Best Sleeping Position for Shoulder Pain

Shoulder pain can be caused by many different reasons – and it can affect how we function during the day, how we move around, our ability to drive, sit at a desk, carry bags/shopping/kids, cook, and of course sleep at night.

The most common causes of shoulder pain can include:

• Shoulder impingement
• Shoulder Bursitis
• Tendonitis in the shoulder muscles (Rotator Cuff Muscles)
• Rotator cuff muscle tears
• Frozen shoulder (Adhesive Capsulitis)
• Arthritis in the shoulder
• Referred pain from the neck to the shoulder

Some of these shoulder conditions can cause increased pain at night, especially when you are lying down which makes it hard to get a good nights sleep…

It can be hard to get comfortable to be able get to sleep, or the pain can wake you during the night too.

The night pain in the shoulder can be due to several reasons that may include:

• Fatigue and strain of the muscles and joints from use of the shoulder during the day in “normal” daily activities,
• Irritation and inflammation of the bursa and tendons from “normal” shoulder use during the day,
• Direct pressure of the mattress on the shoulder when lying on your symptomatic/problem side, especially when you have been asleep and not moving for an extended amount of time compressing the structures of the shoulder,
• Sleeping on the non affected shoulder causes the affected/painful shoulder to be unstable and unsupported, as the ball of the shoulder doesn’t sit properly in the socket – hence can cause further impingement, muscle spasm and pain,
• Sleeping with your arm above your head, across your body or in an altered unstable position can also cause pain and instability

So if your shoulder hurts, what is the best way to sleep??

Before you go to bed…

Well, there are several measures that you can take to help support your shoulder and the surrounding structures before you even get to bed!

These include:

• Resting your shoulder as much as possible and avoid aggravating movements such as reaching across your body, over your head, or carrying too much shopping during the day, to avoid it being overly inflamed at night time,
• Using a cold pack on the shoulder on and off during the day and before you go to bed to decrease local inflammation,
• Taking anti-inflammatory medication – as prescribed by your doctor, pharmacist or health professional,
• Taking natural supplements such as magnesium for muscle spasm/cramping and tumeric for inflammation,
• Having the shoulder taped/strapped which helps stabilize the ball in the socket,
• Doing some gentle stretches and movements before you get into bed to help mobilize the shoulder a bit before it doesn’t move for an extended period of time while you are asleep.

When you are in bed… – use props to help support your shoulder, head and neck –

• If you sleep on your non-painful side, hug a pillow in front of you. This will help prevent the affected shoulder slumping forwards too much and compressing the structures in the shoulder. It also helps stabilize the shoulder joint as well.
• Place a pillow or rolled towel behind you to help prevent you from rolling to a position which may be a lot more uncomfortable for your shoulder while you are in a deep sleep and may not feel it immediately,
• If you sleep on your back, then place a pillow or towel under your elbow on the affected side to help lift the elbow which then places the ball and socket joint of the shoulder in a much more supported anatomical position and helps prevent strain on the muscles, ligaments, bursae and joint structures of the shoulder
• Try and avoid sleeping on your stomach
• Use comfortable pillows to make sure your neck is supported well enough which helps take strain off the affected shoulder

Stretches that may help the shoulder before you get into bed or during the night if you wake up in pain may include:

1. Shoulder Shrugs
   1. Start in a resting position and shrug both shoulders up towards your ears and gently lower both shoulders back down to your start position.
   2. Keep breathing and don’t over exert the activation of the muscles of the neck and shoulder when doing the shrugs.
   3. Repeat 5-10 times

2. Shoulder Rolls
   1. Start in a neutral position and roll shoulders forwards 5-10 times and then backwards 5-10 times.
   2. Keep the movements small and controlled and try and make it easy for yourself!

3. Thread the needle
   1. Start on all 4’s on the floor (on your hands and knees)
   2. Lift your right hand off the floor and thread it behind your left arm and in front of your left knee
   3. Your right hand should remain palm up and on the floor
   4. Your upper back (thoracic spine) and shoulder blade will rotate as you turn your body to the left to “thread the needle”
   5. Repeat both sides and for 5-10 times each side
   6. Keep breathing as you “thread the needle”

4. Pec stretch – Your pec muscle sits at the front of your chest and when it is very tight it pulls on your shoulder and can make shoulder and neck pain
   1. Bend your Right elbow and hold onto a doorway with your palm flat
   2. Gently lean forwards and twist your upper body towards the left, ie, away from the doorway and bent elbow
   3. You should feel the stretch at the front of your chest on the right
   4. Keep breathing and hold the stretch for about 30 seconds
   5. Repeat on the other side

NOTE: Avoid the stretches if they cause you any further pain or aggravate your symptoms while you perform them.

Strength work for your shoulder and surrounding muscles are also important to help strengthen, stabilize and support the muscle and joint system. These can include:

1. Rotator Cuff exercises
2. Biceps exercises
3. Triceps exercises
4. Upper back strength exercises
5. Neck strength exercises

For further details on the strength exercises a proper program should be designed just for you and your pain.

Please see an osteopath near you for a personalized diagnosis, treatment and exercise prescription to help manage and treat your pain.

If you experience shoulder pain with associated symptoms such as chest pain, shortness of breath, nausea, malaise and fatigue, seek immediate medical attention to help rile out any serious medical conditions

Written by Dr Gaby Nowak, Osteopath and Pilates Instructor