by Adam Brown
updated July 17, 2020
It seems unfair. One night you go to bed feeling fine and the next day you have severe shoulder pain. Everything from brushing your teeth to washing your hair feels nearly impossible. You think back to the last few days to try to find a justification for this new ailment, but nothing seems to fit.
Why did I wake up with shoulder pain?
If you have no history of shoulder problems the most likely answer has to do with your sleep position. People frequently sleep on their shoulder in a way that causes their rotator cuff tendons or shoulder bursae to become pinched. It may not hurt at the time, but after several hours this position creates an inflammatory response. It is this inflammation in the pinched structure that is so painful upon waking.
Rest assured that for most people, pain will decrease over the first 48 hours. But many will still be left with some symptoms. If you are one of those unlucky people, a consultation with an experienced Physiotherapist is in order.
How can I avoid Waking Up With Shoulder Pain Again?
Most people get into the habit of sleeping in one preferred position. It is not always easy to make a change to your sleep position, but it may be required to say goodbye to your shoulder pain. If you follow these two guidelines to obtaining a shoulder pain free sleep position you will be ahead of the game;
1. QUARTER TURN – People experience pain if they sleep directly on their upper arm. This position creates a sustained compression force between the humerus or upper arm bone and the glenoid or “cup” of your shoulder. If you turn just a bit onto your front or back the compression is reduced and your chances of waking up in pain are reduced too.
2. ELBOW BELOW SHOULDER – If you sleep in a position where your elbow is closer to the headboard than your shoulder, you may be increasing your risk of waking up in pain. When your arm is elevated in this way and your muscles are at rest, your rotator cuff tendons and your shoulder bursae can become pinched between the cup of your shoulder and your upper arm bone. If this position is allowed to persist it will result in pain, and in many cases it will cause damage to the structures being pinched.
What are some other Possible Causes of My Morning Shoulder Pain?
In some cases a painful morning is just the way a more significant shoulder problem begins. If that is the case, your symptoms will persist beyond 48 hours and will not be sufficiently relieved by a change in your sleep position. Here are some possible causes of more persistent shoulder pain.
1) Frozen Shoulder
Frozen shoulder is a problem that seems to come out of nowhere and starts with a very painful phase followed by stiffness that, if left untreated, can take a very long time to heal and feel normal again. You can read more about this problem in our earlier blog post What is Frozen Shoulder?
2) Scapular Dyskinesis
Described by Jerry Seinfeld as chicken wing shoulder blades, this is a condition that causes you to have poor control of your shoulder blade (or scapula). As the shoulder blade forms the base of attachment of your shoulder to your thorax this problem can lead to a host of painful structures. The results can be overuse and over-stretch pain on muscles that are failing to do their job, pain from the joint itself because of altered mechanics or even nerve pain from the bundle of nerves that run from your neck down your arm.
3) Thoracic Spine Stiffness
We’re all getting a bit stiffer as we sit hunched over our laptops for hours on end. What many people don’t realize is that in order to reach up over our heads we need good mobility from our spine and rib cage. If they are stiff we have no choice but to require the shoulder to move more than it is meant to – eventually leading to pain.
4) Rotator Cuff Tendinitis / Tendinosis
This is essentially a breakdown of the rotator cuff tendons that are deep inside your shoulder. It can caused by repetitive movements, maintaining the shoulder in a position where they are pinched (such as sleeping on your arm), poor shoulder mechanics (see above) as well as other general health factors that effect the resiliency of your soft tissues.
5) Referred Pain
Many patients come to our physiotherapy clinics with “shoulder pain” that after a comprehensive assessment turns out to be pain referred from their neck. It is important to be working with a registered physiotherapist who can recognize and understands this link and who can then apply the correct treatment.
At Cornerstone Physiotherapy in Toronto, North York, and Burlington, our physiotherapists bring patients through a complete shoulder examination. By the end of our assessment you can rest assured that your random shoulder pain will no longer seem random, and you’ll have a great plan to get back to living pain-free.
Adam Brown MClScPT
Adam is a respected and highly sought after physiotherapist with clinics in Toronto, North York and Burlington. He educates orthopaedic physiotherapists on clinical reasoning and treatment planning for shoulder pathologies among a host of other conditions.
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