Making the Connection: Sleep and Injuries


When we’re sick or injured, we all know that getting plenty of rest is important. This is because during sleep your muscles and soft tissues heal and scar tissue develops. Scar tissue is the dense fiber that the body creates to repair injuries, whether it’s a sudden injury or a chronic injury that develops over time.

What people don’t realize is that the way you sleep can aggravate an injury and prevent it from healing properly.

This is because when scar tissue develops it can bind up and tie down tissue that needs to move freely. This buildup is known as adhesions, trigger points or knots. As scar tissue builds up, muscles become shorter and weaker, tension on tendons can cause tendonitis, and nerves can become trapped. This can reduce range of motion and strength, and create pain. If a nerve is trapped you may also feel tingling, numbness, and weakness.

It’s important to sleep in a neutral position so that your body can heal properly from injury.

And even if you don’t have an injury, if you’re not sleeping in a neutral position, you can create problems like my patient Sam.

Sam is a 35-year-old male that came to the office because he had been suffering with low back pain for “as long as he could remember.” He explained that he had a “knot” of pain located on the right side of his back just above the hip bone. He had been to numerous chiropractors, acupuncturists, osteopaths, orthopedists, and pain management specialists over the past 12 years. Some of the treatments helped for a few hours but none were permanent or long-term.

We performed a thorough history and evaluation, including an extensive overview of lifestyle and biomechanics.  Sam exercises 3-5 days a week and has a healthy diet. Past MRI and X-rays showed a normal healthy spine. So I asked Sam about his sleeping habits – he spends most of the time prone, or on his belly.

After a physical exam we realized that in addition to Sam’s low back pain, there was also significant decrease in the movement of the neck. The decrease in neck movement could possibly be attributed to the fact that his head was rotated most of the night. In the office we did myofacial release technique in which ART was utilized as well as manual manipulation/chiropractic release of the joints. He was advised to sleep in his normal position until the next treatment. Sam left the office feeling better than he had in years and was pain-free until the next morning. What that told us was that his muscle tension was possibly related to his sleep position. I then gave Sam sleep directions with tips on how to keep a neutral position. After the second treatment and change in sleeping pattern, Sam’s pain was gone for good.

Repetitive Stress and Sleeping

When sitting, standing, or holding any general position for too long our limbs can get sore or “fall asleep,” which can also happen during sleep.  Most healthy adults sleep an average of 6-8 hours, or up to 1/3 of our lives.  During that time, many have experienced numbness or soreness otherwise described as “sleeping” or ”dead” limbs.  This sensation will usually dissipate after changing positions or shaking the limb out. In some cases the sensation can be strong enough to wake us up.

Why do limbs fall asleep? The simple answer is that blood flow to the muscle and nerves is compromised.  This depletes the muscles of the resources needed to function, slowing the nerve conduction which creates this loss of feeling. Common triggers for this compromise are sleeping positions.

Ergonomics and repetitive stress are known triggers of injuries such as carpal tunnel syndrome, Achilles’ tendonitis, plantar fasciitis, joint and Disc degeneration. Many people take the time to change the way they sit at a desk, type on a computer, drive a car, and talk on a phone. Repetitive stress injuries can occur while doing mundane everyday activities, and sleeping is no exception.

How should we sleep?

The two ideal positions to sleep in are on your sides or on your back. We want to avoid sleeping on our stomachs to avoid torsion. Torsion in the neck and lower back can create compression of the discs, degeneration and muscle strain.

Ideal Side Position

Lay on your side with a pillow under your head and between your legs:
To ensure a neutral position your pillow should be as thick as the distance between your ear and shoulder. The pillow between your legs should ensure that the top leg does not cross over the bottom leg.

Ideal Back Position

Lay on your back with one pillow under your head and one or two under your knees:
When on your back we want to focus on the curve of your spine. Choose a pillow that will support the natural curve of your neck. The pillow under your knees should have enough height to keep your low back comfortably flat against the mattress.

Every person is a little different and may need other specific variations, for further assistance call your local chiropractic specialist so you can wake up feeling truly well rested.

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  • Some great tips here – thank you very much. Stay well and happy !

  • JP

    Thank you for this. I thought i would be about scars – can you please post something about preventing or diminishing scar tissue? I recently suffered a lesion on my forehead, which was stitched back together and is now healing slowly. I'm researching healing methods.

  • deckliss

    I was just confused by reading the title of this blog. But when I read it I found some strong reason behind it.

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  • RoBoat

    I started sleeping on my back 4 years ago after being a life-long twisted side/stomach sleeper. It was one of the best things I ever did for my health. My chronic neck pain has been relieved. Plus as a bonus, I believe that since I am no longer squishing wrinkles into my face for 8 hour stretches at a time, my face has not been aging as quickly!

  • That’s the problem, I too feel sometime in the morning after my sleep. So it caused due to wrong sleeping position. I would certainly take care of it from now on. Really useful tips.

  • Jennifer Johnson

    Lower back pain is really a very serious condition if not dealt properly. If your are not sleeping in a position to give rest to your body then it give rise to the back pain or injuries related to your spine or the shoulders. I really appreciate that you have mentioned the basic & the correct postures to sleep in the nights to avoid any discomfort and pain.
    AOK Emergency Room

  • ACP

    I find that sleeping on my side for years and years has also cause issues in my left shoulder arm and lat muscle. Now that I’ve switched to my right for some time I am starting to feel similiar discomforts. Anyone else have issues?

  • ACP

    I find that sleeping on my side for years and years has also cause issues in my left shoulder arm and lat muscle. Now that I’ve switched to my right for some time I am starting to feel similiar discomforts. Anyone else have issues?

  • Snowgoose

    Any recommendations for changing your sleep pattern? I know full well that sleeping on my stomach reeks havoc on my neck and gives me chronic headaches, but in the middle of the night I always seem to turn onto my stomach no matter how I start off sleeping (on my back).

  • Michelle

    I get the pain in my stomach I start off on my side I struggle to sit up in the morning with pain :/