Musculoskeletal Health: Nighttime Pain

Musculoskeletal Health: Nighttime Pain

We spend about a third of our lives in bed with the goal of getting a good night’s sleep. Yet, the reality is that for some people, much of that time is spent not sleeping. It can be difficult to sleep, especially with pain. Research shows that pain interferes with sleep and poor sleep worsens pain.

Pain has many causes, among them various musculoskeletal conditions. It is difficult to manage such pain during the day and it can be even more challenging at night.

Musculoskeletal Pain

Your musculoskeletal system supports your body. It’s primarily made up of bones, joints, cartilage, muscles, tendons, ligaments, and connective tissue. These structures are present throughout your body, thus you may have pain from a musculoskeletal problem anywhere - from the muscles supporting your neck to a bone in your ankle joint. However, the neck, shoulder, back (especially the lower back), hip, and knee are the areas most often affected.

Common Causes

The most common causes of musculoskeletal pain include:

  • Sprains and strains -- injuries to muscles, tendons, or ligaments

  • Incorrect or lack of movement, or overuse -- like poor lifting technique, bad posture, lack of physical activity, or repetitive movements.

  • Arthritis -- long-term wear-and-tear on joints, especially osteoarthritis. Bursitis is another joint-related cause of pain. It is inflammation of the small sacs (bursae) that lubricate some of the joints.

  • Injuries and accidents -- strains and sprains from sports injuries, slips & falls, or sudden, jarring movements.


The onset (how it starts) of musculoskeletal pain varies depending on the cause.

  • Pain may develop suddenly. For example, if you slip on the ice and land on your hip, you may sprain one of the ligaments in the hip.

  • Pain may develop gradually. For example, over time you may develop osteoarthritis in one of your shoulders. The joint changes often worsen, resulting in increasing pain

  • Pain may come and go. For example, you may damage one of your knees from the wear-and-tear of years of running. With some treatment, the pain may lessen, only to recur.

Musculoskeletal Pain At Night: What You Can Do

As with any painful condition, nighttime may be a particularly difficult time. You can make some changes to help lessen pain at night and improve your sleep. 

Activity and Exercise

  • Daytime activity. Being active during the day helps with sleep. Try to get some exercise every day. Remember to avoid those activities that increase pain. 

  • Gentle stretching. Try slowly moving the painful area before you go to sleep or if you wake up during the night.

  • Strengthening exercises. Keep your bones, joints, and muscles strong. Goodpath has therapeutic exercise videos - for example for hip pain, knee pain, and back pain.

Medicines and Supplements

  • Heat application. Applying heat helps lessen pain. You can apply heat throughout the day or if you wake up during the night with pain. To prevent injury to your skin, only use heat for minutes at a time or as recommended by package instructions.

  • Topical pain reliever. Patches, gels, and rubs applied to the area help lessen pain. Using gentle massage when applying gel or cream adds to the pain relief. 

  • Timing of pain medicines and supplements. Carefully follow instructions. Your doctor, pharmacist (or a Goodpath coach) can answer questions and work with you to determine the best time to take them e.g. to be most effective at night time.

  • Timing of sleep medicines and supplements. As with pain medicines, following instructions and timing are essential.

Mind-Body Techniques 

  • Cognitive behavioral therapy (CBT). CBT for insomnia (CBT-I) and CBT for pain are psychological treatments that help you change your thoughts, feelings, and behaviors as they relate to sleep problems or pain.

  • Relaxation techniques. Deep breathing, guided imagery, and other techniques can help you relax before bedtime or get back to sleep if you wake at night. They can help lessen your pain-associated anxiety and stress.

Sleep Environment And Position

  • Sleep environment. Make sure you’re comfortable.

    • An appropriate bedroom temperature helps with sleep. You don’t want to wake up because you’re too hot or too cold. 

    • Staying warm can also help you maintain a healthy sleep position. As an example, an appropriate sleeping position may make it difficult to cover part of your body, so you’ll need to wear something to stay warm and comfortable.

    • Keep lights and noise to a minimum.

  • Mattress comfort

    • Your mattress should be medium-firm and allow for good body alignment regardless of your sleep position, your ears, shoulders, and hips should be aligned.

    • An older mattress may no longer provide good support. If it’s been years since you last bought a mattress, it may be time.

  • Sleep position

    • Avoid sleeping on your abdomen as it's difficult to maintain good body alignment.

    • Don’t sleep with your arms under or above your head.

    • When moving from one position to another, do it carefully. Try not to twist or make quick movements.

    • There are specific sleep positions depending on the location of your pain.

There are specific sleep positions to consider, depending on the location of your pain. Explore these; they are not only comfortable but may also support musculoskeletal health.

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