Shoulder pain at night: causes, prevention, treatment, best exercises

Shoulder pain is a lot to, well, shoulder. It can take a big toll on your quality of life and daily routine. Shoulder pain doesn't just sideline you from your favorite strength class or tennis game. It can make seemingly simple daily activities such as brushing your hair or putting away groceries excruciating, if not impossible.

But shoulder pain at night is particularly challenging because it disrupts your sleep, creating a vicious cycle that can lead to even more pain, notes Heather Broach, PT, DPT, a physical therapist at Hinge Health.

Here, learn more about what causes shoulder pain at night, and how to prevent and treat it - especially with exercises from our Hinge Health physical therapists.

What is shoulder pain?

Your shoulder is made up of several joints that work closely with muscles and tendons (thick connective tissue that connects muscle to bone) to allow you to do everything from scratch your back to throw a perfect pitch. Your shoulder's versatility can also make it more susceptible to tendon inflammation, tears, instability, and arthritis. This can lead to pain - sometimes only when you move your shoulder, and sometimes all the time.

Shoulder pain itself is very common - it's estimated that up to a quarter of all people experience it over a month-long period. And unfortunately, shoulder pain often flares up at night. "Inflammation from the day settles in while your muscles are resting," explains Dr. Broach. Then consider that you may be twisting and turning at night - or even sleeping on a sore shoulder - and it's no wonder you wake up stiff and achy.

Causes of shoulder pain at night

Here are some of the most common reasons you may experience shoulder pain at night.

Your sleep position. You may wonder, "Can your shoulder hurt from sleeping on it?" Yes, it can. "We're often told that sleeping on our back is the best way to avoid back or neck pain, but it can worsen shoulder pain since it can strain your shoulder joint," explains Dr. Broach. If you sleep on your stomach or back with an arm above your head, that can make the pain even worse. Sleeping on your side can also put pressure on your shoulders and worsen discomfort. See below for tips on how to adjust your go-to sleep position to minimize shoulder pain.

Shoulder bursitis. This condition means you have inflammation of the bursa - thin, sac-like structures that cushion the joints in your shoulder. What does shoulder bursitis feel like? "My patients tell me it can feel like a hot knife cutting through their shoulder," says Dr. Broach. "It's a very relentless sharp pain that can be aggravated by your sleeping position, especially if you sleep on the affected side."

Rotator cuff tears. If you experience a painful shoulder at night that makes it hard to fall asleep or wakes you up, you may have a tear in one of your rotator cuff tendons (a group of muscles and tendons that helps you move your arms). You may also notice pain and weakness when you try to lift your arm overhead when you're awake.

Other conditions that can worsen pain from sleeping include shoulder impingement, swelling from a rotator cuff injury, a pinched nerve, arthritis of the shoulder, and frozen shoulder, where the connective tissue in your shoulder's ball and socket joint thickens and stiffens. All of these injuries can worsen at night, Dr. Broach notes, because the inflammation can get worse when the area is compressed as you lie down. "You're also in bed without as many distractions, so you're more aware of the pain," she adds.

When to see a doctor

Shoulder pain at night or first thing in the morning is not uncommon, so you don't necessarily need to race to the doctor if you wake up with a stiff, sore shoulder. But if your symptoms don't start to improve with ice, over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve), and some gentle stretching and strengthening exercises, then you should go to a doctor to get it checked out. See a doctor if you notice any of the following:

• Swelling

• Redness

• Tenderness and warmth around your shoulder joint

• Intense pain that prevents you from doing daily activities

• Trouble breathing or a sense of chest tightness or pain. These can actually be signs of a heart attack, which is a medical emergency.

Prevention tips

If you have shoulder pain at night, you'll want to know, "How do I stop my shoulder from hurting when I sleep?" There are many things you can do to manage and prevent shoulder pain that's affecting your sleep.

Tweak your sleeping posture.

• If you're a back sleeper, rather than sleep with your arm over your head, rest it on a folded blanket or low-lying pillow, so that your arm is by your side rather than overhead. This will take strain off your affected shoulder and help keep it in alignment with the rest of your body. 

• If you sleep on your side, lie on the side of your body without shoulder pain and use pillows to keep your bum shoulder and arm in a straight, more neutral position. "The top of your arm bone should be right next to your side, lying on your ribs," says Dr. Broach. 

• If you sleep on your stomach, "rest your face toward the side of your body that bothers you. This is less likely to cause shoulder pain," Dr. Broach says.

Work strategically. "I tell people that when they work at their desk, make sure their materials are as close to them as possible, to avoid times when their arms are extended out," explains Dr. Broach. This will help reduce risk of tendinitis, or even shoulder impingement, that can worsen nighttime shoulder pain.

Lean on it less. "Cranky shoulders don't like to be leaned on," says Dr. Broach. Don't use chairs with arm rests at work, so you're not tempted to lean while you scroll on your computer. Keep this in mind when you drive. "People tend to lean a lot on their affected shoulder when they drive, but you want to avoid it," stresses Dr. Broach. Keep both hands on either side of the steering wheel and try not to turn the wheel in a way that causes your arms to cross the midline of your body.

Be careful with physical activities. If you're prone to shoulder strain, you'll want to be more careful about lifting, overhead reaching, and reaching behind. 

• Lift lighter weights

• Keep weights close to your body and limit lifting to below shoulder level 

• Throw balls underhand or sidearm

• If you swim, do sidestroke or breaststroke 

• Limit pushing exercises such as pushups, bench presses, flies, and shoulder presses

• If you play tennis, don't serve overhand

Stretch out before bed. You may find that you go straight from hours of being hunched over your computer to collapsing into bed at the end of a long day. But just as this can cause sleep problems such as insomnia, it can affect your shoulders as well, says Dr. Broach. Try this simple shoulder stretch before bed: reach one arm across your body at chest height. Use your other hand to pull your arm closer to your body. Hold for thirty seconds, then switch sides. 

Treatment for nighttime shoulder pain 

The following tips from our Hinge Health physical therapists and medical doctors can provide relief for shoulder pain at night.

• Ice, ice, baby. Ice the area on and off for 15 minutes, three to four times a day, for two to three days.

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol), can be helpful for shoulder pain. It's important to make sure that you are safely able to take these medications, based on your medical history.

• Physical therapy. A therapist can teach you range-of-motion exercises, as well as stretching, strengthening, and stabilization exercises. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Steroid injections. If over-the-counter medication does not offer sufficient pain relief, your doctor may suggest cortisone steroid injections to help counter pain and inflammation.  

• Complementary treatments. Talk to your provider if you're interested in trying alternative treatments for shoulder pain relief, such as massage, acupuncture, or chiropractic care.

Exercise is really key when it comes to treating and preventing nighttime shoulder pain. "Strengthening the muscles that support your shoulder will help keep your shoulder joint stable, and stretching them will help restore range of motion and prevent future injury," explains Dr. Broach. 

Surgery for shoulder pain

In most cases, shoulder pain improves with time and conservative treatments like those above, however some conditions may benefit from surgery. Talk to your doctor about whether you're a good candidate for surgery. 

If your shoulder hurts when you wake up, exercise may be the last thing on your mind. But gentle stretches can help ease the pain and even help prevent shoulder pain at night. Here are a few gentle exercises from Hinge Health that are commonly used to prevent and treat shoulder pain.

Dr. Broach recommends that when you wake up, throw a heating pad onto your sore shoulder for 10 minutes while you sip your morning coffee, then do the given exercises.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT tip: Outsource your vacuuming

Hire someone to do it or make it a family member’s chore. “Vacuuming can really exacerbate shoulder pain because there’s a lot of twisting, bending, and lifting,” says Dr. Broach. “You’re also causing your hands to cross your body at the midline, which can strain the shoulders.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Athwal, G. S., & Widmer, B. (2018, March). Shoulder Pain and Common Shoulder Problems. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-pain-and-common-shoulder-problems/

2. Prestgaard, T. A. (June, 2021). Patient Education: Frozen Shoulder (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/frozen-shoulder-adhesive-capsulitis?search=Frozen%20Shoulder%20(Beyond%20the%20Basics)&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

3. Shoulder pain When to see a doctor. (n.d.). Mayo Clinic. Retrieved from https://www.mayoclinic.org/symptoms/shoulder-pain/basics/when-to-see-doctor/sym-20050696#:~:text=Make%20an%20appointment%20with%20your

4. Simon, S. M., & Roberts, M. (2021, April 15). Patient Education: Rotator Cuff Tendinitis and Tear (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/rotator-cuff-tendinitis-and-tear-beyond-the-basics?search=Rotator%20Cuff%20Tendinitis%20and%20Tear%20(Beyond%20the%20Basics)&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

5. van der Windt, D. A., Burke, D. L., Babatunde, O. et al. (2019). Predictors of the effects of treatment for shoulder pain: protocol of an individual participant data meta-analysis. Diagnostic and Prognostic Research, 3, 15. doi:10.1186/s41512-019-0061-x