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

If you lie propped up on your elbow for some time, it’s likely when you go to first move it, it’s stiff. Same with sitting on a crossed hip or ankle. As you start to move, the joint rapidly loosens and there’s no lasting impact. Do this enough, though, and it can become harder for a joint to consistently rebound to its correct alignment. And as the joint further deforms, this stiffness may become pain.
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While this applies to extremity joints, these days it seems more prevalent in the spine. If your day entails primarily kneeling, it can become increasingly stiff and painful to straighten your knee(s). More commonly, though, if your day is spent protruding your neck looking at a computer or rounding your back driving in a car’s bucket seat, your spine may enter the stiffness-pain paradigm.

For many joints, it can be hard to notice stiffness/motion loss. Detecting stiffness, however, is often important in the prevention of pain, especially with previously painful joints. I therefore teach my patients how to self-test their affected joint each day. If stiffness is spotted, their corrective exercise should be performed to restore full joint motion and prevent unwanted escalation into pain. --Laura