfort during daily activities.
Reference: Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. 4th Edition. 2017.6. How Physiotherapy Can Help
Stretching and mobilization: Restore flexibility in tendons and capsule.
Strengthening exercises: Support rotator cuff and scapular muscles, reducing stress on stiff tissues.
Functional training: Teach safe daily movements to maintain mobility.
Education: Understanding that pain often comes from stiffness—not just tears—reduces fear and improves adherence to exercises.
Outcome: Most older adults can restore comfortable range of motion, improve function, and reduce pain, even if imaging shows age-related changes.
Take-Home Message
Shoulder stiffness and restricted movement often cause more pain than minor rotator cuff tears or bursitis seen on scans.
Age-related changes in tendons, muscles, joint capsule, and bone are normal and common.
Soft tissue treatment and heat can reduce stiffness, improve comfort, and enhance mobility.
Physiotherapy is effective in restoring movement, strength, and function, helping maintain shoulder health.
