Experiencing Shoulder Pain From Sleeping? Here’s What You Need To Know

Morning shoulder pain can range from a dull ache to sharp discomfort. It can often last a few hours or even the entire day, impacting daily activities and restricting movement. Common causes include poor sleeping positions, strained muscles, underlying conditions like tendonitis, rotator cuff tear or impingement, acromioclavicular joint osteoarthritis, and bursitis. Studies estimate that 18-26% of adults suffer shoulder pain at any time. 

Many patients with this orthopedic problem take medications regularly to manage the pain. However, frequent use of drugs may lead to potential side effects. Medications may not always address the root cause of the pain. 

However, the body has a natural ability to heal itself. Procedures using Regenexx injectates utilize interventional orthobiologics to support the body’s natural healing process, offering an alternative recovery path without medications or surgery.

What’s Behind Your Shoulder Pain?

The shoulder comprises four joints. It connects the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). These bones are connected by ligaments and tendons, which keep the shoulder stable and enable movement. Cushions of cartilage keep shoulder movements smooth and friction-free.

The components of the shoulder most commonly affected by pain are:

• Glenohumeral joint. The ball-and-socket joint in the shoulder connects the humerus and scapula, allowing arm movement.
• Acromion. A bony projection on the scapula that forms the top of the shoulder.
• Rotator cuff. A group of four muscles and tendons that stabilize the shoulder and enable arm movements.

In 70% of people affected by shoulder pain, discomfort arises from the portion of the shoulder under the acromion. This type of pain is known as subacromial pain and is felt on the outer side of the joint. It worsens when lying on the affected shoulder, in the morning, or when lifting the arm sideways.

Certain groups are more prone to developing shoulder pain. Risk factors include:

• Age: Individuals over 40 are more prone to pain. This is due to the age-related wear and tear of shoulder structures, like cartilage. 
• Occupation: Jobs and activities requiring repetitive overhead movements increase the risk of injuries and wear and tear. At-risk professions include construction work and painting. Athletes in sports like tennis, baseball, volleyball, and football are more prone to shoulder injuries and pain. 
• Physical condition: Poor posture, a sedentary lifestyle, or low muscle conditioning can increase the risk.
• Medical conditions: Underlying issues such as arthritis, diabetes, and cardiovascular diseases can worsen shoulder problems.

Common causes of shoulder pain after waking up include:

Poor Sleeping Positions

Sleeping in an awkward position can significantly strain shoulder muscles and joints. The shoulder may become compressed against the mattress when sleeping on one side. This position reduces or cuts off proper blood flow and causes pain. 

In a 2024 study, there appeared to be a link between sleeping position and pain associated with rotator cuff tears. In this study, 52 out of the 58 patients with this shoulder problem were side sleepers. 

Sleeping with the arm in an unnatural position can pull on the shoulder ligaments and muscles, leading to discomfort and strain. Pain can worsen if the sleeping position remains unchanged throughout the night.

Inadequate Mattress And Pillow Support

A mattress or pillow that lacks proper support can contribute to shoulder pain. If a mattress is too soft or too firm, it can cause misalignments in the body during sleeping. This causes the shoulder to bear more weight than it should. 

Similarly, using a pillow that is either too high or too flat can misalign the neck and shoulder, resulting in muscle tension and discomfort. 

Rotator Cuff Injuries

Rotator cuff tears are common, especially among athletes and older adults. Typical injuries include:

• Tendinitis: Tendinitis is the inflammation of shoulder tendons. It often occurs from overuse or repetitive forceful activities.
• Tears: Partial or complete tears can affect several shoulder components. These include ligaments, tendons, and muscles. These tears often stem from acute injuries or wear and tear.

• Impingement: Shoulder impingement occurs when the shoulder muscles rub against the acromion. This can happen due to repetitive motions or lifting overhead. Impingement often leads to difficulty in moving the arm and shoulder.

• One study highlights that shoulder impingement syndrome is a leading cause of shoulder pain. It accounts for 44-65% of all shoulder complaints.

A 2014 study highlighted that patients with symptomatic rotator cuff tears typically experience:

• Intense pain
• Severely disturbed sleep
• Limited movement
• Reduced muscle strength and function
• Restricted daily, leisure, and occupational activities
• Emotional and financial burdens

Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, causes stiffness and pain in the shoulder joint. It develops when the connective tissue around the shoulder thickens and tightens. This can restrict movement, making the shoulder feel “frozen.” 
This condition can arise from prolonged immobility, like being immobilized after shoulder surgery. Certain conditions also increase the risk. A 2021 study found that people with diabetes are five times more likely to develop a frozen shoulder.

Adhesive capsulitis develops in stages:

• Freezing stage: Pain reaches peak intensity, and the range of motion decreases. This stage lasts from six weeks to nine months.
• Frozen stage: Pain may ease down, but the shoulder remains stiff. The range of motion significantly decreases. This phase can last for four to six months.
• Thawing stage. Movement gradually improves. This last phase can last from six months to two years. 

Findings from a 2022 study show that recovery from a frozen shoulder can vary greatly, and some individuals experience ongoing pain and limited mobility. This condition impacts not only physical health but also mental well-being, often leading to a loss of function and changes in personal identity.

Nerve Compression

Nerve compression in the neck or shoulder can lead to shoulder pain. This condition is commonly known as a pinched nerve. Nerve compression interferes with the normal transmission of nerve signals. This can result in sharp or burning sensations, tingling, and numbness. Pain from nerve compression usually radiates from the shoulder down into the arm. 

Shoulder function can be significantly disrupted by compression of the brachial plexus. This is a network of nerves transmitting signals from the spine to the shoulder. Common causes include poor posture, repetitive motions, or holding a single position too long. 

Bursitis

Bursitis is the inflammation of the bursae, the small fluid-filled sacs cushioning bones, tendons, and muscles near the joints. The most commonly affected bursa in the shoulder is the subacromial bursa, located under the acromion. Bursitis in this area manifests as pain and stiffness. The symptoms are especially noticeable in the morning.

Common causes include repetitive motions, impingement syndrome, and conditions like arthritis or injuries. These cause the inflammation of nearby structures, which spills over into the bursa. 

Recognizing The Signs Of Shoulder Pain When Waking Up

The signs of shoulder pain vary. Some patients experience mild discomfort that goes away within a few minutes or hours of waking up. Others deal with severe pain that lasts the entire day, disrupts sleep, and interferes with daily activities. 

Common symptoms include

Morning Stiffness

Morning stiffness usually manifests as reduced shoulder mobility right after waking up. This stiffness often lasts for about 30 minutes. 

Causes can include poor sleeping posture, mild inflammation from arthritis, or minor rotator cuff injuries. It usually improves with gentle shoulder movements and appropriate care. 

Dull Or Sharp Aches

Shoulder pain can manifest as:

• Dull aches: Dull but persistent pain often indicates low-grade, chronic inflammation. This type of inflammation is common in conditions like arthritis. 
• Sharp aches: Sharp but short-lived pain typically indicates acute inflammation. This type of inflammation occurs following a traumatic injury, such as a ligament or rotator cuff tears or impingements. 

Numbness And Tingling

Numbness and tingling in the shoulder or arm often indicate nerve compression. When nerves are compressed, they cannot transmit signals related to movement and sensation to the brain. This results in tingling, numbness, and shock-like sensations. 

Causes of nerve compression include:

• Pinched nerves, like cervical radiculopathy.
• Frequent overhead motions.
• Trauma or fractures.
• Neuropathy, or nerve damage. 
• Poor posture or incorrect body alignment.
• Joint swelling or bone spurs, which may be caused by arthritis.
• Tumors are located on structures near the nerves.

Poor sleeping positions can aggravate the pressure on nerves during the night. This can amplify the tingling sensation when waking up.

Tenderness And Radiating Pain

Pain in the shoulder can be localized or radiate to nearby structures. Radiating pain may indicate problems such as compressed nerves or widespread inflammation. Common causes include tendonitis, neuropathy, and severe rotator cuff injuries. 

Swelling And Inflammation

The body’s inflammatory response follows an injury, infection, or damage caused by wear and tear. This process involves a series of reactions to contain the injury and start healing. These include pain sensations, stiffness, swelling, and a sensation of warmth around the injured area. 

Swelling occurs when the body redirects healing fluids containing oxygen and nutrients to the injured site. This swelling can stiffen the shoulder joint, restrict movement, and intensify pain. 

H3: Limited Range Of Motion

While sleeping, reduced movement causes fluid accumulation in the shoulder joint and tissues. This leads to sensations of stiffness in the morning. Inflammation can worsen during rest, leading to increased pain upon waking. 

Additionally, a lack of muscle activity overnight can make connective tissues tighter. This combination makes the shoulder feel more painful and less mobile upon waking. Incorporating gentle exercises can improve morning shoulder mobility.ms include:

Will Shoulder Pain Go Away On Its Own?

Shoulder pain can sometimes resolve on its own. Minor issues like slight strains or mild tendinitis often heal with rest and at-home care. However, more severe injuries or chronic conditions may require medical attention and longer recovery periods.

General recovery guidelines for common shoulder conditions include:

• Rotator cuff tears: Minor tears can heal with rest and at-home care in four to six weeks. More severe tears can take three to six months to heal. If surgery is involved, recovery can take six to 12 months. 
• Impingement: Full recovery can take three to six months. Care usually involves rest, icing, and physical therapy. 
• Bursitis: If caused by injury, bursitis can heal within a few days. If caused by overuse, recovery can take several weeks or more.  
• Tendinitis: Mild tendinitis can heal within two to four weeks. Recovery for severe cases can take several months and involve six to eight weeks of physical therapy, rest, and icing. 
• Frozen shoulder: A frozen shoulder can take up to two years to heal fully. Patients usually undergo physical therapy for several months. 
• Nerve compression: Recovery from nerve compression involves addressing the root problem. Timelines vary from a few days to several months. 

These guidelines are influenced by several factors, including:

• Pain intensity
• The severity of the injury
• Adherence to treatment plans
• Overall patient health
• Lifestyle changes

Certain adjustments can support recovery. These include improved posture, regular exercise, and avoiding activities that strain the shoulder.

Home Remedies To Alleviate The Pain

Home remedies are often the first line of treatment for shoulder pain. Common methods include:

• RICE: This method involves rest, ice, compression, and elevation. It helps reduce pain and swelling through different mechanisms:
  • Resting prevents further injury.
  • Icing slows blood flow to minimize swelling.
  • Compression applies pressure to reduce swelling.
  • Elevation promotes fluid drainage. 

While icing is beneficial initially, prolonged use may affect the healing process. This occurs because of the reduced blood supply containing healing factors.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): While NSAIDs help manage symptoms, they do not address underlying causes of inflammation. Long-term use can lead to side effects like increased risks of stroke, heart attack, kidney disease, and stomach ulcers. 

• Stretches: Regular stretching can maintain flexibility and reduce pain. These exercises should be supervised by a physical therapist to avoid further injury. Useful stretches include:
  • Shoulder rolls: Gently roll shoulders forward and backward to ease tension.
  • Cross-body shoulder stretch: Stretch each arm across the body to lengthen shoulder muscles.
  • Doorway stretches: Stretch arms in a doorway to open up the chest and shoulders.
  • Child’s pose: This yoga pose stretches the back and shoulders. It involves kneeling and extending the arms toward the floor, resting the forehead on the ground.
  • Thread the needle: Twist under the body while on all fours, to stretch the shoulders.
  • Neck release: Gentle neck stretches to relieve shoulder tension.
  • Triceps stretch: Stretch the triceps by pulling the elbow behind the head.
  • Wall angels: Stand against a wall and move arms like a snow angel, to improve shoulder mobility.
  • Eagle arms pose: Wrap arms in front to stretch the shoulders and upper back.
  • Pendulum stretch: Leaning forward and swinging the arm in small circles to increase the range of motion.
  • Wall crawls: Face a wall and “walk” fingers upwards, keeping the shoulder relaxed and elbow slightly bent. This exercise helps stretch and strengthen the shoulder muscles, promoting flexibility and reducing stiffness.

Getting To The Root Of The Problem

Shoulder pain can be a non-specific symptom, indicating several possible conditions. Without proper diagnosis, patients might resort to merely taking medications. This may temporarily ease pain but doesn’t address the underlying issue. Over time, undetected issues like arthritis or injuries can worsen and lead to severe complications.

Physicians utilize a comprehensive approach to help diagnose shoulder pain and guide treatment decisions:

• Medical history: The physician will gather detailed medical history information. This includes previous injuries, medical conditions, and lifestyle factors that might contribute to shoulder pain.
• Physical examination: A thorough physical examination assesses the shoulder’s range of motion, strength, and areas of tenderness. The physician uses the SANS (Stability, Articulation, Neuromuscular, Symmetry) evaluation approach to examine the body in motion and may use advanced diagnostics to analyze the shoulder as an integrated system.
• Imaging tests: The physician reviews existing MRIs and other scans. They may also conduct ultrasound scans for a real-time view of the shoulder’s internal structures. 

After examination, the physician will recommend a treatment plan that is fully customized around the patient’s needs.

Conventional Treatments For Shoulder Pain

When home remedies fail to alleviate shoulder pain, conventional treatments for shoulder pain include:

• Shoulder braces: Braces are used to support the shoulder and limit movement. This helps stabilize the joint and prevent further injury. However, prolonged use can weaken shoulder muscles due to underuse. 
• Physical therapy: Physical therapy strengthens shoulder muscles and improves flexibility. It’s essential for recovery but requires consistent effort and time. Missing sessions or improper execution of exercises can slow down progress or even worsen the condition.
• Surgery: Physicians may prescribe surgery if conservative treatments fail or in the case of disabling shoulder conditions. Depending on the cause of shoulder pain, possible surgical interventions include:
  • Arthroscopic surgery to repair torn or damaged tissues.
  • Surgical rotator cuff repair.
  • Shoulder replacement to replace damaged parts of the shoulder with artificial components.
  • Shoulder stabilization surgery to correct recurring shoulder dislocations.

Each surgical option has specific applications. However, any surgery generally involves considerable recovery time and potential complications such as infection or decreased range of motion. 

Additionally, these interventions may not always achieve the desired outcomes. A 2022 study indicated that rotator cuff repairs can have a significant re-tear rate. The study reports that, in a systematic review of rotator cuff repairs, re-tear occurred in 27-50% of patients within nine years of the surgery. Re-tears may require revision surgeries.

Is There A Non-invasive And Non-pharmaceutical Way To Reduce Pain And Improve Mobility?

Medications may temporarily relieve pain, but some shoulder conditions, like frozen shoulders, can take years to heal or may never get better. Long-term medication use can cause severe side effects. Additionally, letting the underlying cause of pain go untreated can worsen shoulder health.

In some cases, morning shoulder pain may be managed by supporting the body’s natural healing process, reducing the need for medications or surgery. The Regenexx approach provides a non-surgical path for those suffering from torn shoulder pain by supporting the body’s natural ability to heal with interventional orthobiologics, offering an alternative to traditional treatments like medications or surgery.

Physicians using Regenexx lab processes create custom treatment plans for each patient’s needs.

Regenexx SD Injectate

Procedures using Regenexx SD injectate include a patented protocol that utilizes Bone Marrow Concentrate (BMC), which contains the patient’s own mesenchymal stem cells. The cell processing for a Regenexx-SD injectate routinely achieves 20x concentration— far above what non-Regenexx cell processing can achieve.

Regenexx-SCP Injectate

Procedures using Regenexx-SCP injectate represent a supercharged version of platelet-rich plasma (PRP). In this process, blood is drawn and then processed to isolate the platelets and growth factors. The growth factors are then purified, concentrated, and injected into the shoulder area using imaging guidance for precision. Regenexx-SCP injectate provides a higher concentration of growth factors compared to typical PRP procedures.

Regenexx-PL Injectate

Procedures using Regenexx-PL injectate are a highly specialized derivative of platelet-rich plasma (PRP) with a faster and more concentrated release of growth factors compared to typical PRP.  The PL injectate is often combined with other orthobiologics such as PRP and bone marrow concentrate.

How To Prevent Shoulder Pain In The Morning

Much can be done to improve shoulder health through lifestyle and activity modification, reducing the need for painkillers. Implementing the following strategies under the supervision of a physician can help. 

Maintain Proper Posture

Maintaining good posture throughout the day can prevent or lessen shoulder pain. Strategies include:

• Ensuring that desks and chairs are ergonomically adjusted. 
• Reducing slumping or hunching forward during activities like texting.
• Sitting with the back straight, shoulders back, and feet flat on the floor.
• Taking breaks to stand and stretch every hour to avoid stiffness.
• Strengthening the core muscles with regular exercises to support the spine.
• Wearing supportive footwear to maintain body alignment.
• In sports, working with a trainer to improve form.
• Working with a physical therapist to learn targeted exercises.

Hydrate And Maintain A Healthy Diet

Hydration and a balanced diet play crucial roles in muscle and joint health. Drinking enough water keeps tissues hydrated and flexible. A diet rich in vitamins and minerals, including calcium and vitamin D, supports bone and joint health. Additionally, anti-inflammatory foods like leafy greens and fatty fish reduce inflammation, aiding overall shoulder health.

Exercise Regularly

Regular exercise strengthens shoulder muscles and improves flexibility. For prevention, it is important to incorporate shoulder-specific stretches and strength training. Additionally, activities like swimming and resistance band exercises improve movement patterns and joint stability. 

Mindfulness practices like yoga can increase stability, strength, flexibility, and recovery from injuries. A 2024 study conducted on Indian athletes shows that a combination of yoga and physical therapy can assist in recovery after rotator cuff injuries.

Make Adjustments To Your Sleeping Positions

One study suggests that regular side sleeping can contribute to shoulder pain. Adjusting sleeping positions can protect your shoulder from unnecessary strain:

• Offload the shoulders by sleeping on the back. If the shoulder hurts in this position, it can be propped up using a pillow or blanket.  
• Side sleepers can sleep on the unaffected side. 
• Sleeping on the stomach should be avoided, as it twists the neck and shoulders. 

Optimize Your Sleeping Environment

Creating an optimal sleeping environment for shoulder pain involves:

• Choosing the right mattress: A 2021 study found improvements in shoulder pain and function in patients using a medium-firm mattress. Among the patients analyzed, improvements increased within four weeks of switching mattresses.
• Choosing a supportive pillow: Supportive pillows keep the neck and spine aligned. Side sleepers should use a thicker pillow to fill the gap between the shoulder and neck, reducing strain. 

Invest In Ergonomic Sleeping Aids

Investing in ergonomic sleeping aids like specially designed pillows and mattress toppers can enhance comfort and support. 

Memory foam pillows mold to the shape of the neck and shoulders. This helps provide consistent support throughout the night. Additionally, wedge pillows can elevate the upper body, reducing shoulder pressure. These aids distribute weight and alleviate stress on the shoulders

Consider Ways To Manage Shoulder Pain 

Regenexx offers a specialized approach to helping reduce pain and improve mobility by supporting the body’s natural ability to heal through interventional orthobiologics, reducing the need for surgery or prescription drugs. 
Consult with a physician in the licensed Regenexx network to determine if this approach is right for managing your shoulder pain.