If there is a common complaint from all the shoulder cases I’ve seen, it’s this: Why does my shoulder hurt at night?
Truth is, 24% of people around the world have experienced shoulder pain at some point in their life. (1) Unfortunately for some, it’s present at night when they are trying to relax and get some sleep. If left unchecked, night-time pain can result in sleep disturbance, anxiety, and depression. (2)
So what causes night-time shoulder pain? And what can you do to calm down your painful shoulder joint? Let’s find out.
5 causes why your shoulders ache at night
1. Delayed onset muscle soreness
Notice that familiar body ache you feel a few hours after a shoulder workout? That’s delayed onset muscle soreness (DOMS). It results from a strenuous or sudden increase in activities.
It happens because your muscles accumulate microscopic tears with physical activity. This is normal. But, after some time, these tears will have your muscles feeling sore.
2. Unstable shoulders
Different structures keep the shoulder joint stable and allow smooth movement. These include:
- Rotator cuff tendon
- Biceps tendon
- Shoulder bursa
- Shoulder capsule
With an unstable shoulder, these structures could hit or rub against your shoulder blade. This, in turn, leads to a vicious cycle of pain and inflammation whenever you use your arms.
If this goes on, it could lead to:
3. Sleeping position
Certain sleeping positions can cause shoulder pain at night. This is especially true if you favor sleeping on one shoulder for too long or with an outstretched arm.
In these positions, your own weight applies direct pressure on your shoulders, irritating your rotator cuff tendons and bursa. They could even impede blood flow. Ultimately, the result is shoulder pain at night.
4. Direct Trauma
Falling into or getting hit on your shoulder can cause injuries such as rotator cuff tears or shoulder bursitis. When these injuries happen during the day, it could take a while before you start to feel their effects on your body.
But, when swelling and inflammation have built up, those bumps and bruises become night shoulder pain.
5. Poor sleep schedule
To prepare you to sleep, your body’s hormone levels change. Two examples of these hormones include cortisol and melatonin.
Cortisol is our body’s version of an anti-inflammatory drug. Meanwhile, melatonin regulates our sleep-wake cycle.
Without a regular sleep schedule, your cortisol and melatonin go to abnormal levels. This can manifest in physical symptoms such as shoulder problems.
What to do about nighttime shoulder pain
Here are a few treatment options that can help deal with your condition:
Ice or warm compress
Both of these modalities are useful in the immediate relief of pain. (3) They’re easy to use, too. Just apply them directly on your affected shoulder for 15 minutes and you’re done.
But, when should you use each one?
As a general rule, if you have been experiencing shoulder pain within 3 days, then use an ice pack. If it’s more than that, use a hot pack.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most effective over-the-counter pain medication.
Common examples include Ibuprofen, Mefenamic acid, and Celecoxib.
Consult your doctor for proper dosage and how frequently you should take these meds.
Promote a proper sleeping position
If night pain ever happens again, you can try adding in more pillows. Here are some tips:
- Side sleepers: Sleep on the side opposite your injured shoulder and place the pillows between your arms and legs.
- Front and back-sleepers: Increase the height of your pillow so that your spine is in line. This reduces the stress on your neck and shoulders.
For further reading: The best ways to sleep with shoulder pain
Most of the causes of shoulder night pain come from either poor mechanics or acute injury. A trip to your physical therapist can help alleviate pain by proper assessment and treatment. They can also minimize future shoulder injuries.
When should I worry about shoulder pain?
Check with your doctor if:
- Your pain level is constant even with the various treatment above
- Your painful shoulder has cost you sleepless nights
- If it started to affect your daily life
Your doctor will do a full physical exam to see what is causing your shoulder to hurt that way.
From there, treatment options may vary. It can either be from using corticosteroid injections for instant pain relief to various surgical options.
Is it safe to take painkillers before I sleep?
Over-the-counter NSAIDs are safe and do not affect sleep quality as long as they’re taken in small amounts per day (1200mg). (4)
But, the same cannot be said with stronger doses and types of pain killers. It is still best to consult your doctor before trying out these drugs to avoid overdose and other complications.
How can I tell if I tore my rotator cuff?
There is a preceding event in rotator cuff tears. Either you fell directly on it or you lifted a very heavy object. You’ll immediately feel intense pain and weakness with each shoulder motion. Your shoulder pain may even be worse at night.
So if you ever experienced these symptoms, get them checked by your doctor. Surgery may be an option if non-surgical treatments have failed. (5)
After a long day of work, you deserve to have a night filled with quality time and relaxation. Once that familiar nighttime pain flares up again, you should now be well informed about what you can do and when to seek treatment.
- Bento, Thiago Paulo Frascareli et al. Prevalence and factors associated with shoulder pain in the general population: a cross-sectional study. Fisioterapia e Pesquisa [online]. 2019, v. 26, n. 4 [Accessed 30 October 2021], pp. 401-406. Available from: https://www.scielo.br/j/fp/a/LqHfbngt3FfBHbtsxLVBh3r/
- Cho, Chul-Hyun et al. “Is shoulder pain for three months or longer correlated with depression, anxiety, and sleep disturbance?.” Journal of shoulder and elbow surgery vol. 22,2 (2013): 222-8. DOI: 10.1016/j.jse.2012.04.001
- Dehghan, Morteza, and Farinaz Farahbod. “The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study.” Journal of clinical and diagnostic research: JCDR vol. 8,9 (2014): LC01-4. doi: 10.7860/JCDR/2014/7404.4818
- Gengo, Francis. “Effects of ibuprofen on sleep quality as measured using polysomnography and subjective measures in healthy adults.” Clinical therapeutics vol. 28,11 (2006): 1820-6. DOI: 10.1016/j.clinthera.2006.11.018
- Ramme, Austin J et al. “Surgical Versus Nonsurgical Management of Rotator Cuff Tears: A Matched-Pair Analysis.” The Journal of bone and joint surgery. American volume vol. 101,19 (2019): 1775-1782. DOI: 10.2106/JBJS.18.01473