Night-time shoulder pain is a frustrating and surprisingly common problem. You can move your arm without much issue during the day, yet as soon as you try to settle into bed, the discomfort sets in. It can make falling asleep difficult, and even if you do drift off, the pain might wake you up in the middle of the night.
This pattern is often puzzling for people but there are very real reasons why it happens. Understanding them can be the first step towards getting relief and a better night’s rest.
Why the Pain Shows Up at Night
The way you use your shoulder during the day is different from what happens when you rest at night. Several factors can make symptoms worse in the evening or while sleeping:
1. Reduced movement
During the day, you are constantly moving, which increases blood flow and keeps the shoulder joint lubricated. At night, your shoulder is held in one position for hours. This can cause stiffness and make inflammation more noticeable.
2. Fluid and inflammation changes
When you lie down, fluid in the body redistributes. If there is irritation in the joint or surrounding tissues, the fluid can build up around the inflamed area, increasing pressure and pain.
3. Sleeping position
If you lie directly on your painful shoulder, you compress the tissues, which can aggravate soreness. Even sleeping on the opposite side can sometimes pull on the shoulder or cause it to drop forward into a strained position.
4. Less distraction
Pain can feel worse at night because you’re no longer distracted by daily activities. Without other sensory input, your brain can become more aware of discomfort signals from the shoulder.
Common Causes of Night-Time Shoulder Pain
While the exact cause should be confirmed by a physiotherapist or healthcare provider, several shoulder issues are well-known for causing night pain.
1. Rotator cuff tendinopathy or tear
The rotator cuff is a group of muscles and tendons that stabilise your shoulder. Overuse, age-related changes, or injury can cause irritation or partial tearing. Pain often appears when lying on the affected side or lifting your arm overhead.
2. Shoulder impingement
This happens when the tendons or bursa (fluid-filled sacs) in the shoulder get pinched during movement. It can cause aching at rest, especially at night.
3. Bursitis
Inflammation of the bursa can make the shoulder tender to touch and uncomfortable in certain positions, particularly when compressed during sleep.
4. Frozen shoulder (adhesive capsulitis)
This condition causes stiffness and pain that gradually worsens over time. Night pain is a hallmark symptom, often in the early stages.
5. Referred pain from the neck
Sometimes, shoulder pain is not coming from the shoulder itself but from nerve irritation in the neck. This can still cause discomfort when lying down.
6. Postural strain
Long hours at a desk, repetitive work, or gym training with poor form can cause muscular imbalances. This can leave the shoulder joint sitting slightly out of its optimal alignment, contributing to night discomfort.
What You Can Do for Relief
If you are dealing with night-time shoulder pain, there are practical steps you can take before it becomes a bigger problem.
1. Adjust your sleeping position
- If you sleep on your side, try lying on your non-painful shoulder with a pillow in front of you to support the affected arm.
- If you sleep on your back, place a small pillow under your upper arm to reduce tension.
2. Use gentle mobility exercises
Light movements during the day can prevent stiffness. Examples include shoulder circles, pendulum swings, and gentle stretches, but avoid pushing into pain.
3. Strengthen supporting muscles
Building shoulder and upper back strength can improve stability and reduce irritation. Your physiotherapist can guide you with specific rotator cuff and scapular exercises.
4. Avoid aggravating movements before bed
Heavy lifting, overhead work, or prolonged slouching late in the evening can flare up symptoms just before you sleep.
5. Manage inflammation if present
Applying ice for short periods in the evening may help reduce swelling. If recommended by your GP or physio, anti-inflammatory measures can be considered.
6. Check your desk and posture habits
Make sure your workstation supports good posture, with your shoulders relaxed and elbows at 90 degrees. This can help prevent unnecessary shoulder strain.
When to See a Physiotherapist
If your shoulder pain persists for more than two weeks, worsens over time, or starts to interfere with your daily activities, it’s a good idea to get it assessed. A physiotherapist can:
- Identify whether the problem is in the shoulder or referred from elsewhere
- Check for signs of rotator cuff injuries, impingement, or frozen shoulder
- Prescribe targeted exercises to restore mobility and strength
- Use manual therapy or taping to support recovery
- Advise on long-term prevention strategies
Early intervention often means faster recovery and less chance of the pain becoming chronic.
Final Thoughts
Shoulder pain that’s worse at night but manageable in the day is not unusual, but it’s a signal worth paying attention to. It can be linked to inflammation, posture, muscle imbalances, or specific shoulder conditions like rotator cuff injuries. By adjusting your sleeping position, maintaining gentle movement, and addressing the underlying cause, you can improve your comfort and protect your shoulder health.
If the pain doesn’t settle or starts affecting your day-to-day life, a physiotherapist can guide you back to pain-free sleep and help you keep it that way.
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📞 Call 01604 385343 (Northampton) or 01908 713973 (Milton Keynes) or Book Online today!
