You’re tossing and turning in bed, trying to go to dreamland. But the dull, throbbing pain in your shoulder has been bugging you for the entire day, even more so at night. In the morning, simple tasks like brushing your hair and picking up groceries can be difficult or near impossible.
But why does your shoulder pain only flare up at night? What can be done to resolve this? Read on to find out the mystery behind the night-time pains and the various TCM methods to treat them!
Why is my shoulder pain worse at night?
Shoulder pain worsens at night due to minimal or lack of movement, slowing down blood flow to the shoulders which leads to stiffness and pain. Poor sleeping position like laying on the side or sleeping with your arms overhead places more pressure on your shoulder joints, resulting in stiff and achy shoulders in the morning. Overtime, shoulder pain can disrupt deep sleep patterns and hinders recovery, leading to a never-ending cycle of worsening shoulder pain.
In TCM, shoulder pain flares up at night due to the invasion of pathogenic cold (寒) ailment. There are external and internal factors for pathogenic cold. External factors can come from being drenched in the rain or frequent exposure to cold wind. This causes Qi stagnation, which creates blockage in the vessels, bringing pain. Cold also has the ability to restrain activity of Qi, which reduces transport of nutrients to parts of the muscles and tendons. This may create tension in the muscles that may accumulate and develop into aches.
Internal factors refer to cold that arises within the body such as the consumption of cold food/drinks, leading to Yang and Qi deficiency in various “TCM organs” such as the spleen, kidneys, and/or heart. This disrupts the flow of Qi and blood to the shoulder joints, leaving them undernourished and more prone to stiffness and pain. Yang and Qi deficiency can also lead to other symptoms such as stomach pain, vomiting, fever, and diarrhoea.
What are some TCM treatment options?
TCM treatment provides pain relief by expelling coldness from the body to improve Qi and blood circulation. More importantly, TCM aims to address the root causes of your condition to prevent pain from developing in the future.
At Singapore Paincare TCM, we offer a range of specialised TCM services targeted to your needs. Our physician will first understand your medical history, location of pain, type of pain, and more to identify the root causes of your shoulder pain. This enables the physician to create a targeted treatment plan that involves the following:
Acupuncture involves the insertion of thin needles into specific acupoints of the body to remove Qi blockages and stimulate Qi flow. Tuina provides similar effects but uses a combination of massage techniques such as stretching, pressing, kneading, and rolling. This treatment re-establishes a harmonious Qi balance in the body, in turn restoring the body’s natural healing abilities, minimising the risk of injuries. In addition, acupuncture/tuina stimulates the release of endorphins, which is our body’s natural painkillers, to relieve any pain and tension in the body. For shoulder pain, common acupoints include:
- Jian Jing (肩井, GB21): Located on the middle of the shoulder line (directly above the nipple) This acupoint helps to relieve shoulder and neck pain. Do note that this acupoint can also risk inducing labour; the physician will avoid this acupoint for pregnant women.
- Feng Chi (风池, GB20): Expels pathogenic wind out of the body, stimulating blood flow to ease tense muscles. It is located at the 2 depression points between the base of the skull and the top of the neck (near your hairline), one on each side.
- Yang Ling Quan (阳陵泉穴, GB34): Located in the depression diagonally in front and below the head of the fibula (at the outer side of the knee), this acupoint improves liver Qi and alleviates pain. It is often used for issues involving the fascia, which forms an important part of the shoulder. It is also suitable for those suffering from pain in the lower extremities e.g. knees.
Cupping is another TCM treatment that involves placing special glass or plastic cups onto specific points on the skin to create suction. It draws the skin into the cup, creating a space between the skin and the muscles which release tension in the muscles. Cupping promotes lymphatic circulation and direct more immune cells to the area of inflammation, which can in turn reduce painful swelling. Cupping usually leaves a temporary redness on the skin, which will lighten up and disappear within 1-2 weeks.
The placement of the cups depends on the specific causes of your condition, which requires a consultation with a physician. For shoulder pain, the cups are more commonly placed along the shoulders as well as the upper back. Cupping is generally safe, though you should seek your doctor’s opinion if you have conditions such as blood disorders, low blood pressure, and/or are pregnant.
Moxibustion is a non-invasive procedure that involves the burning of a herb called mugwort (Arthemisia vulgaris) in the form of a moxa stick over specific points of the body. The heat from the burning can expel coldness from the body, which is especially useful for shoulder pain at night since it is predominantly caused by the invasion of pathogenic cold. In addition, moxibustion is known to reduce swelling from acute injuries and improve local circulation. Moxibustion is often used to complement acupuncture in treating frozen shoulder and provide pain relief.
Herbs are natural ingredients to address health issues and restore balance and harmony in the body. Herbs can be combined based on the individual’s unique constitution to optimize the therapeutic effect and resolve the root causes of the health issue.
To expel coldness from the body (which is causing shoulder pain at night), herbal formulas like Kudzu Decoction (葛根汤) (quite commonly found in supermarkets) and Notopterygium Decoction (羌活胜湿汤) (you have a good chance of finding it in large TCM products shops) are the ones for you. Turmeric 姜黄 and ginger 生姜 tea can reduce inflammation and swollen shoulders with their anti-inflammatory properties. For pain relief, Ru Xiang (乳香) and Mo Yao (没药) invigorate the Qi and promote the flow of blood to resolve pain caused by Qi/blood stagnation. These herbs are available at TCM herbal shops.
Herbs are often consumed complementary with TCM services like acupuncture to maximise the therapeutic effects and achieve a pain-free body as soon as possible. To understand which herbs can maximise the therapeutic effects specific to your body’s constitution, it is better to seek a physician’s consultation.
What are some lifestyle changes to avoid shoulder pain?
While treatment methods can relieve your current shoulder pain, good lifestyle habits are just as important to avoid future injuries.
Changing sleeping posture
Shoulder pain at night happens when you place your body weight on your shoulders for a prolonged period of time. To avoid this, have your arms by your side rather than overhead. But if you naturally toss and turn in your sleep, it could be a sign of stress and anxiety in your life. Perform some relaxation techniques like deep breathing and meditation before sleeping. (Or surround yourself with pillows to prevent excessive movement). Try to avoid sleeping on the side or stomach as it increases the risk of developing shoulder pain and spine issues respectively. However, if you have either of those sleeping habits, use pillows to prop your head and neck up such that your spine is aligned, and rest your face towards the side where your shoulder is hurting.
Maintain good posture
Avoid slouching when sitting or standing. If you’re working, keep everything within arms’ reach – this would avoid reaching for objects that would put more strain on your back and shoulders. Good posture is also important when exercising, especially when it involves lifting heavy objects. Tighten the core and lift from your legs rather than the back. To minimise strain on the shoulders, aim to avoid lifting anything above the shoulders unless it is recommended by a physiotherapist or any other qualified personnel.
Stretching helps to remove tension, increase flexibility and range of motion in your shoulder joints. Do note that you should stop if you feel intense pain at any point during the exercises. Some useful exercises that you can try out are:
Roll your shoulders in a circular motion in a forward and backward direction.
Thread the needle
On your hands and knees, start by lifting your left hand and moving it through the space between your right arm and right leg until your left shoulder touches the floor. Hold that position for about 1 minute before repeating on the other side.
Bring your arm across your chest and use the opposite arm to hold the arm in place for about 1 minute.
Cow face pose
Reach your right arm up while the left arm stays down. Bend your elbows such that your right fingertips are touching the left placed behind your back. If you cannot reach the fingertips, use a towel to achieve similar position of the arms.
For a more extensive treatment, you can seek physical therapy, where licensed physiotherapists will perform a series of stretching, massage, strengthening, and joint stabilisation exercises based on your condition. Heat treatment or other non-surgical methods may be used to maximise the effects.
Get the Appropriate Paincare
Try out any of the tips above to bid farewell to your shoulder pain – and get a good night’s sleep! At Singapore Paincare TCM Wellness, we integrate a unique east-west approach to maximise the effects of our treatments. Our physicians and therapists undergo multiple training at Singapore Paincare Academy (administered by Singapore Paincare Medical Group) to gain a better understanding of clinical conditions so that together with their TCM expertise, they can help patients recover.