A mainstay of those over 45 years old but extremely rare in those below that age. The emerging evidence suggest that there is 2 causes of this movement limiting and very painful complaint. The first and main reason is one of pain and severe muscle guarding although we still don’t know exactly why this happens. The second and seldom seen cause is down to a pathological change in the structure of the shoulder capsule, (or bag) that surrounds the main ball and socket joint in the shoulder, and causes it to become stiffer and severely restricts movement in a very different way than the first type. The two different types require very different treatments, the first and most common type is often treated solely through a specific rehabilitation programme but sometimes in addition to pain relief injections if there has been no significant progress in the first 4-6 weeks of the rehab only approach. The second type can only be decided after a failed period of rehabilitation and often requires referral to an Consultant Surgeon specialising in the Shoulder. Ultimately if you have a stiff and painful shoulder a assessment with a specialist LWF MSK Physiotherapy is your first port of call.