Signs a Shih Tzu is in Pain

Overview

Sometimes it’s easy to tell when your Shih Tzu is hurt. Other times, it’s not so clear. Maybe your sweetie took a tumble, slipped, or had a little accident, but you’re unsure if they’re experiencing discomfort. So, how can you tell if your Shih Tzu is in pain?

This article walks you through the subtle, breed-specific clues that something might be wrong. You’ll learn how Shih Tzus often hide discomfort, why pain may show up differently in this breed, and what changes in behavior, posture, or mood are worth noticing.

Shih Tzu dog sitting next to sign that says Signs of Discomfort

Why Pain Can Be Hard to Spot in a Shih Tzu

When a Shih Tzu is hurting, the signs aren’t always clear. This breed tends to hide discomfort in subtle ways, and both their behavior and body structure play a role.

1) They mask weakness instinctively. Like all canines, Shih Tzus are wired to downplay pain. Even serious discomfort might go unnoticed if you're only looking for the obvious signs.

2) They’re naturally stoic. Many Shih Tzus won’t cry or yelp when something hurts. Instead, they may avoid stairs, hesitate before jumping, or walk more slowly. These quiet changes can get mistaken for age or mood.

3) Their reactions can seem backwards. While a Shih Tzu might act fussy over a nail trim or overly dramatic during a grooming session, true pain often quiets them. You may notice less movement, less playfulness, or more careful positioning.

4) Their bond with you can blur the picture. Because this breed is so people-focused, many Shih Tzus try to stay close and act fine even when something’s wrong. A tail wag or cuddle doesn’t always mean they feel okay.

5) Their anatomy hides some signs. Shih Tzus are brachycephalic, meaning their flat faces already make breathing harder. If they start panting or breathing rapidly from pain, it may be dismissed as typical for the breed. Their large eyes are prone to irritation, but extra blinking or squinting can look like sleepiness. Long floppy ears and thick facial hair can also hide signs of infection or strain.

What this means for you: If your Shih Tzu ever takes a tumble, slows down unexpectedly, or just seems off, you may not always be able to rely on obvious symptoms. It may be the quiet shifts that tell the real story.

Immediate Red Flags After a Fall or Injury

Before we cover the more subtle signs of discomfort, let’s go over what to look for right away. If your Shih Tzu recently fell, was stepped on, got jostled during play, landed awkwardly, etc., these are the most urgent signs to watch for. They can appear within seconds and often point to a serious issue that needs prompt veterinary care.

Watch for:

A sudden yelp followed by silence or freezing in place. This can mean a shock response or intense pain.
Limping or not bearing weight on one leg. Any inability to walk normally should be taken seriously and can be due to a torn ligament or even fractured bone.
Disorientation or head tilt. May indicate head trauma, inner ear injury, or neurological trouble.
Tense or swollen abdomen. A firm belly could point to internal bleeding or injury.
Shallow or rapid breathing. This may be due to pain, fear, or a chest injury.
Refusal to move, flinching when touched, or collapsed posture. These are strong signs your dog is trying to protect an injured area or is in too much pain to move.

Tip: Use clean, gentle hands to slowly run along your Shih Tzu’s legs, ribs, and belly. Feel for heat, swelling, or reactions like flinching or pulling away. This may help you locate a tender spot your dog is too stoic to show directly.

Physical Signs That a Shih Tzu Is in Pain

Not all pain shows up with a loud yelp or obvious injury. In many cases, the clues are physical, but subtle enough to miss if you’re not looking closely. A Shih Tzu that has an injury may move differently, hold their body in an unusual way, or suddenly avoid things they used to do with ease.

Here are some of the most common physical signs to watch for:

Limping, stiffness, or an uneven gait. This could point to a sore paw, joint discomfort, or even a spinal issue.
Reluctance to jump, climb stairs, or walk on slippery floors. Pain in the legs, hips, or back often shows up as hesitation rather than refusal.
Hunched back or lowered head. These protective postures can signal discomfort in the spine, neck, or abdomen.
Trembling or shaking (not related to cold or fear). Muscle trembling can be a stress response to internal pain.
Flinching or snapping when touched. A normally gentle Shih Tzu may suddenly react when a sore spot is handled.
Change in tail carriage. A tail that’s tucked, held unusually low, or not wagging can be a clear indicator that your sweetie isn’t feeling well.

These physical cues often appear before other symptoms, like distressed vocalization or refusing to walk, so they’re worth paying close attention to, especially if they’re new or unusual for your Shih Tzu.

Behavior Changes That Signal Discomfort

Sometimes, pain shows up not in how your Shih Tzu moves, but in how they act. If the physical signs aren’t obvious, shifts in behavior can offer the next set of clues. Because this breed is naturally affectionate and fairly routine-driven, even small changes in their mood, energy, or habits can be meaningful.

Watch for these behavior changes:

Sudden clinginess or, conversely, hiding in unusual places. Some Shih Tzus seek comfort when they’re not feeling well; others prefer to be left alone.
Withdrawal from family interaction. A dog who usually greets you at the door or follows you from room to room may start keeping their distance.
Decrease in playfulness or excitement. If toys and daily routines aren’t met with the usual spark, it could be because something hurts.
Whimpering, whining, or low growling. Especially when lying down, being touched, or shifting positions.
Excessive licking of one body part. Dogs often lick at the source of pain, even if there’s no visible wound.
Restlessness or inability to settle. Pacing, frequent position changes, or struggling to get comfortable may signal internal discomfort.
Increased sensitivity to noise or handling. If your dog flinches from touch or startles easily, they may be feeling vulnerable or overwhelmed by discomfort.
Vacant stares or zoning out. Pain can cause some Shih Tzus to mentally withdraw. If your normally alert dog seems unusually still or distant, this quiet behavior may be a coping response to discomfort.
Changes in sleeping position. Sleeping more stiffly, curled tightly, or only lying on one side can signal physical discomfort.

These kinds of changes are easy to overlook at first, especially if they happen gradually. But taken together, they can help you spot pain that your Shih Tzu might otherwise keep hidden.

The Hidden Clues in a Shih Tzu's Expression

Wondering if your dog’s face could tell you more? It turns out, it can. Subtle changes in a dog’s expression are becoming an important method in detecting discomfort.

In veterinary medicine, there’s a growing focus on “grimace scales”, which are tools used to detect pain by analyzing facial expressions. These scales are already well-developed for some animals, including cats, horses, and rabbits, and are widely used in both research and clinical care.

Each scale is species-specific, based on how that animal typically responds to pain. For example, the Feline Grimace Scale was published in 2019 and is now used in vet clinics to help detect pain in cats, who are famously stoic.

But here’s what’s surprising:

Dogs don’t yet have an official grimace scale. That’s not because they don’t show pain on their face. It’s because dogs are incredibly diverse in facial shape and expression. A Chihuahua’s face looks nothing like a Mastiff’s, and even within breeds, there’s variation. This has made it harder for researchers to create a one-size-fits-all tool. That said, pilot studies are underway, and vets are increasingly recognizing facial cues as part of pain assessments.

What to Watch For:

Every Shih Tzu is unique, so the main idea is noticing what looks different from their usual, relaxed expression. Here are some facial signs that may point to discomfort:

Eyes. Squinting, half-closed lids, or more frequent blinking can indicate pain that is not just in the eyes, but sometimes the jaw, neck, or head.
Brow. A furrowed or “worried” look may reflect facial tension or internal discomfort.
Ears. Held back or carried oddly. Even with floppy ears, you may notice subtle changes in position or stiffness.
Muzzle and jaw. A tight mouth, clenched jaw, or slightly open mouth can signal oral or facial pain.
Stillness. An unusually blank or emotionless expression may be a dog’s way of shutting down in response to discomfort.

Please note: Facial changes alone can’t confirm pain, but they’re valuable clues, especially when paired with shifts in behavior or posture. Some veterinary teams already include facial tension in post-surgical assessments.

When to Act and What Not to Do

Not every sign of pain means you need to rush to the vet, but some do. Others might seem less urgent but still call for a prompt check-in. Knowing when to act (and what not to do in the meantime) can make a big difference in helping your Shih Tzu feel better, faster.

Call your vet right away if:

Your Shih Tzu can’t stand, walk, or keeps collapsing.
There is bleeding from the mouth, nose, or rectum.
Breathing is labored or their gums appear pale or bluish.
They cry out sharply when touched.
Or if anything seems severe or alarming, even if it’s not on this list.

Trust your instincts. If something feels urgent or looks dramatically different from your dog’s normal behavior, it’s always better to call the vet than to wait.

Call within 24 hours if:

Limping, stiffness, or odd movement continues for more than a few hours.
They refuse food or water, or eat far less than usual.
They’re unusually quiet, withdrawn, or not acting like themselves.
You’ve noticed a combination of subtle changes that just don’t sit right with you.

Remember, you don’t need to wait for things to get worse to justify a call. Veterinarians would much rather check early than treat something that’s been brewing for too long.

Helpful tip:

If you're unsure how to describe what you’re seeing, take a short video. Whether it’s a limp, strange breathing, or a new posture, showing your vet directly can make assessment and treatment easier.

And here’s what not to do:

Don’t give human pain medications. Tylenol (acetaminophen), Advil (ibuprofen), and Aleve (naproxen) are toxic to dogs and can cause serious harm, even in small amounts.
Don’t assume your dog will “walk it off.” Shih Tzus are masters at pushing through mild pain, which can allow injuries or conditions to get worse.
Don’t delay for days if your dog still seems off. Waiting too long can make treatment harder or more expensive.
Don’t ignore your gut feeling. You know your Shih Tzu better than anyone. If something feels wrong, bring them for a checkup.

Final Thoughts

Pain in a Shih Tzu isn’t always loud or obvious. It can show up in small ways, such as how they move, behave, or respond to daily routines. By knowing what to look for and trusting what you observe, you can catch issues early and get your sweetie the care they need.

Even if you’re not completely sure, it’s always better to ask your vet than to wait and wonder. Your Shih Tzu counts on you to notice the quiet signs, and now, you’re better equipped to do exactly that.

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