Pain guide · Shoulder pain

Shoulder pain at night: lying on your side, the rotator cuff, frozen shoulder and how to sleep

Shoulder pain that is worse at night is common and, on its own, rarely a sign of anything serious. The three usual causes from mid-life, the rotator cuff, frozen shoulder and arthritis, all ache more in bed, especially when you lie on the sore side, and poor sleep can make the pain feel worse by day. No trial has tested the best sleeping position, but health services, including the National Health Service (NHS), give simple advice on pillows and positions.

Most shoulder pain eases with time, gentle movement and the right exercise: in one trial, specific shoulder exercise cut night pain far more than general exercise did. Chest pain that spreads to your arm is a 999 call, and a shoulder that looks out of place after a fall needs accident and emergency (A&E). Constant night pain that doesn't change whatever position you lie in, with weight loss, a fever, night sweats or a history of cancer, needs a general practitioner (GP). This guide covers those warning signs, how to tell the causes apart, how to sleep tonight, how much pain is fine, and a three-stage plan with a 3D demo of every move.

3-stage exercise plan When to get help 50 sourcesUpdated 23 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E: after a fall or injury, your shoulder looks out of place or has changed shape, or you cannot move your arm. Do not drive yourself, and do not try to put it back in yourself.
Call 999: shoulder or arm pain with chest pain that feels tight or squeezing, or chest pain that spreads to your arms, neck or jaw, especially with shortness of breath, sweating or feeling sick. It could be a heart attack.
Call 999 or go to A&E: if you are or could be pregnant, shoulder tip pain (where the shoulder ends and the arm begins) with sudden severe tummy pain, dizziness or fainting. It can mean bleeding from an ectopic pregnancy.
Same day (GP or NHS 111): the shoulder or arm is hot, swollen or red, or you have a high temperature or feel unwell. A joint infection needs same-day care.
Same day (GP or NHS 111): sudden or very bad shoulder pain; you cannot move your arm; the arm or shoulder is badly swollen or has changed shape; pins and needles that do not go away; no feeling in the arm; the arm is hot or cold to the touch; pain that started after an injury such as a fall; or severe pain in both shoulders.
Same day (GP or NHS 111): sudden weakness lifting the arm after an injury or fall. A rotator cuff tear caused by an injury needs urgent referral to a shoulder specialist. After a dislocation in anyone over 40, the rotator cuff should be checked: about 40% have a tear.
Same day (GP or NHS 111): you are over 50 and have new pain and stiffness in both shoulders (often the hips too), especially with morning stiffness lasting more than 45 minutes. This can be polymyalgia rheumatica. With a new headache, jaw pain when chewing or problems with your vision, contact a GP immediately. If you suddenly can't see from 1 or both eyes, call 999 or go to A&E.
Contact your GP or call NHS 111 urgently: new shoulder pain with no clear cause if you have ever had cancer, human immunodeficiency virus (HIV), tuberculosis (TB) or an inflammatory arthritis; or shoulder pain with feeling unwell, loss of appetite, a fever, weight loss you can't explain or night sweats. This is the Leicestershire Partnership NHS Trust's advice.

See a doctor or physiotherapist if

Pain that is getting worse or has not improved after 2 weeks of looking after it yourself, or it is very hard to move your arm. In many areas you can refer yourself to physiotherapy.
A past history of cancer, an unexplained lump or swelling, weight loss, or pain that is constant and does not ease when you change position.
You smoke or used to, and have shoulder pain with a cough that will not go away, breathlessness or weight loss.
Pins and needles or a cold arm alongside neck pain, or a new loss of strength or feeling in the arm that you cannot explain (a possible nerve problem).
Numbness or tingling in your thumb and fingers that wakes you at night: see a GP if it is getting worse or not going away. It can be carpal tunnel syndrome, which our carpal tunnel guide covers.
Pain that wakes you most nights for more than a few weeks despite changing how you sleep, or that is just as bad whatever position you lie in: our suggestion is to see a GP or physiotherapist. In many areas you can refer yourself.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

The outside of the shoulder and upper arm, worse lying on that side

Also sore lifting the arm out or overhead, often with a painful arc partway up, and reaching behind you; it hurts but isn't blocked. Usually the rotator cuff, often called impingement or subacromial pain.

Read: Shoulder impingement (rotator cuff pain) →Night pain with weakness lifting or turning the arm out, from 60 or after a fall

A possible rotator cuff tear. Sudden weakness after an injury needs checking the same day.

Read: Rotator cuff tear →A deep ache, stiff in every direction, very bad at night

Hard to turn the arm out (doing up a coat, reaching a back pocket) and painful lying on that side. Commonest from 40 to 65 and linked with diabetes, thyroid problems and the menopause: frozen shoulder.

Read: Frozen shoulder →A deep ache with grinding and stiffness, usually over 60

Painful lying on that side, with a big loss of turning the arm out: arthritis of the shoulder joint.

Read: Shoulder arthritis →Sudden, very bad pain that wakes you, with no injury

Very tender, sometimes after overuse: possibly calcium in a rotator cuff tendon. Sudden or very bad pain needs a same-day check, as the warning signs say.

Read: Calcific tendinitis →The front of the shoulder, worse reaching back or overhead

Usually alongside rotator cuff problems: the long head of the biceps.

Read: Biceps tendinitis (front of shoulder) →The top of the shoulder, at the end of the collarbone

Sore lying on that side or reaching across your body: the acromioclavicular (AC) joint.

Read: AC joint injury and pain →Pain from the neck into the shoulder or arm, with pins and needles or burning

NHS inform says shoulder pain can come from the neck even when the neck doesn't hurt: possibly a pinched nerve in the neck.

Read: Pinched nerve in the neck →Tingling or numbness in the thumb and first fingers that wakes you

Sometimes with an ache up the arm, and usually worse at night: possibly carpal tunnel syndrome.

Read: Carpal tunnel syndrome →Shoulder pain when you swim

Usually an overloaded rotator cuff, which our swimming guide covers.

Read: Shoulder pain when swimming →A stiff or sore neck when you wake

Our neck pain from sleeping guide covers pillows and positions for the neck.

Read: Neck pain from sleeping →Recovering from rotator cuff surgery

Your surgical team's plan comes first; our rotator cuff repair guide covers the usual stages and sleeping after surgery.

Read: Rotator cuff repair →

Both shoulders, often the hips too, stiff and painful for more than 45 minutes each morning, over 50

Possibly polymyalgia rheumatica: get help the same day, as the warning signs say.

Pain that is constant and doesn't change whatever position you lie in

Especially with weight loss, night sweats, a fever, feeling unwell or a history of cancer, or a cough or breathlessness if you smoke: see a GP, as the warning signs explain.

Shoulder or arm pain with chest pain that feels tight or squeezing

Possibly a heart attack: call 999, as the warning signs say.

Understand it

Night pain is part of the common shoulder problemsStrong evidence

Shoulder pain is common: about 1 in 3 adults have it at some point, an NHS trust says, and it lists discomfort when lying on the painful side at night among the usual symptoms. Rotator cuff related pain, also called subacromial pain, is "the most common reason for shoulder pain", NHS inform says, and frozen shoulder and arthritis are the other two common causes from mid-life.

Night pain is part of the picture for all three. With subacromial pain "it may be difficult to lie on the affected shoulder which can disturb your sleep" (NHS inform), and the NHS says impingement pain "may be worse at night while you're sleeping". Frozen shoulder pain "can be worse at night and disturb sleep" (the NHS) and "is often worse at night and when you lie on the affected side" (NHS inform), and the Chartered Society of Physiotherapy (CSP) says it gives "quite significant pain, especially at night". With a rotator cuff tear, pain at rest and at night is common, especially lying on that shoulder, and with shoulder arthritis "night pain is common, and sleeping may be difficult", say the American Academy of Orthopaedic Surgeons' patient pages.

Sources 1, 2, 3, 4, 5, 6, 7, 8, 9

Sleep and shoulder pain go togetherEmerging evidence

Poor sleep is the rule rather than the exception once shoulder pain lasts. In 130 people with shoulder pain for 3 months or more, 81.5% had disturbed sleep, far more than in people without pain, and worse pain went with worse sleep. Across 4 studies of people with rotator cuff tears, 40.8% to 89.0% slept poorly; in 20 people wearing activity monitors, sleep was shorter and more broken than in people without tears in earlier studies; and in 343 people with shoulder problems, sleep was poorest with frozen shoulder.

The link may run both ways: in 1,454 adults followed for 2 years after the 2011 Japanese earthquake, poor sleep went with new shoulder pain (about twice the odds). That's one unusual group, so it can't prove that poor sleep causes shoulder pain.

Sources 10, 11, 12, 13, 14

Why the shoulder hurts more in bed: what's known and what's guessedEmerging evidence

Lying on the shoulder presses on it. In a lab study of 20 healthy volunteers, pressure under the roof of the shoulder (the subacromial space) was lower lying on the back than on the side or front. People with pain in one shoulder often lie on it: in 83 people, 67% of those who slept on one side slept on the painful side.

Other explanations are research ideas, not tests you can use: blood flow in a small artery at the front of the shoulder was higher in people with night pain from rotator cuff tears, especially lying down in a group whose night pain eased by sitting up; shoulder tissue from people with tears or frozen shoulder showed more receptors for melatonin, the sleep hormone; and in 61 people with rotator cuff related pain, worse night pain went with more disability and with changes in one rotator cuff tendon on a magnetic resonance imaging (MRI) scan.

Sources 15, 16, 17, 18, 19, 20

Does sleeping on your side cause shoulder problems?Mixed evidence

It hasn't been shown. The idea was put forward as a hypothesis, and in one clinic 52 of 58 people with rotator cuff tears were side sleepers, but there was no comparison group. In 761 workers, sleeping position wasn't linked with shoulder pain or rotator cuff tendinopathy, and sleeping with the arms overhead went with less pain, not more; the authors suggest people with sore shoulders may already avoid some positions.

Side sleeping is normal: in 664 workers wearing sensors, people spent about 54% of their time in bed on their side, and changed position about 1.6 times an hour.

Sources 21, 22, 23, 24

When night pain needs checkingStrong evidence

What matters is the company night pain keeps. An NHS trust advises contacting a GP or NHS 111 urgently for new, unexplained shoulder pain with a history of cancer, HIV, TB or inflammatory arthritis, or with feeling unwell, loss of appetite, a fever, weight loss or night sweats. The NHS says see a GP for pain in a bone "particularly if it's worse at night". Lung problems can cause shoulder pain: the NHS lists chest or shoulder pain among lung cancer symptoms, Arthritis UK says a doctor may suggest a chest X-ray for unexplained shoulder pain lasting more than 3 weeks in a smoker over 40, and the National Institute for Health and Care Excellence (NICE) asks GPs to arrange an urgent chest X-ray for people 40 and over with two or more unexplained symptoms such as a cough, tiredness, breathlessness, chest pain or weight loss (one, if they have ever smoked).

On its own, night pain is a weak sign. In older people sent for a test for a rotator cuff tear, night pain was a weaker sign of a tear than weakness turning the arm out or being 65 or over. In 482 people at a back pain clinic, 213 had night pain and none was found to have a serious disease; that study was in back pain, not shoulder pain.

Sources 1, 25, 26, 27, 4, 28, 29

When a scan helpsStrong evidence

Usually not at first. An NHS trust says scans aren't required in most cases of rotator cuff related pain, because "many of the structural changes that are seen on a scan are normal particularly as we get older". Rotator cuff changes on scans are common without pain, and rise from about 10% of people at 20 or under to 62% at 80 or over.

A health professional may arrange an X-ray to check the cause, which shows arthritis and calcium deposits. An ultrasound or MRI scan matters after an injury with weakness, when a repair may be needed. A chest X-ray is for the lung signs in the warning list.

Sources 30, 31, 32, 26

How it usually goesEmerging evidence

Most new shoulder pain improves within 6 to 8 weeks, an NHS trust says, and NHS inform says a new problem or a flare should begin to settle within 6 weeks; the NHS says self-care usually takes 2 weeks to start helping, and recovery can take 6 months or longer. In 349 people seeing a GP with new shoulder pain, 23% had recovered at a month and 59% at a year; neck pain and severe daytime pain at the start went with slower recovery. Night pain hasn't been shown to predict a worse outcome.

Rotator cuff related pain often takes a while: about half of cases settle within about 6 months without treatment, an NHS hospital trust says, and with exercise an NHS trust expects at least 12 weeks, sometimes up to 24, perhaps with little change in the first 6. Frozen shoulder can take more than 2 years. Night pain usually eases as the daytime pain does: in one exercise trial it fell from 46 to 15 out of 100 over 3 months, and after rotator cuff repair, sleep improved within 6 months. No one can promise a date.

Sources 1, 33, 32, 34, 35, 36, 30, 7, 4, 37, 11

What helps, and how strong the evidence is

How to sleep: health-service advice, untested in trialsEmerging evidence

Arthritis UK suggests lying on your good side with a pillow under your neck, a folded pillow to support your painful arm in front of your body and another behind your back to stop you rolling onto the painful side, or one or two pillows under the painful arm if you sleep on your back. An NHS trust gives the same pillow advice, and NHS inform says to rest the arm "in a supported position".

No trial has tested a sleeping position, pillow or mattress for shoulder pain. Lying on the back gave the lowest pressure in the shoulder in a lab study, but no position was linked with shoulder pain in 761 workers. In 27 people with back and shoulder discomfort, new medium-firm mattresses were followed by less discomfort over 12 weeks, with no comparison group. For back pain, the CSP says whatever mattress feels most comfortable is best.

Sources 4, 1, 30, 33, 15, 23, 38, 39

Specific shoulder exercise eased night pain in one trialEmerging evidence

In 102 people with long-standing impingement pain who were on a waiting list for surgery, a programme of 2 rotator cuff and 3 shoulder-blade exercises (3 sets of 15, twice a day for 8 weeks, then once a day to 12 weeks) cut night pain by 32 points out of 100 over 3 months, against 12 points with general exercise. Overall, 69% had a good result against 24%, and only 20% then chose surgery against 63%.

Everyone in the trial had a steroid injection as part of a test before it started, and they were a selected group, so the size of the effect may not carry over to everyone.

Source 37

A long programme may add little to good adviceStrong evidence

In 708 adults with rotator cuff problems in 20 NHS trusts, up to 6 physiotherapy sessions of progressive exercise over 16 weeks did no better over a year than a single session of advice with a home exercise programme. The message: a few good exercises done consistently, with advice on activity, may be as good as a long course.

Source 40

Keep the shoulder moving by dayStrong evidence

For the first 1 or 2 days, NHS inform advises reducing activities but moving as much as symptoms allow, resting the arm supported, and moving the shoulder gently for 10 to 20 seconds every hour while awake; then using it more and staying at or returning to work. The NHS says don't stop using the shoulder completely, as that can stop it getting better, and an NHS trust advises against complete rest. Pacing (breaking up the jobs that flare it) is part of the same trust's advice. This is consistent guidance rather than trial evidence.

Sources 33, 32, 1, 30

Injections: short-term reliefStrong evidence

In the same 708-person trial, a steroid injection gave a small improvement in pain and function at 8 weeks, and slightly better sleep scores, but no benefit at 6 or 12 months. NHS inform says injections can help the pain but won't cure subacromial pain. An NHS trust keeps them for exceptional cases where pain stops you exercising, and warns that "multiple injections can be harmful to the health of your rotator cuff". For frozen shoulder, Arthritis UK says a steroid injection or hydrodilatation (an injection that stretches the joint lining) can help, and most people make a full recovery.

Sources 40, 2, 30, 4

Sleep habits are worth getting rightEmerging evidence

Poor sleep went with new shoulder pain in one cohort. No trial has tested whether better sleep eases shoulder pain, but the NHS's habits for better sleep cost nothing: the same wake-up time every day, an hour to relax before bed, a comfortable mattress and pillows, and no caffeine or alcohol in the 6 hours, and no exercise in the 4 hours, before bed.

Sources 14, 41

Machines and gadgetsMixed evidence

In a small trial in people with impingement, shortwave diathermy (heat from a machine) helped pain during activity a little, and less in people with night pain. Special shoulder pillows and adjustable beds haven't been tested for shoulder pain, and sleeping positions sold as "safe" or "unsafe" aren't backed by the studies of workers.

Sources 42, 23

How much pain is OK while you exercise?

The 5 out of 10 rule, and tonight is the testEmerging evidence

For the strengthening, this guide uses the shoulder hub's rule. During shoulder strengthening, pain up to about 5 out of 10 is acceptable, and a little is expected. By your next session it should be back to where it was before. If it isn't, use a lighter band or weight or a smaller range next time, not nothing.

This is how the Holmgren trial set each person's load: pain was not allowed above 5 out of 10 during the exercises, and any increase had to settle back to the starting level before the next session; otherwise the load came down. In long-lasting muscle and joint pain, exercise that allowed some pain did no worse than pain-free exercise. If pain climbs week on week, or a warning sign appears, stop and get it checked.

Tonight is the test, as two NHS trusts' leaflets put it. Exercise pain "should calm down within a few hours and shouldn't affect your sleep that evening"; if it disturbs your sleep and the pain is still raised the next day, you probably did too much, so do less next time. One of the trusts sets a lower ceiling (4 out of 10); either way, the night after is the check.

For the gentle movements in stage 1, keep to NHS inform's "minimal" band, 0 to 3 out of 10, while night pain is constant.

Sources 37, 36, 30, 43, 44

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Calm the nights: gentle movement, little and often

While night pain is constant or comes most nights, about the first 1 to 2 weeks. Set up your bed (the written steps below), move the shoulder gently through the day as NHS inform advises, and keep walking. Keep these moves within 0 to 3 out of 10. With any warning sign, get checked first. Doses are editorial unless a source is named.

Pendulum exercise (Codman's pendulum) demonstrated on the 3D figure

3D demoPendulum exercise (Codman's pendulum)Beginner · A bench or box

About 1 minute (10 small circles each way), 2 to 3 times a day, and once before bed · The move page's dose, an editorial starting point; NHS inform's shoulder exercises include pendulum swings. Before bed is our suggestion

Harder: Table slide (seated forward reach)

Shoulder rolls demonstrated on the 3D figure

3D demoShoulder rollsBeginner · No equipment

10 to 15 slow circles each way, once or twice through · The move page's dose, an editorial starting point. A way to move the shoulder gently every hour, as NHS inform advises

Harder: Shoulder CARs (controlled articular rotations)

Table slide (seated forward reach) demonstrated on the 3D figure

3D demoTable slide (seated forward reach)Beginner · A bench or box

10 slow reps, 1 to 3 times a day · The move page's dose, an editorial starting point. Pain-free while it's very irritable, as the move page says

Easier: Pendulum exercise (Codman's pendulum) · Harder: Overhead lat stretch at a bench (elbows on the bench)

Stick-assisted external rotation (lying) demonstrated on the 3D figure

3D demoStick-assisted external rotation (lying)Beginner · Other / check instructions

10 slow reps, pain-free, twice a day · The move page's dose for a very irritable shoulder, an editorial starting point. Turning the arm out is the movement frozen shoulder and arthritis lose first

Harder: Standing band external rotation

Thoracic rotation demonstrated on the 3D figure

3D demoThoracic rotationBeginner · No equipment

6 rotations per side, moving with the breath · The move page's dose. Keeps the upper back moving while the shoulder is too sore to stretch

Easier: Side-lying open book · Harder: World's greatest stretch

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

10 to 20 minutes most days, arms swinging naturally · As in our shoulder pain guide; walking outdoors counts the same

Harder: Treadmill jogging

Move on when: You can find a position that lets you sleep for most of the night, daytime pain is mostly 5 out of 10 or less, and the shoulder is back to its usual level by the next morning (our suggestion; our frozen shoulder guide moves on when night pain comes and goes rather than being constant).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Load the rotator cuff, and keep the nights settled

About weeks 2 to 8, on most days: rotator cuff and shoulder-blade strengthening within the 5 out of 10 rule, built up from small numbers as NHS inform and two NHS trusts advise. An NHS trust's leaflet asks for at least 4 days a week, ideally 6. Doses are editorial unless a source is named.

Standing band external rotation demonstrated on the 3D figure

3D demoStanding band external rotationBeginner · A band + An anchor point

Light band, elbow at your side: 2 to 3 sets of 5 to 8, building to 3 sets of 15 · The end point is the Holmgren trial's 3 sets of 15; starting at 5 and building to 15 is an NHS hospital's progression

Easier: Stick-assisted external rotation (lying) · Harder: Side-lying external rotation

Side-lying external rotation demonstrated on the 3D figure

3D demoSide-lying external rotationBeginner · A dumbbell

Lying on your good side with a light weight (a tin of beans): 2 to 3 reps at a time, building to sets of 8, up to 2 sets of 15 · NHS inform's side-lying external rotation, with its pacing. You lie on the other side, so it suits a shoulder you can't lie on

Easier: Standing band external rotation · Harder: Cuban rotation

3D demoBand rowBeginner · A band + An anchor point

3 sets of 10 to 15, stopping 2 to 3 reps short of failure · The move page's dose, an editorial starting point. A shoulder-blade exercise like the Holmgren trial's

Harder: Supported single-arm dumbbell row

Scaption raise demonstrated on the 3D figure

3D demoScaption raiseBeginner · A dumbbell

2 sets of 8, thumbs up, to shoulder height, lowering over 3 s, building to 3 sets of 10 to 15 · Building to our shoulder pain guide's dose; the start is editorial. Stop below any painful arc

Easier: Band lateral raise · Harder: Smith machine upright row

Wall push-up demonstrated on the 3D figure

3D demoWall push-upBeginner · A wall

2 sets of 10, small range · As in our shoulder pain guide. Wall push-ups are in an NHS trust's rotator cuff leaflet

Harder: Push-up

Side-lying open book demonstrated on the 3D figure

3D demoSide-lying open bookBeginner · No equipment

8 to 10 slow openings each side, pausing 2 s at the end · The move page's dose, an editorial starting point. Lie on the good side first (our suggestion), and keep it pain-free with impingement symptoms, as the move page says

Harder: Thoracic rotation

Move on when: You can finish every set within the pain rule, nights are no worse after exercise days, and lifting the arm to shoulder height is comfortable (our suggestion, using an NHS hospital trust's night check).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Strengthen overhead, and the full night back

From about week 8, 3 to 5 days a week, then 2 days a week for the long term: heavier and overhead strength, one change at a time, as our shoulder pain guide's last stage does, while sleeping on the sore side comes back by the written steps below. An NHS trust expects at least 12 weeks, sometimes up to 24.

Prone Y-T-W raises demonstrated on the 3D figure

3D demoProne Y-T-W raisesBeginner · No equipment

2 rounds of 8 of each shape · As in our shoulder pain guide

Easier: Wall angel · Harder: Bent-over reverse fly

Scapular push-up (push-up plus) demonstrated on the 3D figure

3D demoScapular push-up (push-up plus)Beginner · No equipment

2 to 3 sets of 10, on a wall or bench first · As in our shoulder pain guide

Easier: Dumbbell shoulder-blade punch · Harder: Push-up

Band internal rotation demonstrated on the 3D figure

3D demoBand internal rotationBeginner · A band + An anchor point

2 to 3 sets of 15 · As in our shoulder pain guide

Harder: Side-lying external rotation

3D demoFace pullIntermediate · A band

3 sets of 12 to 15 · As in our shoulder pain guide

Easier: Prone Y-T-W raises · Harder: Tuck back lever

Shoulder press with a band demonstrated on the 3D figure

3D demoShoulder press with a bandBeginner · A band

3 sets of 8 to 12, once reaching overhead is comfortable · As in our shoulder pain guide

Harder: Push press

Chest-supported dumbbell row demonstrated on the 3D figure

3D demoChest-supported dumbbell rowBeginner · A dumbbell + A bench or box

3 sets of 8 to 12 · As in our shoulder pain guide

Harder: Supported single-arm dumbbell row

Move on when: Our suggestion: once your nights have been settled for 2 weeks, start lying on the sore side for a few minutes at a time (the written steps below), and keep two strength days a week for the long term. If the shoulder wakes you more after a busy day, drop back a step for a few days.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

How to sleep tonight (written steps)

Our 3D figure can't show these changes. They come from Arthritis UK, two NHS trusts, NHS inform and the NHS; no trial has tested a sleeping position or pillow for shoulder pain, and where a step is our suggestion, it says so.

1. Don't lie on the painful shoulder for now (Arthritis UK and an NHS trust).
2. On your good side: a pillow under your neck, a folded pillow in front of you to hug and rest the sore arm on, and another pillow behind your back so you don't roll onto the sore side in your sleep.
3. On your back: one or two pillows under the sore arm so it's supported.
4. If lying flat is the problem, prop yourself up on pillows or a wedge, or sleep in a reclining chair for a few nights (our suggestion; a study describes a group whose night pain eased sitting up).
5. Before bed: a few gentle pendulum swings or shoulder circles, and heat or an ice pack wrapped in a towel for up to 20 minutes, whichever helps (the NHS and NHS inform). Painkillers such as paracetamol or ibuprofen can help you keep moving; ask a pharmacist which suits you.
6. If you wake in pain, get up, move the arm gently for a minute and resettle the pillows (our suggestion).
7. Good sleep habits help any pain: the same wake-up time, an hour to relax before bed, and no caffeine or alcohol in the 6 hours, and no exercise in the 4 hours, before bed (the NHS).
8. Pregnancy: the NHS says the safest position to go to sleep in is on your side, either side; after 28 weeks, going to sleep on your back can double the risk of stillbirth. If one shoulder is sore, sleep on the other side with the pillow support above.

Sources 4, 1, 30, 33, 32, 18, 41, 45

By day: keep it moving, and pace it (written steps)

These come from NHS inform, the NHS and an NHS trust's leaflet.

1. In the first 1 or 2 days, reduce what you do but move as much as you comfortably can, and move the shoulder gently for 10 to 20 seconds every hour while you're awake (NHS inform).
2. Then use the shoulder more, and stay at or go back to work if you can (NHS inform). Don't stop using it completely (the NHS).
3. Break up the jobs that flare it, such as painting, gardening or reaching, into smaller chunks, and step closer to things rather than reaching out (an NHS trust's pacing advice).
4. Avoid both doing too much and doing too little (the same trust).
5. Heat or ice for up to 20 minutes at a time, such as a hot water bottle or frozen peas wrapped in a tea towel (the NHS), but not if you have problems with circulation or feeling in the skin (NHS inform).

Sources 33, 32, 1, 30

The full night comes back (written steps)

No trial has tested how to return to sleeping on a painful shoulder. These steps are our suggestion, built on two NHS trusts' leaflets.

1. Stages 1 and 2: not on the painful shoulder; on your good side or your back, with the pillow set-up above.
2. Stage 3: once nights have been settled for 2 weeks and exercise days don't wake you more, try a few minutes on the sore side at the start of the night, rolled slightly forward with the arm resting on a pillow in front of you rather than trapped under your body.
3. Roll off before it builds, and add a few minutes every few nights.
4. If the shoulder wakes you more after a busy day or a harder session, that day's load was too much: drop back a step for a few days.
5. Flare-ups happen. Reduce the exercises rather than stopping, and keep two strength days a week for the long term, as an NHS trust's leaflet recommends.

Sources 36, 30

Injections, painkillers and surgery

A steroid injection eases pain and sleep for a few weeks, not for months, and an NHS trust warns against repeated injections. Talk to your GP about one if pain stops you doing the exercises. The NHS suggests paracetamol or ibuprofen, and heat or cold, so you can keep moving.

Surgery is for selected rotator cuff tears and for frozen shoulder that doesn't respond, as our rotator cuff tear and frozen shoulder guides explain. After rotator cuff repair, sleep improved within 6 months in the studies reviewed.

Sources 40, 30, 2, 4, 11, 32

Positions to swap, and why

Habit or position	Why it matters	Instead
Lying on the sore shoulder while it's irritable	It's the usual trigger: lying on the affected side hurts with rotator cuff pain, frozen shoulder and arthritis, and most people with pain in one shoulder who sleep on one side lie on the painful one.	Your good side with a pillow hugged in front and another behind your back, or your back with pillows under the arm.
Lying with the sore arm trapped under your body, if it hurts	Comfort: pressure in the shoulder changes with position, though sleeping with the arms overhead wasn't linked with more pain in a study of workers.	Rest the arm on a pillow in front of you or beside you (our suggestion).
Keeping the arm still, or in a sling, to rest it	The NHS says don't completely stop using your shoulder, because it can stop it getting better.	Gentle movement for 10 to 20 seconds every hour while awake, such as pendulum swings.Try: Pendulum exercise (Codman's pendulum)
A long day of reaching, lifting or painting while the nights are bad	Peaks of activity flare rotator cuff pain, an NHS trust says.	Break jobs into chunks, step closer instead of reaching, and spread them over the week.
The sleeper stretch	It's done lying on the sore shoulder, which compresses it, and its gain wasn't significant in a trial, as our shoulder pain guide's stretch table says.	The cross-body stretch if it doesn't pinch (not with AC joint pain).Try: Cross-body shoulder stretch
Forcing a stretch into pain, such as the overhead lat stretch, with a very irritable or frozen shoulder	While the shoulder is very irritable, our frozen shoulder guide keeps movement pain-free, and the NHS advises against making up your own strenuous exercises.	Pain-free assisted movement with the table slide.Try: Table slide (seated forward reach)
Heavy overhead pressing at the gym in the first weeks	The NHS advises against using heavy gym equipment while the shoulder hurts.	Band external rotation for the rotator cuff in stage 2, then the band press in stage 3.Try: Standing band external rotation
Repeated steroid injections to get through the nights	The benefit lasts weeks, not months, and an NHS trust warns that multiple injections can harm the rotator cuff.	Exercise, and one injection only if pain stops you doing it, after talking to your GP.
Asking for a scan straight away	Rotator cuff changes on scans are common without pain, and most people with rotator cuff pain don't need one.	Get checked if a warning sign appears.

Routines to follow

Shoulder mobility and stability routine (with a band)

A 25-minute band routine for healthy shoulders: move the shoulder and upper back through their range, then strengthen the rotator cuff and shoulder blades.

25 minBeginner12 movesA wall, A band

Neck and shoulder stretches

Eight gentle neck and shoulder stretches for desk stiffness, done standing or seated in ten minutes.

10 minBeginner8 movesA wall

Upper back mobility routine

A 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.

12 minBeginner8 movesA foam roller, A wall

Bedtime stretch routine

A slow, 10-minute floor routine to unwind before sleep: child's pose, twists, happy baby and slow breathing.

10 minBeginner7 movesFirm cushion, A wall

More moves for this area

Questions people ask

Why does my shoulder hurt more at night?

Lying on the shoulder presses on sore tendons and joint surfaces, and the three commonest causes, the rotator cuff, frozen shoulder and arthritis, all ache more in bed, especially on the affected side. Pain that eases when you change position is the usual pattern. Pain that doesn't change whatever position you lie in, or comes with feeling unwell, needs checking.

What is the best sleeping position for shoulder pain?

No trial has tested one. Health services suggest lying on your good side with a pillow under your neck, a folded pillow hugged in front of you for the sore arm and another behind your back so you don't roll over, or lying on your back with one or two pillows under the sore arm. Use whichever lets you sleep longest.

Should I sleep on my painful shoulder?

Not while it's sore: health services advise lying on the other side or your back for now. Once your nights have been settled for a couple of weeks, try short spells on it again and build up gradually (our suggestion). There's no evidence that lying on it causes lasting harm.

Can sleeping on your side cause shoulder pain or a rotator cuff tear?

It hasn't been shown. People with shoulder pain often lie on the painful side, and most people with tears in one clinic were side sleepers, but that study had no comparison group; in 761 workers, sleeping position wasn't linked with shoulder pain or rotator cuff problems. Most people spend about half the night on their side anyway.

Is shoulder pain at night a sign of cancer?

Rarely. Night pain is common with ordinary shoulder problems. Get it checked if the pain is constant and doesn't ease whatever position you lie in, or comes with weight loss you can't explain, night sweats, a fever, feeling unwell or a past cancer, or, if you smoke or used to, a cough or breathlessness.

Why does my shoulder hurt at night with numbness in my fingers?

Pins and needles or numbness with shoulder pain can come from a nerve in the neck, even without neck pain. Tingling in the thumb and first fingers that wakes you is often carpal tunnel syndrome, which is usually worse at night. See a GP if it keeps happening or you notice weakness; our pinched nerve and carpal tunnel guides cover both.

How can I relieve shoulder pain at night?

Set up your pillows before you sleep, move the shoulder gently through the day, and try heat or an ice pack wrapped in a towel for up to 20 minutes before bed. Painkillers such as paracetamol or ibuprofen can help you keep moving; ask a pharmacist which suits you. Over weeks, strengthening is what eases night pain most: in a trial, specific shoulder exercise cut night pain by 20 points out of 100 more than general exercise.

Why does my frozen shoulder hurt so much at night?

Night pain is typical of the early, painful stage of frozen shoulder, and lying on that side makes it worse. It usually eases as the condition moves on, though full recovery can take more than 2 years. Gentle, pain-free movement suits this stage, and a steroid injection can ease bad nights for a while; our frozen shoulder guide covers both.

Will a special pillow or mattress help shoulder pain at night?

None has been tested for shoulder pain. Ordinary pillows to hug and to stop you rolling over are what health services suggest. For the mattress, choose what feels most comfortable.

Could shoulder pain at night be my heart?

Shoulder or arm pain with chest pain that feels tight or squeezing, or chest pain spreading to your arms, neck or jaw, especially with breathlessness, sweating or feeling sick, could be a heart attack: call 999. Shoulder pain that changes with how you lie or move your arm is much more likely to come from the shoulder.

How long does shoulder pain at night last?

It depends on the cause, and no one can promise a timescale. Most new shoulder pain improves within 6 to 8 weeks, rotator cuff pain often takes 3 to 6 months with exercise, and frozen shoulder can take more than 2 years. Night pain usually eases as the daytime pain does.

When should I see a doctor about shoulder pain at night?

See a GP if it hasn't improved after 2 weeks of looking after it yourself, is getting worse, or it's very hard to move your arm; in many areas you can refer yourself to physiotherapy. Get help the same day for sudden or very bad pain, a hot or swollen shoulder, a fever or feeling unwell.

Related exercise guides

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.