Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. eBicep is not a medical provider and cannot diagnose, treat, or provide medical recommendations. Always consult a qualified healthcare professional for diagnosis and treatment of any injury or medical condition. eBicep and its authors assume no liability for any actions taken based on the information provided.
Waking up with bicep pain—or having pain that prevents you from sleeping—is frustrating and concerning. Let's explore why this happens and what you can do about it.
Why Pain Gets Worse at Night
Several factors can make musculoskeletal pain worse at night:
Reduced distractions: During the day, your attention is divided. At night, with nothing else to focus on, pain becomes more noticeable.
Inflammatory cycles: Cortisol (which has anti-inflammatory effects) naturally decreases at night, potentially allowing more inflammation and pain.
Position: Sleeping positions can put stress on the bicep tendon or muscle, especially at the shoulder.
Reduced blood flow: Lying still decreases circulation, which can increase pain perception in injured tissues.
Muscle cooling: Active muscles have good blood flow; resting muscles cool down, potentially increasing stiffness and pain.
Common Causes of Nighttime Bicep Pain
Bicep tendonitis:
Inflammation of the bicep tendon (especially at the shoulder) commonly causes night pain. The shoulder-position during sleep can aggravate an inflamed tendon.
Muscle strain:
Recent injury or overuse can cause pain that's worse when the muscle cools down and stiffens overnight.
Shoulder problems:
Issues like rotator cuff tendonitis or impingement can cause pain that radiates into the bicep area, often worse with certain sleeping positions.
Delayed onset muscle soreness (DOMS):
Pain from training typically peaks 24-72 hours after exercise. If you trained biceps 1-2 days ago, this may explain nighttime discomfort.
Referred pain:
Neck or upper back issues can refer pain to the arm. If bicep pain is accompanied by neck symptoms, this may be the cause.
Strategies for Relief
Optimize sleeping position:
• Avoid sleeping directly on the affected arm
• Try sleeping on your back with a pillow supporting the arm
• If side-sleeping, hug a pillow to keep the arm supported
Pre-sleep treatments:
• Apply ice for 15-20 minutes before bed if inflammation is suspected
• Gentle stretching may help if muscles are tight
• Over-the-counter anti-inflammatories taken with dinner (consult a pharmacist regarding timing)
Environmental factors:
• Keep the bedroom warm enough—cold can increase muscle stiffness
• Use a pillow or support to maintain comfortable arm position
Address the underlying cause:
• If tendonitis: follow treatment protocols (rest, gradual loading)
• If recent strain: allow adequate recovery time
• If DOMS: time will resolve it, but gentle movement and blood flow help
When Night Pain Indicates a Problem
Some causes of night pain warrant medical attention:
Constant, severe pain: Not just discomfort but significant pain that prevents sleep entirely.
Neurological symptoms: Numbness, tingling, or weakness in the arm or hand along with the pain.
No clear cause: Pain that started without any injury, overuse, or training explanation.
Progressive worsening: Pain that's getting worse over time rather than improving.
Systemic symptoms: Fever, unexplained weight loss, or feeling generally unwell along with the pain.
These warrant evaluation to rule out conditions like nerve compression, referred pain from the spine, or other medical issues.
Helping Pain Resolve
Short-term:
• Modify training to avoid aggravating the issue
• Use ice after any activity that causes pain
• Consider OTC pain relievers as needed
• Optimize sleep position
Medium-term:
• Address any identified underlying cause (tendonitis, strain, etc.)
• Gradual return to training with pain-free progression
• Consider physical therapy if not improving
Prevention:
• Proper warm-up before training
• Progressive loading rather than sudden increases
• Adequate recovery between sessions
• Address any form issues or muscle imbalances
The Bottom Line
Nighttime bicep pain usually relates to inflammation, position, or recent training. Most cases improve with position modifications, addressing the underlying cause, and time. However, severe pain, neurological symptoms, or pain without clear cause warrants medical evaluation.
Don't ignore persistent night pain—it's your body telling you something needs attention.