by Adam Brown MScPT, MClScPT
updated Oct 6, 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 cause, 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 who sleep on their side, frequently sleep on their shoulder in a way that causes their rotator cuff tendons or shoulder bursae to become pinched. It may not hurt right away, but after several hours this position creates an inflammatory response. It is this inflammation of the pinched structure that is so painful when you wake up.
Rest assured that for most people, symptoms will decrease within the first 48 hours. But some will still be left with persistent shoulder pain. If you are one of those unlucky people, a consultation with an experienced Physiotherapist is in order.
Arm Pain in the Morning and Heart Attacks
Left arm pain is a common symptom of a heart attack. And heart attacks most commonly happen in the morning. The pain associated with a heart attack usually increases in intensity over several minutes and may be associated with a tight or heavy sensation in the chest, sweating or a feeling of being generally unwell. If this sounds like you, call an ambulance and go to an emergency room to have your heart properly assessed right away.
How can I avoid Waking Up With Shoulder Pain Again?
Most people sleep in one preferred position. It’s not always easy to make a change to your sleep position, but it may be required to fix your shoulder pain. If you follow these two rules to achieve 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 constant compression force between the upper arm bone (humerus) and the “cup” of your shoulder (glenoid). 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 in this position and your muscles are at rest, your rotator cuff tendons and your sensitive shoulder bursae can become pinched between the cup of your shoulder and your upper arm bone. If you stay in this position 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 first time you feel a more significant shoulder problem. If that is the case, your symptoms will persist beyond 48 hours and will not be relieved by a change in your sleep position. Here are some possible causes of 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). The shoulder blade is the attachment of your arm to your thorax, this problem can lead to a host of painful problems, including shoulder impingement. The result can be overuse and over-stretch pain on muscles that are failing to do their job, pain from the joint itself or even nerve pain from the bundle of nerves that run from your neck down your arm.
3) Thoracic Spine (mid-back) 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 overuse and pain.
4) Rotator Cuff Tendinitis / Tendinosis
This is essentially a breakdown of the rotator cuff tendons that are deep inside your shoulder. It can be 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 affect the resiliency of your soft tissues.
Learn about Rotator Cuff problems here.
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 understand this link and who can then apply the correct treatment.
If you consistently wake up with referred pain from your neck, you may need to change up your pillow. See this article by Physiotherapist Melissa Seifried “How to Choose The Best Pillow For Your Sleep Position”
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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