Understanding Trigger Points – Shoulder pain when sleeping on your side

Client’s Description

referral - infraspinatus - main belly - anteriorPeople complain of pain that disturbs their sleep when lying on the painful shoulder or on the opposite shoulder. It is a deeper pain than the illustration suggests. They have spent most of their time sleeping on that shoulder with that hand in front of them. It usually comes on gradually over months and eventually gets difficult to ignore. It may come on quickly when there is a trauma to the shoulder or an unusual sleeping situation. Often, the afflicted has tried many sleeping positions and would just like to get back to sleeping on their side, which is most restful.

They have trouble reaching back to tuck in a shirt or reaching to the floor of  back seat of the car or extending their arm out to put something on the night stand. This can also create pain when stretching to reach overhead.

referral - infraspinatus - main belly - posteriorThere are other symptoms that are common but not always present, The grip is weak on that hand and they have learned to be careful with things like a coffee cup. They may have pain in the back of the neck but usually don’t complain about that, at first. They may also have pain when reaching high overhead.

The trigger point is activated because sleeping on that shoulder has chronically displaced the humerus in the shoulder socket and the muscle has tightened to stabilize the shoulder. Just a trigger point doing its job.

The tests to see if this muscle is the problem, involve those movements. The first one involves placing the forearm across the low back. The second one involves reaching around the back of your head to place your palm on your opposite ear. Restriction and pain in either of those activities indicates a problem. A few other muscles, especially coracobrachialis, may create pain and restriction in these movements. In that case, the pain pattern will be different.

infraspinatus back test infraspinatus wrap test


Self Care

There are a number of self-care strategies. You can stretch the arm across the front of your body while standing in the shower with the back of the shoulder under hot water. This is one of the most popular and effective strategies for temporary relief. Some people use a tennis ball or other object to press into the back of the shoulder-blade. Unless you get some guidance from your therapist, you could actually aggravate it more than you help it by doing that.


If you can do it, sleeping on your side, with the arm behind you, is usually quite effective and helps the shoulder joint. Most people have trouble with turning over and such when sleeping like that. The most commonly recommended sleeping position is on your other side with arm of the painful shoulder supported so that it is at a right angle from the body. Level 2 trigger points create pain on stretch and draping the arm down across the body creates a sustained stretch that eventually generates enough pain to wake you.

This is usually a small problem in the position of the shoulder joint that just gets worse over time. You should see a bodyworker that knows shoulder work. Most NMT therapists address this by working the rotator cuff tendons, especially subscapularis  which mobilizes the humeral head. They will also know how to more accurately assess this, change posture and work on the spinal components for lasting relief.

Therapy Notes

oit-infraspinatisInfraspinatus is a common problem in the shoulder and the most likely to generate pain when the client sleeps on their side. Its position in the shoulder is critical for stabilizing the head of the humerus from shifting forward.

Mobilizing the humeral head is critical. This is why working the tendon of subscapularis solves pain that is created  by infraspinatus.  Self-care with a change of sleeping position, stretches and a tennis ball can be critical to recovery.

Similar Patterns

Click on these categories to see if there is a referral pattern that better describes your concerns.

 tags-upper-neck tags-shoulder tags-shoulder-joint tags-upper-arm tags-forearm tags-hand


Tony Preston has a practice in Atlanta, Georgia where he sees clients.

He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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