Back vs. Side Sleeping: Impact on Shoulders

Did you know your sleep position can directly affect your shoulder health? Whether you wake up pain-free or with discomfort often depends on how you sleep. Here’s what you need to know:

• Back sleeping is better for shoulder health as it evenly distributes weight, reduces pressure, and keeps your spine aligned.
• Side sleeping can strain your shoulder due to prolonged pressure and misalignment, especially if you already have shoulder pain or injuries.
• Key problems from poor sleep posture include rotator cuff injuries, bursitis, frozen shoulder, and arthritis.
• Quick fixes: Use proper pillows, choose the right mattress, and adjust arm positioning to minimize strain.

Quick Comparison

Factor	Side Sleeping	Back Sleeping
Pressure on Shoulders	High; one shoulder bears body weight	Minimal; weight is evenly distributed
Spinal Alignment	Risk of misalignment if poorly supported	Promotes natural alignment
Pain Risk	Higher, especially with pre-existing issues	Lower when proper support is used
Best For	Non-affected side sleeping with support	Shoulder pain, rotator cuff injuries
Popularity	60%+ of adults prefer this position	Only 8% of adults sleep this way

Switching to back sleeping or improving your side-sleeping setup can help protect your shoulders and reduce pain. Small changes, like using a supportive pillow or adjusting your mattress, can make a big difference.

Sleeping positions - Pt.3: Shoulders | Tim Keeley | Physio REHAB

Side Sleeping: How It Affects Your Shoulders

Side sleeping is a favorite for many, but it can take a toll on your shoulders. When you sleep on your side, one shoulder ends up bearing the weight of your upper body, which can lead to pressure and alignment issues over time.

Pressure and Alignment Problems

Prolonged pressure on one shoulder can reduce blood flow, limiting the delivery of oxygen and nutrients. This pressure can also compress tissues, leading to inflammation in the surrounding soft tissues and straining the rotator cuff.

A study published in Arthroscopy, Sports Medicine, and Rehabilitation in February 2024, led by Richards DP and colleagues, highlighted a strong link between side sleeping and shoulder injuries. Out of 58 adults with rotator cuff injuries, 52 were side sleepers. Another study, featured in the Journal of Manipulative & Physiological Therapeutics in June 2012, found that two-thirds of 83 patients seeking chiropractic care for shoulder pain slept on the side where they experienced discomfort.

Dr. Michael Stone, an orthopedic surgeon at Cedars-Sinai Orthopaedics, points out:

"Side sleeping does not cause shoulder pain, however it may exacerbate symptoms."

For people with pre-existing shoulder conditions - like rotator cuff injuries, bursitis, frozen shoulder, or osteoarthritis - side sleeping can worsen these issues. In cases of rotator cuff damage, the added pressure may even lead to further injury or tearing.

When Side Sleeping Works

For those without shoulder problems, side sleeping can be fine. However, for individuals dealing with shoulder pain or injuries, this position might aggravate symptoms. If you need to sleep on your side, paying attention to pressure relief and proper alignment is crucial. Here are some practical tips to help you sleep more comfortably.

How to Sleep on Your Side Safely

If side sleeping is your go-to or a necessity, these adjustments can help protect your shoulders and promote better alignment:

• Pick the Right Side: Sleep on the shoulder that isn’t painful. This simple switch can make a big difference.
• Maintain Spinal Alignment: Keep your spine neutral by using a supportive pillow for your head. Make sure your ears are aligned with your shoulders and avoid twisting your neck.
• Use Pillows Strategically: A firm pillow under your head helps with alignment. Place a pillow between your knees to support your hips and reduce back strain. If your shoulder hurts, tuck a pillow under the affected arm for added support.
• Position Your Arms Properly: Keep your arms at your sides and avoid placing them under your pillow or raising your elbow above your head. These positions can compress nerves and restrict blood flow.
• Choose the Right Mattress: A medium-firm mattress can evenly distribute your weight, reducing pressure on your shoulders.
• Slightly Elevate Your Knees: Drawing your knees slightly toward your chest can help maintain your spine’s natural curve and ease back pressure.

Even small tweaks to your sleeping habits can make a noticeable difference in how your shoulders feel when you wake up. Taking the time to adjust your position and bedding can help you sleep more comfortably and wake up pain-free.

Back Sleeping: How It Affects Your Shoulders

Back sleeping helps evenly distribute your body weight, which can reduce strain on your shoulders during the night. Unlike side sleeping - where pressure is concentrated on one shoulder - lying on your back spreads the load more evenly across your back and spine. Let’s explore who benefits most from this sleeping position and how it supports shoulder health.

Less Pressure on Shoulders

When you sleep on your back, your shoulders aren’t compressed against the mattress, which promotes better blood flow and reduces inflammation. This even weight distribution is especially important for preventing shoulder pain and aiding recovery.

Back sleeping also minimizes pressure on your spine compared to other positions. Dr. Andrew Bang, a chiropractor at Cleveland Clinic, emphasizes the importance of proper shoulder alignment during sleep for recovery:

"You want to avoid your shoulder dipping down to meet the bed. That's when you feel the pain. Your goal should be to find a neutral posture when you sleep so those ligaments that stretched out during the day can shrink and creep back to their normal position. Let your body truly rest and recover."

By keeping your shoulders elevated and aligned, back sleeping avoids the common issue of shoulder collapse. This position allows your spine to rest neutrally, reducing pressure on nerves and helping shoulder muscles and ligaments fully relax. It also eases muscle tension around the shoulders, which encourages better healing overnight.

Who Should Sleep on Their Back

Back sleeping is especially helpful for those dealing with shoulder pain or recovering from shoulder injuries. If you’re experiencing conditions like rotator cuff problems, bursitis, or general discomfort, this position can provide much-needed relief.

Although back sleeping is beneficial, it’s not as popular as side sleeping. Statistics show that about 74% of people sleep on their side, while only 8% sleep on their back. Interestingly, many people with shoulder pain tend to sleep on the side that hurts - a pattern seen in 67% of participants in one study. Switching to back sleeping could be a game-changer for these individuals, as it aligns with effective recovery strategies for shoulder pain.

How to Sleep Comfortably on Your Back

If you’re transitioning to back sleeping, the right setup can make all the difference. The American Academy of Orthopedic Surgeons suggests a few key adjustments to enhance comfort and reduce pain.

• Pillow placement: Use a pillow under your head that keeps your neck in a neutral position - neither too high nor too low. For added support, place a rolled-up towel or small pillow under your shoulders or between your shoulder blades.
• Arm positioning: If your shoulders feel uncomfortable, rest your arms on a folded blanket or low pillow to keep them aligned. Placing a small pillow under each arm can also provide extra support.
• Lower body alignment: To maintain your spine’s natural curve, place a small pillow under your knees. This reduces pressure on your lower back and ensures proper alignment while you sleep.
• Mattress choice: A medium-firm mattress works best for back sleepers, offering a balance of comfort and support. It should be firm enough to keep your spine aligned without sacrificing comfort.

If you’re worried about rolling onto your side during the night, try surrounding yourself with extra pillows to create a barrier. This can help you stay in the back sleeping position as you adjust to the change.

Dorian Logan, PT, DPT, a physical therapist at Hinge Health, underscores the connection between pain and sleep quality:

"Pain can make it hard to get the restful sleep your body needs, and when you're not well-rested, you're more likely to notice and feel your pain."

Side vs. Back Sleeping: Which Is Better for Shoulders

When it comes to shoulder health, your sleep position plays a bigger role than you might think. Back sleeping generally puts less strain on the shoulders compared to side sleeping. Studies show that lying on your back reduces pressure on the spine and shoulders, while side sleeping can sometimes lead to misalignment, causing pain and discomfort.

Interestingly, even though over 60% of people prefer side sleeping, only about 8% sleep on their back. Many unknowingly choose positions that could worsen shoulder pain.

Dr. Andrew Bang from the Cleveland Clinic offers simple advice:

"If something leads to pain, don't do it."

Side sleeping often causes the shoulder to collapse into the mattress, misaligning the head, shoulders, and spine. This can strain the rotator cuff and lead to discomfort. Back sleeping, by contrast, keeps the shoulders supported and aligned, which can provide relief and improve overall comfort.

That said, side sleeping isn’t entirely off the table. With the right adjustments - like sleeping on your non-painful side and using proper support to prevent your shoulder from slumping forward - it can still be a viable option.

Here’s a quick comparison of the two positions:

Comparison Table: Side vs. Back Sleeping

Factor	Side Sleeping	Back Sleeping
Pressure on Shoulders	High pressure on the bottom shoulder; risk of collapse into the mattress	Minimal pressure; shoulders remain supported
Spinal Alignment	Can cause misalignment if the shoulder dips toward the bed	Promotes natural spinal alignment
Pain Risk	Higher risk of soreness and tightness in shoulders	Lower risk when proper support is used
Best For	Non-affected side sleeping with pillow support	Rotator cuff injuries, bursitis, calcific tendonitis
Popularity	Over 60% of adults choose this position	Only about 8% of adults sleep this way
Sleep Quality Impact	May lead to sleep disturbances due to shoulder pain	Associated with better sleep quality for shoulder issues
Required Support	Firm mattress, pillow between knees, arm support	Pillow under knees, neutral head position
Recovery Benefits	May limit recovery on the affected side	Promotes healing by reducing joint strain

For those dealing with rotator cuff injuries or bursitis, back sleeping often emerges as the better option. Dr. Pamela Mehta, a shoulder surgeon based in San Jose, emphasizes this point:

"The best sleeping position for pain from rotator cuff injury is sleeping on your back."

This advice aligns with research showing that individuals with rotator cuff tears often experience disrupted sleep. Proper positioning can significantly improve both comfort and recovery.

If you’re a side sleeper, don’t worry - you can still make it work. Focus on sleeping on your non-affected side, and use pillows strategically to keep your shoulder properly aligned. Studies confirm that poor sleep positions can lower sleep quality and prolong shoulder discomfort, so finding the right setup is key.

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SHOULDER Reliever: Better Sleep for Shoulder Recovery

Adjusting your sleep position can help ease shoulder pain, but pairing good posture with targeted treatments offers the best results. The SHOULDER Reliever system tackles shoulder pain from two angles: strengthening muscles during the day and supporting recovery while you sleep. This combined approach works in sync with the natural wake-sleep cycle and complements earlier strategies for improving sleep posture.

Daytime Exercises and Nighttime Support

The SHOULDER Reliever employs a two-part system. During the day, exercises focus on strengthening the rotator cuff and lowering the shoulder to reduce impingement caused by bone spurs. At night, a specially designed support sleeve aids healing by promoting blood flow.

As SHOULDER Reliever explains:

"Our simple solution combines our patented daytime exercise and a revolutionary nighttime support sleeve that puts your arm in a position of healing."

The daytime routine is straightforward - just 5 minutes, three times a week. These exercises help reduce impingement and build muscle strength. Internal data shows that wearing the nighttime strap for at least 4 hours per night can significantly enhance recovery. Interestingly, some users have reported substantial improvement using only the daytime exercises. For instance, one individual achieved a 90% recovery without ever using the nighttime brace.

For the best results, start with the daytime exercises and gradually incorporate the nighttime strap, aiming for a minimum of 4 hours of use per night.

Enhancing Sleep Posture with SHOULDER Reliever

The nighttime support sleeve is suitable for both back and side sleepers, though it works particularly well for those sleeping on their back. It prevents you from putting direct pressure on the affected shoulder and keeps your arm from drifting above your head during sleep.

SHOULDER Reliever emphasizes:

"The main benefit is keeping you from sleeping on the affected shoulder and keeping the arm from going above your head. The looser the brace, the better. You don't want it to pull on your hand. If you feel it's too tight, make it looser."

The sleeve gently positions your shoulder for recovery without limiting movement, allowing you to maintain your preferred sleeping style. For side sleepers, it reduces direct pressure on the shoulder, while back sleepers benefit from improved arm positioning that minimizes strain.

User experiences highlight the system’s effectiveness. James H., a 70-year-old dealing with rotator cuff pain for over three years, shared:

"At age 70, I've been dealing with rotator cuff pain for over 3 years. The Shoulder Reliever is the best method by far for strengthening my shoulder and allowing me to get a good night's sleep."

Another user with a torn rotator cuff reported being pain-free after just 14 days of use, while one customer noted their shoulder felt more stable than it had in years.

The system is priced at $189.99, with occasional discounts available via email. It also comes with a 60-day money-back guarantee, giving you the opportunity to see if it suits your shoulder recovery needs and sleep preferences.

How to Change Your Sleep Position

Switching sleep positions can be tough because it’s something we’ve done the same way for years. Dr. Aleksandar Videnovic, director of the Division of Sleep Medicine at Massachusetts General Hospital, explains:

"It's a habit we've developed since infancy."

Still, with patience and the right strategies, you can shift to a sleep position that’s better for your shoulders. Here’s a guide to help you make this change.

Steps to Switch Sleep Positions

If you’re trying back sleeping, start by placing a pillow under your knees to ease pressure on your lower back and keep your spine aligned. Use additional pillows around your hips to stop yourself from rolling over during the night. A medium-firm mattress paired with a cervical pillow can help maintain the natural curve of your neck. To ease into this position, practice lying on your back for 15–30 minutes each night, gradually increasing the time.

For side sleeping, a body pillow can help you stay in position. Place a pillow between your knees to keep your hips aligned, and adjust your mattress firmness to better support your body. Make sure your pillow is the right height to align your head and neck properly. Adapting to this new position might take a few weeks, and you may need to experiment to find what works best for you.

When to See a Doctor

If your shoulder pain doesn’t improve despite changing positions, or if you experience breathing issues, worsening pain, or disrupted sleep, it’s time to consult a sleep specialist. Dr. Rachel Salas from the Johns Hopkins Center for Sleep and Wellness emphasizes the importance of trying new positions but cautions:

"People get into habits and can be reluctant to experiment with position in pursuit of better sleep, but if you can't find a comfortable position, don't ignore that."

Additionally, if you notice numbness, tingling, or sharp pain that persists, these could be signs of an underlying issue that requires medical attention.

Stay Consistent and Use Support Tools

Consistency is key when adjusting to a new sleep position. Even if it feels uncomfortable at first, stick with it to allow your body time to adapt.

To support your progress, consider using tools like the SHOULDER Reliever. This device provides nighttime traction to keep your shoulders aligned and maintain proper spacing for better blood flow and healing. The SHOULDER Reliever is designed to be worn loosely throughout the night, helping you avoid sleeping on the affected shoulder and preventing your arm from moving above your head.

You can also use pillows to maintain neutral arm alignment and incorporate gentle shoulder stretches before bed. Applying a heating pad can relax tight muscles, while cold therapy may help reduce inflammation. Combining these techniques with consistent effort can make the transition smoother while protecting your shoulders.

Conclusion: Better Sleep for Healthier Shoulders

Your sleep position can have a big impact on shoulder health. Choosing the right one could mean waking up refreshed and pain-free instead of starting the day with discomfort. Sleeping on your back stands out as the best option for shoulder health. It reduces strain on your shoulders, neck, and spine while helping your body stay properly aligned through the night.

Interestingly, only 8% of people sleep on their backs - the ideal position for shoulder health - while nearly 70% experience shoulder soreness. This gap between popular habits and what's actually helpful sheds light on why shoulder pain is so common.

When your body maintains a neutral posture during sleep, ligaments can recover more effectively, reducing strain and supporting full recovery.

Orthopedic experts strongly recommend avoiding side sleeping if you’re dealing with conditions like arthritis, bursitis, or tendonitis. Side sleeping puts prolonged pressure on your shoulders, which can worsen issues like rotator cuff injuries or biceps tendonitis.

To take recovery a step further, adding targeted support can make a big difference. Pairing proper sleep posture with tools like the SHOULDER Reliever’s day-and-night system can strengthen muscles and aid healing. In fact, using this system for just 4 hours during the night has shown noticeable benefits.

Switching to back sleeping or improving your current sleep habits can set the foundation for healthier shoulders. Consistent alignment during sleep leads to better rest and pain-free mornings.

FAQs

How can I switch from side sleeping to back sleeping to reduce shoulder pain?

Switching from sleeping on your side to sleeping on your back can help ease shoulder pain and support recovery. To start, try placing a supportive pillow under your injured arm. This reduces pressure and keeps your arm slightly elevated, which can be more comfortable. Adding a small pillow under your knees can also help maintain proper spinal alignment and make back sleeping more comfortable.

It’s important to avoid lying directly on your sore or injured shoulder. Instead, take gradual steps to adjust your sleeping habits. Creating a relaxing sleep environment - like keeping the room dark and quiet - can make the transition easier and improve your overall sleep quality. These small changes can go a long way in protecting your shoulders and aiding the healing process.

What are the best pillow and mattress adjustments to ease shoulder pain while sleeping?

To help alleviate shoulder pain while sleeping, it's important to use a pillow that keeps your shoulder in a neutral position. If you sleep on your back, try placing a pillow under your elbow for added support. For side sleepers, tucking a pillow between your arms can help reduce pressure and provide relief.

A medium-firm mattress works well for easing shoulder discomfort. It strikes a balance between support and pressure relief, making it a great choice for maintaining proper alignment. Adjustable beds can be another option to consider, as they let you elevate your head and arms. This can be especially helpful for side sleepers, as it minimizes pressure on the shoulders and promotes better alignment.

These small adjustments can make a big difference in reducing shoulder strain and improving your overall comfort during sleep.

What daytime exercises can help improve shoulder health and support better sleep posture?

If you're looking to improve your shoulder strength and flexibility for better sleep posture, adding a few simple exercises to your daily routine can make a big difference. Here are some effective options:

• Shoulder blade squeezes: These target the upper back, helping to improve your posture and support your shoulders.
• Gentle shoulder rotations: Perfect for enhancing mobility and easing stiffness in the shoulder joints.
• Across-the-chest stretches: Great for loosening up tight shoulder muscles and improving range of motion.
• Neck stretches: These help relieve tension in the neck, which can affect shoulder alignment and overall comfort.

By including these exercises in your day, you'll not only encourage recovery but also reduce the chances of future discomfort. This makes it easier to drift off and wake up feeling refreshed.