Shoulder Pain When Lifting Your Arm or Sleeping: 7 Common Causes and How to Treat Them
Shoulder Pain When Lifting Your Arm or Sleeping: 7 Common Causes and How to Treat Them
By Anthony El Asmar, DPT, DO, MSc – Osteopath & Physiotherapist in Lebanon
Shoulder pain is one of the most common musculoskeletal complaints affecting adults. Whether you experience discomfort while lifting your arm, reaching behind your back, exercising, or sleeping on your side, shoulder pain can significantly interfere with daily activities.
Some patients describe a sharp pain when raising their arm above shoulder level. Others complain of a deep ache at night, difficulty putting on a jacket, or weakness when lifting objects.
But why does your shoulder hurt, and when should you seek treatment?
As an osteopath and physiotherapist practicing in Beirut and Lebanon, I frequently assess patients with shoulder pain caused by tendon disorders, joint restrictions, muscular problems, and sometimes conditions originating from the cervical spine.
Understanding the possible causes is the first step toward selecting the most appropriate treatment.
1. Rotator Cuff Tendinopathy
The rotator cuff consists of four muscles and their tendons that help stabilize and move the shoulder.
These tendons can become painful when their capacity is exceeded by physical demands or when other contributing factors are present.
Common symptoms include:
Pain when lifting the arm
Discomfort when reaching overhead
Pain when sleeping on the affected shoulder
Difficulty lifting objects
Weakness or pain during certain movements
Rotator cuff tendinopathy is particularly common among people performing repetitive overhead activities, manual work, weight training, or sports involving throwing.
Can osteopathy and physiotherapy help?
Treatment may include activity modification, progressive strengthening, movement rehabilitation, and manual therapy when appropriate.
The objective is to improve shoulder function and gradually increase the tendon's tolerance to activity.
2. Subacromial Pain Syndrome (Shoulder Impingement)
Many patients have heard the term shoulder impingement.
Traditionally, it was described as a tendon being compressed beneath part of the shoulder blade during arm elevation.
However, modern research suggests that shoulder pain is more complex than a simple mechanical pinching problem.
Today, clinicians frequently use the term subacromial pain syndrome to describe a group of shoulder conditions producing pain around the shoulder during movement.
Symptoms may include:
Pain when raising the arm sideways
Discomfort during overhead movements
Pain when reaching behind the back
Night pain
Difficulty with certain gym exercises
What is the best treatment?
Many patients benefit from progressive exercise therapy, load management, and education.
Manual therapy may provide additional short-term symptom relief for selected patients, but it should not replace active rehabilitation.
3. Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder is a condition characterized by significant shoulder pain and progressive restriction of movement.
It often develops gradually and can interfere with simple activities such as dressing, washing your hair, or reaching into a cupboard.
Typical signs include:
Increasing shoulder stiffness
Difficulty lifting the arm
Restricted external rotation
Pain at night
Reduced active and passive shoulder movement
Frozen shoulder is more common in middle-aged adults and in people with certain conditions, including diabetes.
How is frozen shoulder treated?
Management depends on the stage and severity.
Treatment may involve education, appropriate mobility exercises, pain management, and gradual rehabilitation. Some patients may benefit from medical interventions such as corticosteroid injections.
Recovery can take many months, and treatment should respect the patient's pain sensitivity rather than forcing painful movements.
4. Rotator Cuff Tear
A rotator cuff tear can develop following an injury or gradually over time.
However, not every rotator cuff tear causes symptoms, and not every tear requires surgery.
Some people have tears visible on MRI without experiencing significant shoulder pain.
Possible symptoms include:
Shoulder pain during movement
Weakness when lifting the arm
Difficulty performing overhead activities
Night discomfort
Reduced functional capacity
A sudden injury followed by marked weakness or inability to lift the arm should be assessed promptly.
Do rotator cuff tears always require surgery?
No.
Many patients improve with appropriate rehabilitation, depending on the type of tear, symptoms, functional limitations, and individual circumstances.
Large acute traumatic tears or substantial loss of function may require orthopedic evaluation.
5. Shoulder Osteoarthritis
Osteoarthritis can affect the glenohumeral joint, where the upper arm bone meets the shoulder blade.
This condition may cause pain, stiffness, and progressive limitations in shoulder movement.
Symptoms can include:
Deep shoulder discomfort
Reduced range of motion
Stiffness after inactivity
Difficulty reaching overhead
Grinding sensations during movement
Treatment options
Management may involve strengthening exercises, maintaining mobility, modifying aggravating activities, and appropriate pain management.
In advanced cases, orthopedic consultation may be necessary.
6. Biceps Tendon-Related Pain
The long head of the biceps tendon passes through the front of the shoulder.
Pain involving this region may occur alongside rotator cuff disorders or other shoulder problems.
Common complaints include:
Pain at the front of the shoulder
Discomfort when lifting or carrying objects
Pain during certain pulling exercises
Tenderness around the anterior shoulder
Treatment generally focuses on progressive loading, movement assessment, and management of contributing factors.
Importantly, anterior shoulder pain does not automatically mean that the biceps tendon is responsible.
A complete clinical examination is necessary.
7. Cervical Spine Problems: When Shoulder Pain Comes From the Neck
One of the most overlooked possibilities is that shoulder pain may originate from the cervical spine.
Some patients seek treatment for shoulder pain when the actual source involves irritation of cervical nerve structures.
This may occur with conditions such as cervical radiculopathy.
Signs suggesting possible cervical involvement include:
Shoulder pain associated with neck pain
Pain traveling down the arm
Tingling or numbness
Weakness in the arm or hand
Symptoms aggravated by certain neck movements
In these situations, treating the shoulder alone may not adequately address the problem.
The cervical spine and neurological system should also be assessed.
Why Does Shoulder Pain Get Worse at Night?
Night pain is a frequent complaint among patients with shoulder disorders.
Several factors may contribute, including:
Direct pressure on the painful shoulder while sleeping.
Irritation of sensitive shoulder structures.
Reduced ability to change positions comfortably.
Inflammatory processes in certain conditions.
Persistent pain sensitivity.
Night pain alone does not establish a specific diagnosis.
However, persistent or unexplained night pain, particularly when accompanied by systemic symptoms, deserves medical assessment.
What Is the Best Sleeping Position for Shoulder Pain?
There is no single position that works for everyone.
Some practical suggestions include:
Avoid prolonged direct pressure on the painful shoulder.
Sleep on the opposite side with a pillow supporting the affected arm.
If sleeping on your back, place a small pillow beneath the painful arm for comfort.
Avoid forcing the shoulder into positions that significantly increase symptoms.
The goal is to find a comfortable, supported position rather than maintain a rigid sleeping posture.
When Should You See an Osteopath or Physiotherapist for Shoulder Pain?
Consider a professional musculoskeletal assessment if:
Shoulder pain persists or repeatedly returns.
You cannot comfortably lift your arm.
Pain affects your sleep.
You experience weakness during daily activities.
You have difficulty dressing or reaching behind your back.
Your shoulder pain prevents you from working or exercising.
Previous treatments have provided only temporary relief.
Seek urgent medical assessment after significant trauma with deformity or inability to move the arm, or if shoulder pain occurs with chest pain, shortness of breath, or other concerning systemic symptoms.
Progressive neurological weakness also requires prompt evaluation.
How Is Shoulder Pain Diagnosed?
A thorough clinical examination is essential because several shoulder disorders produce similar symptoms.
During an assessment, I consider:
Medical and Pain History
Understanding when the symptoms started, whether an injury occurred, and which activities aggravate the pain.
Shoulder Range of Motion
Evaluating active and passive movements to identify painful or restricted directions.
Muscle Strength
Assessing the rotator cuff and surrounding muscles.
Specific Orthopedic Tests
Using appropriate clinical tests to investigate possible tendon, joint, or other musculoskeletal involvement.
Cervical Spine Assessment
Determining whether the neck or neurological structures may be contributing to the symptoms.
Functional Assessment
Evaluating movements relevant to the patient's work, sports, and daily activities.
Imaging such as ultrasound, X-ray, or MRI may be appropriate in selected cases, but it is not automatically necessary for every patient with shoulder pain.
Can Osteopathy Help Shoulder Pain?
Osteopathic treatment may help selected patients manage pain and improve movement when musculoskeletal factors contribute to their symptoms.
Depending on the clinical findings, treatment may include:
Joint mobilization
Soft-tissue techniques
Manual therapy
Movement rehabilitation
Progressive strengthening
Exercise prescription
Education and activity modification
The important principle is that shoulder pain should not be treated with the same technique for every patient.
A patient with frozen shoulder requires a different management strategy from someone with rotator cuff tendinopathy or cervical radiculopathy.
An individualized approach is therefore essential.
Why Choose Anthony El Asmar for Shoulder Pain Treatment in Lebanon?
If you are searching for the best osteopath or physiotherapist in Beirut or Lebanon for shoulder pain, it is important to consider clinical experience, qualifications, and the quality of the assessment rather than relying solely on promises of immediate relief.
Anthony El Asmar, DPT, DO, MSc, is an osteopath and Doctor of Physiotherapy with more than 13 years of clinical experience in musculoskeletal assessment, manual therapy, and rehabilitation.
In addition to clinical practice, he teaches osteopathy and manual therapy at the university level.
His clinical approach combines:
Detailed musculoskeletal evaluation
Clinical reasoning and differential diagnosis
Osteopathic manual therapy when indicated
Physiotherapy-based rehabilitation
Individualized exercise programs
Patient education and prevention strategies
The objective is not simply to temporarily reduce shoulder pain but to help patients improve movement, restore function, and manage their condition effectively.
Patients seeking osteopathic or physiotherapy care in Lebanon can arrange an assessment at Therapy by Anthony El Asmar, with locations in Achrafieh, Dekwaneh, and Jezzine.
Frequently Asked Questions About Shoulder Pain
Why does my shoulder hurt when I lift my arm?
Pain when lifting the arm can be associated with rotator cuff tendinopathy, subacromial pain syndrome, frozen shoulder, joint disorders, or other conditions. A clinical examination is necessary to distinguish among them.
Why does my shoulder hurt when I sleep?
Direct pressure, positioning, and sensitivity associated with shoulder conditions may contribute to nighttime discomfort. Persistent symptoms should be assessed.
Can an osteopath treat rotator cuff pain?
Osteopathic management may be part of conservative treatment, particularly when combined with appropriate strengthening, education, and activity modification.
Can shoulder pain come from my neck?
Yes. Cervical spine conditions, including cervical radiculopathy, can sometimes cause pain perceived around the shoulder or arm.
Do I need an MRI for shoulder pain?
Not always. Many shoulder conditions can initially be assessed clinically. Imaging is considered when the history, examination, suspected injury, or response to treatment indicates that it may influence management.
Who should I consult for shoulder pain in Beirut?
A qualified osteopath or physiotherapist experienced in musculoskeletal assessment can evaluate many common shoulder problems. Certain injuries or medical conditions may require referral to a physician or orthopedic specialist.
Shoulder Pain Treatment in Beirut and Lebanon
Shoulder pain should not prevent you from enjoying daily activities, working comfortably, or participating in sports.
Whether you are experiencing pain when lifting your arm, discomfort during sleep, shoulder stiffness, or recurring symptoms, the first step is identifying the likely contributing factors.
Anthony El Asmar, DPT, DO, MSc provides individualized osteopathic and physiotherapy-based assessment and treatment for musculoskeletal conditions.
Therapy by Anthony El Asmar
Clinic locations: Achrafieh • Dekwaneh • Jezzine, Lebanon
Areas of clinical practice: Shoulder Pain • Neck Pain • Lower Back Pain • Sciatica • Herniated Discs • TMJ Disorders • Sports Injuries • Musculoskeletal Rehabilitation
Book your shoulder assessment to better understand your symptoms and explore appropriate treatment options.
About the Author
Anthony El Asmar, DPT, DO, MSc is an osteopath, Doctor of Physiotherapy, and university lecturer with more than 13 years of clinical experience. His work focuses on musculoskeletal pain, osteopathy, manual therapy, and functional rehabilitation in Lebanon.