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What should I do if I wake up with shoulder pain?
Shoulder, Sleeping
Plantar Fasciitis Stretch

Causes of shoulder pain in the morning

Waking up with shoulder pain is a frustrating way to start the day, and understanding the potential causes is the first step towards finding relief.

If you wake up with shoulder pain and have no prior history of shoulder symptoms, it is most likely due to an inflammatory response caused by tissue irritation. Inflammation is the body’s natural response to any irritation or damage to any tissue, and waking up with discomfort indicates that you may have irritated some of the structures around your shoulder and neck due to the position you adopted while sleeping.

It’s important to remember that if you didn’t experience any pain before going to bed and woke up with pain, the structural damage to your shoulder is likely minimal. Your shoulders are subjected to more load when you are up and about, reaching for things, carrying, and lifting. Although you may still experience symptoms, they may be temporary and can be easily managed with proper rest and self-care.

At times, shoulder pain may not solely be caused by your sleeping position. Other underlying factors could also contribute to your discomfort, like osteoarthritis, frozen shoulder, rotator cuff involvement, or neck pathology.

How sleeping positions affect shoulder pain

As humans, we tend to develop certain habits that we stick to, including our sleeping patterns. However, following the same sleeping routine and maintaining the same position every night can lead to shoulder pain. In this context, we will go through the three primary sleeping positions and their potential impact.

Side sleeping – Sleeping in the same position on one side repeatedly can result in continuous pressure between the upper arm bone (humerus) and the “cup” of your shoulder (glenoid). This pressure is applied to the subacromial space, which contains the tendons of the rotator cuff and bursa. This area is prone to irritation from prolonged compression.

Arm above the head – Lying down with your arm positioned above your head can strain the shoulder joint by stretching and/or compressing the tissues within it. This position can lead to inflammation or worsen existing shoulder conditions. Furthermore, it can irritate peripheral nerves, which can result in discomfort, pain, or altered sensation that may extend from the shoulder down to the arm and hand.

Stomach sleeping – When you sleep on your stomach, your head is forced to turn to one side, compressing the spinal joints between the vertebrae. This also puts more pressure on the shoulder opposite the direction in which your head is turned. During sleep, your muscles fully relax, leading to sustained pressure on these neck joints and shoulders. This unnatural alignment can worsen any existing discomfort and potentially cause new pain in your neck and back.

How to avoid shoulder pain in the morning

It’s important to know that for the majority of people, symptoms will improve within the first 48 hours. However, some individuals may continue to experience persistent shoulder pain. If you happen to be one of those unlucky individuals, it’s recommended to book a consultation with an experienced physiotherapist. In the meantime, here are some simple tips that can help you sleep more comfortably:

Switch your position: If you consistently wake up with shoulder pain, consider switching your position. Try sleeping on your back or the other side. Sleeping on your stomach usually means your shoulders are positioned above your head, which can cause stress on your rotator cuff and the tissues in the subacromial space, so avoid this where possible.

Quarter turn: Individuals may experience pain if they sleep on their side with their upper arm directly underneath them. This position causes continuous pressure on the tendons and bursa located in the subacromial space. By slightly turning onto your front or back, the compression is alleviated, and the likelihood of waking up with discomfort is reduced.

Elbow below the shoulder: If you sleep with your arm raised and your elbow closer to the headboard than your shoulder, it can compress and irritate the structures in the subacromial region. If this is your typical sleeping position, you could try wearing a nightshirt and keeping the irritated arm inside the shirt instead of out of the armhole to avoid raising it above your head.

Try a different mattress: When it comes to selecting a mattress, it’s crucial to ensure that it’s neither too firm nor too soft. If it’s too firm or too soft, it won’t offer sufficient support to maintain proper spinal alignment, which can lead to shoulder stress, especially for side sleepers. Therefore, it’s essential to choose a mattress that supports the spine’s natural curve while also cushioning the shoulders to prevent pressure points.

Pillow support: Having the right pillow is important for a good night’s sleep. Depending on your usual sleeping position, different types of pillows can help you avoid shoulder pain.

  • If you sleep on your back, you should choose a thicker pillow for support at the bottom and to cradle your neck.
  • If you sleep on your stomach, you should choose a very thin pillow or no pillow at all.
  • If you’re a side sleeper, you should choose a firm, thick pillow that keeps your head level with your shoulders.

Keep in mind that pillows should be replaced every 18 months or so, once they lose their shape and no longer provide proper support to your head and body.

Symptoms of shoulder pain in the morning

If you wake up with shoulder pain, it’s a good idea to note the specific sensations you feel and where they are located. This information could be useful when you describe your symptoms to a physiotherapist. Different symptoms can indicate different structures in the shoulder that might be involved. Some of these symptoms are listed below.

Upper arm – Pain in the upper arm often indicates irritation or inflammation of the tissues in the subacromial space of the shoulder where the rotator cuff tendons and the subacromial bursa lie.

Neck – Pain and symptoms that radiate into the neck may indicate irritation of the joints between the vertebrae, leading to stiffness and discomfort when turning the head.

Top of the shoulder – symptoms specific to the small bony prominence on the top of the shoulder (acromioclavicular joint) occur with side-lying sleeping. Try to avoid sleeping on the painful side and repetitive movements of the arm above shoulder height.

Headaches – Shoulder pain accompanied by headaches may be due to cervical spine issues, tight neck muscles, or referred pain from shared nerve pathways. Inflammatory conditions such as arthritis in the neck or shoulder can also cause headaches.

Altered sensation in the arm – Sensations such as pins and needles or numbness, along with shoulder pain, often indicate nerve compression or irritation. These symptoms can be caused by conditions such as cervical radiculopathy, thoracic outlet syndrome, or rotator cuff injuries affecting nerves.

Weakness of the arm or hand – can occur due to irritation and inhibition of the muscles around the shoulder or the nerves that exit around the neck and shoulder.

If you suffer from any of the symptoms listed above, it is best to visit a physiotherapist. They can diagnose the problem and educate you on the best possible pathway for full recovery.

How to reduce shoulder pain

If you are experiencing shoulder pain, here are some adjustments that can help alleviate it:

  • Try sleeping on your back or the unaffected side to reduce pressure.
  • Avoid sleeping with your arm under your pillow or your elbow above shoulder level, as this can increase compression.
  • Choose a mattress that supports the natural curves of your spine and minimizes pressure points.
  • Opt for a pillow that aligns your head with your shoulders, and remember to replace it every 18 months to maintain proper support.

If the pain persists, it is recommended to consult a physiotherapist.

Other possible causes of shoulder pain

Sometimes, it’s not just the sleeping position that causes the pain. Other factors may be taking place, including:

Frozen shoulder

Frozen shoulder, also known as adhesive capsulitis, is a painful condition that causes inflammation and irritation in the shoulder joint, leading to stiffness and difficulty in moving the affected joint. People with this condition may experience sleep disturbance, especially when lying on the painful side. To alleviate discomfort, it is recommended to support the upper and lower arm with a pillow when lying on your back. If lying on your side, the painful shoulder should be uppermost, and you can either hug a pillow or rest the arm on the side of your trunk and hand on your hip. It’s important to note that this condition develops over time, but pain and stiffness may occur suddenly as well.

Rotator Cuff Injury

The rotator cuff is composed of four muscles that originate from the shoulder blade and extend into the shoulder joint. These muscles provide stability to the arm. Rotator cuff injuries can range from inflammation of the tendons surrounding the area to partial or complete tearing of the muscles. If you have a rotator cuff injury, the best sleeping position to minimize pain and promote healing is lying on your back with a pillow placed under the affected arm. This position helps relieve pressure on the rotator cuff tendons and muscles. It is recommended to avoid sleeping on the injured side, as it can increase the pain and worsen the injury. If lying on your back is uncomfortable, you can lie on the uninjured side with a pillow placed between your arms to support the injured shoulder.

OA

Signs of osteoarthritis (OA) in the shoulder include stiffness, reduced mobility, and persistent pain. These symptoms can disrupt sleep by making it difficult to find a comfortable position and exacerbating pain when lying on the affected side. When experiencing neck symptoms, the best position is lying on your back with proper pillow support to maintain neutral spine alignment. Neck and shoulder pain are often related, indicating mutual involvement. Using supportive pillows and avoiding stomach sleeping can alleviate strain and promote better sleep quality, potentially easing discomfort in both areas..

Neck involvement

Neck and shoulder pain often occur together. If you experience shoulder pain, it’s likely that your neck is also affected, and vice versa. If you have pre-existing neck problems, sleeping in an uncomfortable position can worsen them and cause shoulder discomfort. It’s important to adequately support your neck with pillows that vary depending on the sleeping position you prefer.

FAQs

Does shoulder pain from sleeping go away?

Shoulder pain from sleeping often resolves within the first 48 hours with proper rest, ergonomic improvements to your pillow or mattress and adjustments to sleeping positions. However, if pain persists, it may indicate an underlying issue that could require professional assessment and treatment.

Where do you put your arms when sleeping on your side?

When sleeping on your side, keeping your arms in a neutral position, parallel to your body, to avoid strain on the shoulders and neck is best. You can also place a pillow between your arms to help maintain proper alignment and reduce joint pressure. Avoid placing your arm under your head or pillow, as this can cause compression and discomfort in the shoulder and neck area over time.

How do you get rid of shoulder pain after waking up?

To alleviate shoulder pain after waking up, it is best to slowly move your arms and shoulders, apply a warm compress to relax muscles, and consider adjusting your sleeping position. Avoid repetitive lifting of the arms or reaching behind, and restrict movements that increase your symptoms.

What is the best position to sleep in with shoulder pain?

The best position for sleeping with shoulder pain is on your back, as it evenly distributes weight and reduces pressure on the shoulders. If you must sleep on your side, avoid lying on the painful shoulder and hug a supportive pillow to support the upper arm.

Can a bad pillow cause shoulder pain?

A bad pillow can cause shoulder pain by not providing adequate support. Improper pillow support can lead to neck and shoulder misalignment, increasing strain on muscles and joints. This misalignment can exacerbate existing shoulder issues or even cause new pain. It’s important to choose a pillow that maintains the spine’s natural curve and cushions the shoulders effectively to prevent such discomfort.

Further reading

Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260856/

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