If you’ve ever experienced a shoulder injury, you may know just how stressful nights can be. Instead of relaxing in bed, people with rotator cuff pain will often have the worst symptoms at night, even when the day is almost pain-free. To avoid this nighttime stress, it’s important to properly treat a torn rotator cuff to allow it to heal, as well as make adjustments to your habits and environment that can help you to sleep easier at night.
About the Rotator Cuff
The shoulder is one of the most complex joints in the body, with three main bones that allow the arm to move in every direction. This also means the shoulder can be vulnerable to a range of injuries, including damage to the rotator cuff. The rotator cuff is a group of muscles and tendons surrounding the shoulder joint, whose main job is to keep the head of your upper arm bone firmly in the shallow socket of the shoulder.
Injuries to the rotator cuff are common and may increase with age, though people with certain jobs or hobbies are also susceptible. This can include anyone who uses a repetitive overhead motion, such as a painter or certain professional athletes like baseball players. Tears to the rotator cuff are the most common injury, though wear and tear can also cause problems over time.
The most common causes of rotator cuff pain are:
- Subacromial bursitis – an inflammation of the tissue surrounding the rotator cuff
- Calcific tendonitis – the dissolution of calcium that has formed inside the rotator cuff, which causes inflammation
- Tears to the rotator cuff – which can cause irritation and inflammation
- Tendonitis of the rotator cuff – usually in response to a sudden increase in activity
- Frozen shoulder – inflammation throughout the shoulder joint that causes severe stiffness
Signs of a rotator cuff injury include a dull ache throughout the shoulder, difficulty with range of motion and performing normal activities, and arm weakness.
Why Rotator Cuff Pain Is Worse at Night
It is so common for rotator cuff injuries to cause additional pain at night that it can be considered a symptom used for diagnostic purposes. Yet there is no single known reason that this is the case.
One potential reason for this phenomenon is simply the fact that when we lay on a mattress, no matter the position, additional pressure is put onto the shoulder. Standing and sitting throughout the day does not usually involve an external force on the shoulder, but laying down can press onto the area, causing tenderness and pain.
It is also true that sleep is meant to be restorative, and as the body rests, it may put more energy into healing injuries. This healing can involve increased blood flow or the mending of tissues, which can cause additional soreness in the area of the body that has been injured.
Why are your joints stiff and sore in the morning? It could be because they haven’t been moving and may not yet be lubricated properly for the day. When there is an injury, this can be exacerbated by this normal stiffness.
Ways to Relieve Pain at Home
If you are experiencing evening pain due to a rotator cuff injury, there are steps you can take at home to make the situation more manageable.
Adjust Sleeping Positions
When you are lying flat in bed, gravity increases the pulling and tugging on damaged tissues and joints. Paired with the pressure of a mattress on your shoulder, simply being in bed can be a major factor in your pain. While you will still want to sleep in a bed, adjusting your position and using props can be very impactful.
If you sleep on your back, a pillow or folded blanket placed beneath your arm can prevent your elbow from hitting the bed. This is enough to prevent any slight angles that put a strain on your shoulder by keeping the arm supported and midline with your body. For a side sleeper, try to sleep on the side that isn’t injured. You can stack pillows in front of you to rest your arm on, like a sort of shelf. The use of pillows in these positions allows your shoulder to be in a more neutral position, reducing tension on the joint.
Unfortunately, there is no good way to sleep on your stomach when you are experiencing shoulder issues. The spine is usually not able to be neutral in this position and you may find your arm in an odd position.
Hot and Cold Therapies
Depending on the cause of your injury, you may find some relief from using either heat or cold as a treatment. For inflammation and recent injuries, applying an ice pack in short spurts can help calm down symptoms enough to get rest. With muscle tightness, heat may be more appropriate as it increases blood flow to the area. Some people will choose to alternate between the two, but you can experiment to determine what helps the most.
Medication
While medication won’t fix the underlying cause of your pain, it can bring enough relief to help you get some rest. Many over-the-counter medications, like Tylenol and other NSAIDs, can also help manage the swelling.
You should never rely on medication alone to handle your pain and should always consult with a doctor before adding a new one. However, NSAIDs are a great way to relieve acute pain as needed.
When to See a Doctor
Not all shoulder pain will indicate a severe problem or an injury to the rotator cuff. Sleeping in an odd position or other factors may lead to a night of shoulder pain that isn’t of concern. However, if you experience this pain for multiple nights in a row or you know you have experienced damage to the rotator cuff, you should reach out to a health care provider for further assessment and treatment.
Signs that you may need to seek medical care include:
- Severe shoulder pain that appears suddenly
- Swelling, bruising, redness, or warmth around the shoulder
- Pain that is persistent or worsening
- Pain accompanied by trouble breathing, dizziness, or abdominal pain
- Difficulty lifting the arms above the head
- Any trauma to the shoulder or appearance of deformation
Without treatment, a rotator cuff injury could lead to permanent loss of motion or weakness, as well as progressive deterioration of the joint.
Treatment Options for Rotator Cuff Pain
If there is an underlying injury to the rotator cuff, at-home remedies can help relieve symptoms, but the injury itself will need to be treated. Failing to address the root cause of the pain can cause it to worsen or become a more severe condition over time. Treatment will depend on the type of injury as well as the severity.
In the case of tendinitis and tendinosis, the main treatment will involve rest and avoiding activities that cause pain, in addition to certain home remedies like heat and medication. Physical therapy is the primary intervention for these conditions, with the goal of using stretching and range of motion exercises to strengthen the muscles and increase flexibility.
In most cases, a rotator cuff tear can be treated in a similar manner, including physical therapy and a proper exercise program to improve the function of the shoulder joint. However, some cases require surgery, especially in younger athletes. The type of surgery can vary based on the exact scenario but is usually minimally invasive.
Preventing Rotator Cuff Injuries
Rather than dealing with pain at night and seeking ways to relieve it, the best thing you can do is avoid any rotator cuff injuries to begin with. Many people will not need to worry about this outside of trauma like a car accident, but there are groups at particular risk.
General habits that can help you avoid injuries to the rotator cuff as well as throughout the body may include:
- Maintaining a healthy weight
- Practicing good posture
- Avoiding smoking
- Doing physical activity, including gentle stretching
For those who are athletes or commonly perform acts that put their rotator cuff at risk, the most important method of prevention is to use the proper technique at all times. This can include simple things like warming up before a workout and properly stretching, as well as being sure to gradually increase the intensity of activity rather than suddenly adding it in. It is also critical to use proper lifting, throwing, and catching techniques. Some athletes will have particular equipment that assists with this.
Physical therapy and chiropractic care can also be used as a preventative treatment, allowing you to keep your body functioning properly so that it does not become injured more easily.
Whether you are experiencing pain already or hoping to avoid it in the future, AICA Lithia Springs can help. Our team of specialists includes experts in chiropractic care, physical therapy, pain management, and orthopedics. We will evaluate everything from your anatomy to your sleeping habits to help create a customized plan aimed at helping you reach your goals. Contact us today to schedule your first consultation and begin moving towards nights without shoulder pain