| What We Treat
Polymyalgia Rheumatica
Sudden bilateral shoulder and hip girdle stiffness in someone over fifty is polymyalgia rheumatica until proven otherwise. It needs medical diagnosis, and it responds dramatically to treatment.
Overview
What It Is
Polymyalgia rheumatica is an inflammatory condition causing pain and marked stiffness in the shoulder and hip girdles. It almost never occurs under the age of fifty, comes on over days to weeks rather than gradually, and is characteristically symmetrical. The response to low-dose steroid is usually rapid and is part of how the diagnosis is confirmed.
Bilateral Girdle Stiffness
Both shoulders and both hips, coming on over days to weeks, with morning stiffness lasting well over forty-five minutes.
Symptoms
How It Tends to Feel
These are the features that point towards this diagnosis rather than another:
Bilateral Shoulder Stiffness
Both shoulders, not one. Difficulty washing hair or reaching overhead.
Hip Girdle Stiffness
Difficulty rising from a chair or getting out of the car.
Prolonged Morning Stiffness
Typically lasting more than forty-five minutes, often much longer.
Rapid Onset
Days to weeks. People often recall the week it started.
Systemic Symptoms
Fatigue, low mood, weight loss and occasionally low-grade fever.
Age Over Fifty
Effectively a requirement for the diagnosis.
Causes & Risk Factors
What Drives It
The usual contributors, in rough order of how often they turn out to matter:
Age
Incidence rises steeply after sixty-five. Rare below fifty.
Inflammatory Process
An inflammatory condition affecting the tissues around the joints rather than the joints themselves.
Association With Giant Cell Arteritis
A significant minority have or develop GCA, which is a medical emergency.
Genetic and Environmental Factors
More common in northern European populations, with seasonal clustering reported.
How We Can Help You
Treatment & Management
Treatment is built around what the assessment finds, but generally follows this shape:
When to Seek Help
Red Flags — Don’t Ignore These
Most presentations are straightforward. These features are the exceptions, and warrant prompt assessment:
⚠ Seek Medical Advice If You Notice
- New headache, scalp tenderness or jaw pain when chewing — these suggest giant cell arteritis and need same-day medical assessment
- Any visual disturbance or loss of vision — treat as an emergency
- Fever, night sweats or unexplained weight loss
- Symptoms that do not respond within a week of starting steroid
If any of these apply, contact your GP or seek urgent medical care rather than waiting for a physiotherapy appointment.
Common Questions
Frequently Asked Questions
Is this the same as fibromyalgia?
No. Polymyalgia rheumatica is inflammatory, has abnormal blood tests, affects the shoulder and hip girdles specifically, and responds rapidly to steroid. Fibromyalgia does none of those things.
Why do I need to see a doctor first?
Because the diagnosis rests on blood tests and the response to steroid, and because giant cell arteritis needs excluding. Physiotherapy supports treatment, it does not replace it.
Will physiotherapy help?
Yes, alongside medical treatment. Steroids cause muscle loss and bone thinning, and graded strength work addresses both.
Not Sure If This Is What You Have?
An assessment will tell you what is actually going on and what to do about it. I see everyone myself, and you will leave with a plan rather than a leaflet.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.