Pillows for Shoulder Pain and Side Sleeping

Why nights are worse

• Pressure on the joint. Lying on the sore shoulder compresses inflamed tendons and bursae.
• Pulling on the joint. Lying on the other side lets the top arm fall forward and across the body, which stretches the sore shoulder.
• Reduced movement. Lying still for hours lets stiffness set in.
• Reduced distraction. At night, with nothing else to think about, pain feels louder.
• Neck and spine alignment. A pillow that is too low or high twists the neck, and shoulder pain often follows.
• Condition-related. Rotator cuff tears, bursitis, osteoarthritis of the shoulder, frozen shoulder (adhesive capsulitis), and referred pain from the neck are all common after 60. See frozen shoulder in older adults: home management.

Principles of good side-sleeping support

1. Neutral neck. The head pillow should fill the gap between the head and the mattress, so the nose is in line with the middle of the chest. Not too high, not too low. 2. Supported arm. The top arm should rest on a pillow in front of the body, not hang across it. 3. Open chest. The sore shoulder should not be rolled forward or squeezed. 4. Aligned hips. A pillow between the knees keeps the pelvis level and takes strain off the back. 5. A comfortable mattress, neither so firm that the shoulder bears too much, nor so soft that the body sinks and twists; see mattress firmness for back pain.

Choosing the head pillow

For side sleepers, a thicker, firmer pillow is usually needed than for back sleepers, to fill the space between the ear and the outer shoulder. The right height depends on shoulder width: broader shoulders need more loft.

• Height. When lying on the side, the neck should be level, neither bent up nor down. If the head tilts towards the mattress, add height; if it tilts away, reduce it.
• Firmness. Medium-firm foam or latex that holds its shape; a very soft pillow collapses.
• Shape. A contoured pillow with a higher edge for side sleeping and a lower middle for back sleeping gives flexibility. Some have a notch for the shoulder.
• Adjustable fill. A pillow with removable inserts lets you fine-tune the height.
• Cover and hygiene. Breathable, washable; see pillow hygiene, dust mites and allergies.

See neck pillows for travel and sleep for more on loft and materials.

Pillows for the arm and body

Body or long pillow. A long, firm pillow hugged against the front of the body supports the top arm and leg together. The arm rests on top and the knee on the lower part. It prevents the arm from falling across the chest. A full-length pillow is better than a short one.

Arm pillow or wedge. A small cushion or a folded pillow placed in front of the chest, on which the top arm rests with the hand relaxed. Keep the elbow slightly bent.

Pillow in the armpit. For some people with a sore shoulder, a small, soft pillow under the armpit of the painful side when lying on the back keeps the arm slightly away from the body and relieves pressure.

Rolled towel. A temporary tool: a towel roll under the elbow.

Pillow between the knees

A thin or medium pillow between the knees keeps the legs apart, aligns the pelvis and reduces twisting at the lower back and hips. It also helps after hip replacement if advised; see cushions after hip replacement. A knee pillow with a strap stays in place.

Different sleeping positions

On the good side. Usually best for shoulder pain. Lie on the side away from the sore shoulder, with the sore arm resting on a pillow in front of you, the elbow slightly bent and the hand relaxed. A body pillow supports the arm and the knees.

On the back. Often comfortable for sore shoulders. Place a thin pillow under the sore arm or elbow, so the shoulder does not drop backwards, and a small pillow under the knees. A pillow under the sore upper arm may help. Avoid a high head pillow that pushes the chin to the chest.

On the sore side. Usually avoided, but if you must, a thick pillow in front of the chest and a soft layer, such as a mattress topper, under the shoulder, can reduce pressure. Ask a physiotherapist.

Semi-reclined. For people who cannot lie flat because of pain or breathing, a wedge or an adjustable bed lets them sleep upright; see wedge pillows and positioning a bedridden parent.

Stomach. Often twists the neck and strains the shoulder; try to avoid.

A trial plan for the first week

1. Choose a head pillow height that makes the neck level. 2. Add a body pillow or a firm arm pillow. 3. Add a knee pillow. 4. Try for three nights without changing anything else, noting what wakes your parent. 5. Adjust one thing at a time: a thicker or thinner pillow, a different position of the arm. 6. If the pain is worse after a week, stop and ask a doctor or physiotherapist.

Other ways to ease shoulder pain

• Gentle range-of-movement exercises as taught by a physiotherapist, such as pendulum swings and wall slides. Do not force.
• Heat before exercise and cold after, with care; see hot packs and older skin and heat or cold for joint pain.
• Pain relief as advised by a doctor; see painkillers and older adults.
• Posture. Avoid slumping and long reaching; keep frequently used items at waist to shoulder height.
• Dressing technique. Dress the sore arm first, undress it last.
• Avoid lifting heavy items overhead.
• Review daily gadgets, such as reachers; see reachers and grabbers.
• A sling only if advised.

Warning signs: see a doctor

Seek medical help promptly for shoulder pain with:

• chest pain, breathlessness, sweating or pain down the arm or into the jaw (possible heart problem: call emergency services);
• sudden loss of power or inability to lift the arm after an injury (possible tear or fracture);
• fever, redness, swelling or heat in the joint (infection);
• pain after a fall;
• numbness, tingling or weakness in the arm or hand, or neck pain with arm symptoms;
• night pain that is severe, constant and unrelieved by position, which needs investigation;
• unexplained weight loss or a history of cancer; or
• pain that has not improved after several weeks.

Care of pillows

Wash covers weekly and pillows as the label directs; replace flattened pillows. Body pillows need washable covers and regular airing.

When to ask a professional

A physiotherapist can diagnose the cause of shoulder pain, teach exercises and advise on positions and pillows. A doctor can assess for tears, arthritis, frozen shoulder and other causes, and offer injections or surgery where needed. An occupational therapist can advise on daily activities. Our care advisors can arrange a physiotherapist visit and recommend supports.