Is Your Sleep Position Harming Your Rotator Cuff?

Injuries to the rotator cuff muscles that stabilize the ball-and-socket shoulder joint are the most common cause of shoulder pain.¹Holdaway LA, Hegmann KT, Thiese MS, Kapellusch J. Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):408. Published 2018 Nov 23. doi:10.1186/s12891-018-2319-9 Unsupported sleeping positions, such as sleeping with the arms above or behind the head, increase the likelihood of rotator cuff pain, whereas sleeping on the back with arms by the side helps avoid the risk of rotator cuff pain.²Kempf B, Kongsted A. Association between the side of unilateral shoulder pain and preferred sleeping position: a cross-sectional study of 83 Danish patients. J Manipulative Physiol Ther. 2012;35(5):407-412. doi:10.1016/j.jmpt.2012.04.015

Adopting an ergonomic sleeping position and making adjustments to your sleeping surface reduces strain on the shoulders, alleviating rotator cuff pain and preventing future flare-ups.

How to fix rotator cuff pain caused by nighttime habits

If you are waking up with rotator cuff pain, which is commonly experienced in the deltoid muscle or upper arm, your sleep position could be to blame. Sleeping in awkward positions puts stress on the shoulder joint and increases the risk of impingement or compression of the rotator cuff tendons.³Werner CM, Ossendorf C, Meyer DC, Blumenthal S, Gerber C. Subacromial pressures vary with simulated sleep positions. J Shoulder Elbow Surg. 2010;19(7):989-993. doi:10.1016/j.jse.2010.04.039 This compression contributes to inflammation and irritation that manifests as pain and stiffness at rest and with certain motions.

Sleep positions to adopt if you have rotator cuff pain

The best sleeping position to prevent rotator cuff pain is on your back, with your arms resting comfortably at your sides.³Werner CM, Ossendorf C, Meyer DC, Blumenthal S, Gerber C. Subacromial pressures vary with simulated sleep positions. J Shoulder Elbow Surg. 2010;19(7):989-993. doi:10.1016/j.jse.2010.04.039 This neutral shoulder alignment minimizes stress and pressure points around your shoulder area. For some, placing a small pillow underneath each elbow and upper arm while lying on the back further assists in maintaining a neutral position. 

Sleep positions to avoid if you have rotator cuff pain 

Sleeping on your side or stomach tends to put more strain on the shoulder joint.³Werner CM, Ossendorf C, Meyer DC, Blumenthal S, Gerber C. Subacromial pressures vary with simulated sleep positions. J Shoulder Elbow Surg. 2010;19(7):989-993. doi:10.1016/j.jse.2010.04.039 These positions often lead to impingement of the rotator cuff tendons, causing inflammation and pain. 

Sleeping with your arms overhead in any position also risks compressing the rotator cuff tendons.

Pain from a rotator cuff injury intensifies at night

Rotator cuff pain often intensifies at night. Research shows proinflammatory proteins increase during sleep, which exacerbates shoulder discomfort in individuals with rotator cuff injuries.⁴Longo UG, Facchinetti G, Marchetti A, et al. Sleep Disturbance and Rotator Cuff Tears: A Systematic Review. Medicina (Kaunas). 2019;55(8):453. Published 2019 Aug 8. doi:10.3390/medicina55080453

Additionally, the nerve endings that transmit motion to the brain are not stimulated during rest, which “opens” the pain gate and increases pain sensitivity at rest.

The majority of individuals with damaged rotator cuffs experience disrupted sleep due to severe nighttime pain.⁴Longo UG, Facchinetti G, Marchetti A, et al. Sleep Disturbance and Rotator Cuff Tears: A Systematic Review. Medicina (Kaunas). 2019;55(8):453. Published 2019 Aug 8. doi:10.3390/medicina55080453

However, studies indicate this nocturnal shoulder pain tends to resolve after surgical repair of the torn rotator cuff tendon.⁵Zheng ET, Lowenstein NA, Collins JE, Matzkin EG. Resolution of Sleep Disturbance and Improved Functional Outcomes After Rotator Cuff Repair. Am J Sports Med. 2023;51(7):1852-1858. doi:10.1177/03635465231169254

How to sleep if you have rotator cuff tear or surgery

Navigating nights might prove challenging, but there are some helpful solutions for managing pain and improving sleep quality while healing from a rotator cuff tear.

• Sleep on your back and keep your arms by the side of your body.
• Sleep in an inclined position on a reclining bed.
• Avoid sleeping on the injured side to prevent aggravating the condition. 

Taking a pain-relieving medication or applying a medicated cream to the shoulder area before going to bed helps calm down the nerves and prevents a nighttime flare-up. 

Similarly, applying a heat pack on the shoulder for 10-15 minutes before going to bed increases blood circulation to the sore region and provides a calming effect before bedtime. 

Mattresses and pillows that aid in rotator cuff healing 

Research suggests that using a medium-firm mattress helps reduce pressure on the shoulder area, alleviating pain.⁶Jacobson BH, Boolani A, Smith DB. Changes in back pain, sleep quality, and perceived stress after introduction of new bedding systems. J Chiropr Med. 2009;8(1):1-8. doi:10.1016/j.jcm.2008.09.002

Doctors also recommend maintaining the affected shoulder in a relaxed, natural position using a pillow on the side to reduce pressure on the shoulder.⁷Khazzam MS, Mulligan EP, Brunette-Christiansen M, Shirley Z. Reply to the Letter to the Editor: Sleep Quality in Patients With Rotator Cuff Disease. J Am Acad Orthop Surg. 2018;26(21):e466. doi:10.5435/JAAOS-D-18-00453 Specialized pillows, such as wedge or contoured pillows, are more effective than regular pillows in maintaining a neutral shoulder position.⁸Lei JX, Yang PF, Yang AL, Gong YF, Shang P, Yuan XC. Ergonomic Consideration in Pillow Height Determinants and Evaluation. Healthcare (Basel). 2021;9(10):1333. Published 2021 Oct 7. doi:10.3390/healthcare9101333 

Whatever combination of pillows or mattress types you choose, it is always a good idea to have someone observe you and provide feedback on what a neutral position looks like relative to what it feels like. 

Ergonomically designed pillows (such as contoured pillows) and mattresses are helpful in reducing shoulder pain, but the ideal design is influenced by an individual’s sleeping habits and body type. A process of trial and error is necessary to determine the ideal sleeping surface to reduce rotator cuff pain.

Medical treatment for rotator cuff injuries

Initial treatment of rotator cuff injuries can involve some combination of physical therapy, chiropractic treatment, injection treatments, massage therapy, and prescription pain medication.

See Rotator Cuff Injuries: Treatment

If shoulder pain persists for more than 6 months, more invasive treatments may be recommended.

See Rotator Cuff Tear Surgery