It’s not uncommon that sleeping makes problems worse. That is, symptoms become exacerbated and/or movement becomes limited. Morning stiffness to a small extent is allowable when it comes to spinal flexion, but, otherwise, after being up and about for a few minutes, you should have the same amount of mobility you went to bed with.
During sleep, we often spend considerable time in one position without moving - whether we want to or not. It is my opinion that most orthopedic problems are related to movements and postures, so it makes sense that, just like with sitting or walking, sleeping postures can easily make people worse (or better).
If the thought process is that people need muscular strength to “hold” or “stabilize” joints in the right position, then there must be profound weakness if the simple act of sleeping causes joints to destabilize. Similarly, sleeping should not be aggressive enough to strain/pull muscles.
My thought process is this: I agree healthy joints should be able to withstand prolonged positions while sleeping, but I don’t think the answer is muscle-driven stability. And I don’t think muscles get pulled in our sleep. Benign positions like sitting or lying can indeed move joints - regardless of how much muscle is nearby. And these subtle changes can commonly cause symptoms. On the whole, strength is wonderful, but I believe we need to get the joint better first by moving the joint itself.
It’s true that spinal discs enlarge when we lie down to sleep, and that may be the sole factor why someone has more pain and/or less motion upon waking (vs related to any certain position). But even if that is the causative factor, then, again, I want to primarily address the disc (part of the joint) versus address the musculature around it. It’s also true that not all orthopedic problems are joint problems. Sleeping on a painful tendon can worsen symptoms, too. But most problems do have to do with joints - and addressing them effectively is important. -- Laura
A lot of health measures take time, but we don’t often consider them nuisances. For one, because they’re normalized habits and, two, because we easily recognize their value. Many of these revolve around preventing infection. Our musculoskeletal system benefits from daily or at least regular attention as well. Is checking your motion or performing certain movements cumbersome? Well, it does take a few minutes. But if you value bathing and hand washing and devote time to those, you can also value the health of your joints, tissues, and nerves. The choice is yours - and, to be clear, it is a choice. (No equipment is required.) Like infections, musculoskeletal disorders cannot be 100% prevented, but “inconvenient” preventative measures (not just exercise) go a long way. -- Laura
1. How long has it been this way?
2. What brought this about and what brings it about?
3. Is it limited actively?
4. Is it limited passively?
5. Is there pain with active ROM?
6. If so, when? If so, where?
7. Is there pain with passive ROM?
8. If so, when? If so, where?
9. How does the end of the ROM feel?
10. Is it consistently like this, or does it vary?
There are more concerns regarding the whole patient presentation and problem at hand, but these focus in on range of motion (the entire motion available to a joint). Presumably I’m only discussing ROM with a patient if it’s problematic. This may seem like a lot, but it really only takes a few minutes to get these verbal and physical answers. Knowing the questions to raise is step one, knowing how to physically test it (the easiest part) is step two, and knowing how to interpret the findings is step three.
Learn more about the world of diagnosing and treating orthopedics here!