Why do I experience more shoulder pain at night?
While rotator cuff injuries are most common in athletes who perform repeated overhead movements, anyone can suffer from a shoulder injury. Typically, shoulder pain at night is associated with conditions like tendinitis, bursitis, biceps tendinopathy, impingement, or rotator cuff injuries.
With any of these conditions, patients may experience a limited range of motion, muscle stiffness, numbness, or shoulder pain.
The reasons why rotator cuff pain worsens at night are not well understood. One possibility is that any existing pain or inflammation in the shoulder is exacerbated by the arm’s natural static position or contorted positioning while sleeping.
Unsurprisingly, many patients struggle to find a sleeping position where the shoulder can rest comfortably. For example, sleeping on your side causes the full weight of your torso to be placed onto your shoulder, causing unnecessary strain and discomfort.
However, while sleeping positions can contribute to shoulder pain, they are often not the root cause. Individuals who experience shoulder pain at night should first consult a medical professional to receive a proper diagnosis and treatment plan. 
What to do before bedtime?
While it may not be possible to completely avoid shoulder pain at night, there are measures that can be taken to decrease the level of discomfort and risk of further injury.
Depending on the severity of the rotator cuff injury, simple conservative treatments may be all that’s needed for a full recovery.
In any case, the RICE method –Rest, Ice, Compression, and Elevation– is almost always recommended for the first 48 hours following an injury.
- Resting the shoulder and limiting unnecessary overhead or lateral movements of the arm will help prevent additional strain on the shoulder;
- Ice will stimulate blood flow to help alleviate some of the pain;
- Compression will help to stabilize the shoulder and allow the muscles and tendons in the shoulder to rest;
- Elevation, if the pain allows, can also help to reduce swelling, pain, and discomfort. 
Similarly, over-the-counter pain medication can also help to alleviate many symptoms and can be very useful for people who experience the most shoulder pain while falling asleep.
Some physicians may also recommend a shoulder immobilizer, which is an orthotic device designed to support and limit your shoulder from doing certain motions.
Rotator cuff braces can be especially effective at night, as they stabilize the shoulder joint in the correct position and prevent undesired displacement and positioning. 
Should I massage a sore shoulder?
Before massaging your shoulder, you should consult a medical professional to ensure you don’t worsen an existing shoulder condition or injury.
Gently massaging a sore shoulder can be very helpful for shoulder impingement, rotator cuff muscle strains, and tendinitis, to reduce inflammation, prevent scar tissue from building up, and help realign torn fibers of the ligament.
There are various types of massage, such as effleurage, friction, static pressure, and stretching– each serving a unique purpose.
However, rather than attempting to self-massage your injured rotator cuff yourself, you should consult with a massage therapist who has a thorough understanding of shoulder biomechanics and tissue healing. 
Should I stretch my shoulder with a rotator cuff injury?
Physical therapy is another at-home treatment method that physicians frequently suggest.
Stretching exercises that are designed to improve flexibility in the rotator cuff often help to restore flexibility and range of motion, and prevent muscle stiffness.
However, any stretching or strengthening exercises should be performed with extreme caution, as there is a possibility that you can overstretch or overextend your rotator cuff, which would completely disrupt its recovery.
Patients should consult with a physician before performing physical therapy to make sure that stretching exercises would be beneficial for their specific injury. 
Alternative sleeping positions
Sleeping at night with a rotator cuff injury, or other shoulder condition, can be especially uncomfortable and painful.
In addition to the conservative treatment methods listed above, patients might consider trying different sleeping positions to reduce strain on the injured shoulder.
Sleeping on the side
Sleeping on your side is typically reported as one of the more uncomfortable sleeping positions for shoulder pain. By lying on one side, all the weight from the upper body is placed onto the shoulder joint.
As your body relaxes, the additional weight on the shoulder can aggravate the rotator cuff, leading to inflammation and micro-tearing. However, if sleeping on the side is the easiest way to fall asleep, there are minor changes that could help protect an injured rotator cuff.
First, you should try to lie with your pain-free shoulder on the bottom and your injured shoulder resting on top.
Additionally, you may try to bend your legs toward your chest and position a pillow between your legs. 
If the pain persists, you could also consider propping your injured shoulder up with a pillow under the armpit. 
Sleeping on your back
Sleeping on your back is one of the better positions for rotator cuff pain, as your spine is aligned and your shoulders will bear little weight.
Ideally, your arms would be placed on your stomach or by your side, and would not stretch above your head, as this could strain the muscles and tendons that support the rotator cuff. 
Sleeping on your stomach
When sleeping on your stomach, it may be tempting to tuck your arms underneath the pillow, but this puts additional pressure on the neck and shoulders.
One possible solution to this, is positioning your arms at your side, against your body. 
Alternatively, you can place one pillow underneath your hips and another one underneath your shoulders to prevent the shoulder from sagging.” 
Sleeping at an incline
Many patients also find that sleeping in a reclined position is more comfortable than lying horizontally on your back, as your rotator cuff doesn’t have to support any weight.
What sleeping positions should I avoid?
Individuals with rotator cuff injuries should avoid sleeping in positions where the injured shoulder must bear additional weight or stretch above the head.
This includes sleeping on the side of the injured shoulder, constantly switching sides while sleeping, and sleeping with your arms tucked underneath your pillow or body.
If possible, people who experience shoulder pain should consider adjusting their sleeping position to alleviate strain on the rotator cuff as much as possible.
- “Shoulder Pain at Night.” The Cleveland Shoulder Institute, 15 Mar. 2021, clevelandshoulder.com/shoulder-pain-night/.
- “Sprains.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 Sept. 2020, www.mayoclinic.org/diseases-conditions/sprains/diagnosis-treatment/drc-20377943.
- “Instructions for Wearing Your Shoulder Immobilizer Brace.” The Johns Hopkins Hospital, 10 May 2010.
- “Rotator Cuff Injuries and How Massage Therapy Can Help.” Head to Toe Muscle Clinic, h2tmuscleclinic.com/rotator-cuff-injuries-and-how-massage-therapy-can-help/.
- “Rotator Cuff Injury.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 30 Apr. 2020, www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/diagnosis-treatment/drc-20350231.
- “Slide Show: Sleeping Positions That Reduce Back Pain.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 22 Apr. 2020, www.mayoclinic.org/diseases-conditions/back-pain/multimedia/sleeping-positions/sls-20076452?s=3.
- “Is Your Sleeping Position Harming Your Rotator Cuff?” Is Your Sleeping Position Harming Your Rotator Cuff?: Next Step Orthopedics: Orthopedic Surgeons, www.nextsteportho.net/blog/is-your-sleeping-position-harming-your-rotator-cuff.
Elizabeth Miclau is an undergraduate at Harvard College, planning to pursue a concentration in life sciences or sociology. As a member of both Puerto Rico’s National Diving Team and Harvard’s Women’s Varsity Swimming and Diving Team, she has a strong background in elite athletics. In the past year, she has contributed to several journal publications and peer-review-funded research projects.