Joint and Muscle Pain at Night: What Physical Therapists Recommend to Feel Better

If you’ve ever been kept up all night by joint or muscle aches, then you know just how much pain can interfere with your ability to get a good night’s rest. There’s even a name for it: painsomnia. And it’s fairly common — about 70% of people with osteoarthritis, for example, experience pain that affects their sleep, according to the Arthritis Foundation. Even if you don’t have a chronic condition like arthritis, other musculoskeletal-related discomfort, like muscle strains, can prevent you from falling and staying asleep.

“Many of my patients report that their pain is worse at night, but I reassure them that there’s a lot they can do, like stretching before bed, to feel better and sleep soundly,” says Christine Dang, PT, DPT, a physical therapist at Hinge Health. 

Read on to find out why your joint and muscle pain may worsen when you sleep, and what Hinge Health therapists recommend to ease the nighttime achiness. 

Common Causes of Joint and Muscle Pain at Night

Why can pain sometimes feel worse at night? There are many reasons, according to Hinge Health physical therapists. They include:

Less movement. When you’re lying still at night, many things can add up to more pain. One common issue is less blood flow to sensitive tissues in the body. "Nerves love high blood flow, so the lack of movement at night is often why people with nerve pain have higher pain levels as they sleep," says Dr. Dang.

Fewer distractions. During the day, you’re on the go, whether it’s doing work, running errands, or finishing household chores. “At night, when you lie down in a quiet room, you suddenly don’t have as many distractions, so you’re more aware of what’s going on in your body, including pain,” points out Dr. Dang.

Worries about pain. This is known as pain catastrophizing. “You lie in bed and think about how much you hurt, and worry that it’s not going to get better,” says Dr. Dang. As a result, you focus on your pain, which may also prevent you from falling asleep. 

Sleep Quality, Joint Pain, and Mental Health

Research shows that up to 90% of people who experience chronic pain have problems with insomnia. Unfortunately, this can create a vicious cycle. “When people have pain at night and can’t sleep, it impedes their recovery as levels of stress hormones such as cortisol shoot up, which, in turn, increases pain,” says Dr. Dang. 

There’s another reason why you want to improve your sleep. Too little sleep, or poor quality sleep, has been linked to depression, according to a 2022 study in the Journal of Affective Disorders. When you’re depressed, you may also be less able to tolerate joint and muscle pain, notes Dr. Dang. And you may be less inclined to do activities you enjoy, which may decrease movement which can contribute to joint pain and even more negative feelings. 

A key to breaking this vicious cycle is — not surprisingly —  exercise. A 2023 study in the Journal of European Cardiology found that doing at least 150 minutes of moderate to vigorous activity a week helps counteract the health consequences of not getting enough sleep. Other research suggests exercise can help you get deep, more restorative rest. Plus, movement is vital to managing joint pain. 

When Movement Is Hard

While movement and exercise are often first-line treatments for joint and muscle pain, it can be understandably challenging to build an exercise routine if you’re tired from lack of sleep and generally feeling down. So when it comes to working out, it’s best to start slow and gradually increase your level of activity as your energy improves. 

Many people worry that exercise will make their joint pain worse, may not be safe for their joints, or do more damage. All of these are myths. In fact, being sedentary is associated with worsening arthritis symptoms. Targeted exercises and stretches, on the other hand, can help keep joints healthy and strengthen weaker muscles that often accompany joint pain.

And beyond the physical benefits (decreased pain and stiffness), exercise therapy for joint pain boasts psychological benefits (improved emotional well-being) and functional benefits (more independence and improved ability to do daily tasks). 

Treatment Options and Tips to Relieve Nighttime Joint Pain

If nighttime aches and pains have you tossing and turning, it’s important to find strategies to help you sleep deeper and longer. The following are recommended by Hinge Health physical therapists to help relieve joint pain at night so that you can get your rest.

Do some gentle stretches. Soothing stretches before bed can ease tension in muscles that tend to get tight, like your back, hip, and hamstring muscles," explains Dr. Dang. A 2019 study in the Brazilian Journal of Psychiatry found that people who did stretching exercises three times a week for four months reported better sleep quality than those who didn’t.

Try some deep breathing before bed. “Deep breathing can help you to manage stress, which in turn can reduce hormones that trigger inflammation in the body,” says Dr. Dang. Research shows these sorts of meditation practices can help to improve sleep troubles among people with sleep disturbances such as insomnia.

Try an over-the-counter pain reliever. If discomfort is so intense that it prevents sleep, speak to your doctor to find out if there is an over-the-counter pain reliever, such as ibuprofen, acetaminophen, or naproxen that you can safely take to relieve pain. You can also try a topical nonsteroidal anti-inflammatory such as diclofenac (Voltaren). 

Stay active during the day. Regular exercise has consistently been shown to help improve insomnia, as well as sleep quality in general, according to a 2021 review of 22 studies in the journal Frontiers in Psychiatry. If it hurts to move, you can start slowly with low-impact activities such as walking, cycling, and swimming and gradually work up to higher-impact activities, advises Dr. Dang.

Do some physical therapy. A physical therapist can show you strengthening and stretching exercises to help to relieve joint pain, which will make sleeping easier. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

The above upper body stretches are recommended by Hinge Health physical therapists to do before bed to relax tense muscles and help you prepare for bed.

The above lower body stretches are recommended by Hinge Health physical therapists to do before bed to relax tense muscles and help ease you into sleep.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Adjust Your Sleep Environment

Since it may be harder to sleep if you’re sore, try optimizing your sleep space for comfort. Keep your bedroom on the cool-ish side, Dr. Dang recommends. The National Sleep Foundation recommends anywhere between 60 to 67 degrees. Dr. Dang also suggests you keep your room quiet and dark — you can use a fan or white noise machine to help reduce noise, and blackout shades to help reduce light. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. 

Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Osteoarthritis and Sleep. (2022b, March 15). Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/fatigue-sleep/osteoarthritis-and-sleep 

2. Nijs, J., Mairesse, O., Neu, D., Leysen, L., Danneels, L., Cagnie, B., Meeus, M., Moens, M., Ickmans, K., & Goubert, D. (2018). Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Physical Therapy, 98(5), 325–335. doi:10.1093/ptj/pzy020

3. Yannis Yan Liang, Feng, H., Chen, Y., Jin, X., Xue, H., Zhou, M., Ma, H., Ai, S., Yun Kwok Wing, Geng, Q., & Zhang, J. (2023). Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: a population-based cohort study using accelerometry. European Journal of Preventive Cardiology, 30(9). doi:10.1093/eurjpc/zwad060

4. Xie, Y., Liu, S., Chen, X.-J., Yu, H.-H., Yang, Y., & Wang, W. (2021). Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Psychiatry, 12. doi:10.3389/fpsyt.2021.664499

5. D’Aurea, C. V. R., Poyares, D., Passos, G. S., Santana, M. G., Youngstedt, S. D., Souza, A. A., Bicudo, J., Tufik, S., & de Mello, M. T. (2019). Effects of resistance exercise training and stretching on chronic insomnia. Brazilian Journal of Psychiatry, 41(1), 51–57. doi:10.1590/1516-4446-2018-0030

6. Black, D. S., O’Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2015). Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances. JAMA Internal Medicine, 175(4), 494. doi:10.1001/jamainternmed.2014.8081

7. Healthy Sleep Starts Before You Hit the Sheets. (2022, March 13). National Sleep Foundation. https://www.thensf.org/healthy-sleep-starts-before-you-hit-the-sheets/