Morning Stiffness Part 1

It’s that morning again! That moment when you wake up and keep hitting the snooze button, but you know that you just need to get up. The thoughts of the day’s tasks bring back all that anxiety and tension, and just make you want to stay buried in bed. After about 10-20 minutes of deciding when to get up or if you should sleep some more, you finally take the courage to sit up (that is if you don’t feel that stiffness) and rest your feet on the ground.

But then it hits you like a slap. You notice that you can’t move fast enough and the more you move, the more you cringe from all the discomforting stiffness. The kind of stiffness that makes you think that maybe you slept wrong or arthritis is finally kicking in early this year. Your mornings become dreadful and your mood has gone down to dread. Yet you have no choice but to get ready quick, make your breakfast, drink your coffee, and head out for another “fun” day at work.

The day goes by and the stiffness is now a lot less that you barely think about it, especially if you have a more active lifestyle than those with desk jobs. All day grinding out your duties, you then head home to finally relax and unwind from the stresses of the day. Then BOOM!! Pain and stiffness kicks in. Maybe not as bad as it is when you wake up, but still intense enough that it makes you concerned.

Now you’ve been this way for quite some time. You then find the courage to call up your doctor and see what is going on and what you can do. So, you go to the doctor in the hope that you can solve the issue. He/She will likely sit you down and take a brief BS 5-minute history of what you are feeling, order you an X-Ray or an MRI to waste your time and money, and depending on your results, will prescribe you anti-inflammatories or shoot you with a cortisone shot to mask the pain, and finally advise you not to lift anything more than 10 lbs. If the pain meds didn’t do their job, then the doc raises his hands up and passes you over to physical therapy.

So now that the doctor is relieved and doesn’t have to deal with you due to his uncertainty, and you are going to physical therapy where a therapist is seeing 4 people an hour and the environment feels like a sweat shop. They hook you on some heat and e-stim for a good 15 minutes, which is basically a time save for the therapist, and then the therapist “works” on you with some massage and techniques he learned 20-30 years ago. They then leave you at the gym area doing another 20 minutes of bike and some “core” exercises. The therapist will most likely give you home exercises that are printed out in PDF and just tell you do to these exercises 1-2 times a day. Chances are though that you won’t even bother doing these movements because they have no immediate effect and simply are boring…and they are!!

This can go on and on with PT until your follow up with your doctor for another series of pain meds and injections. Does all this sound familiar, or at least close to something you have experienced? Well, this is what most people battle with when they experience intense stiffness in the morning or even at nights. Unfortunately, the doctor will not sit there for at least 30 minutes to take a more thorough history of your stiffness so he can then track down the causes. The doc simply doesn’t have the time for that, the energy, or even the skills to sit you down and figure out where all of this is coming from. So, therapists like us are the ones to save the day! Therapists that are open-minded and skilled enough to understand that there are always hidden causes to injuries and dysfunctions.

I personally used to be one of those therapists that would see 4 people an hour on a slow day, and I remember that almost NOBODY felt better at their end of the session because it was impossible to fully commit to what each patient truly needed. Working in an environment like that is what motivated me to finally go out on my own.

After seeing the doctor multiple times, going to PT, trying to do your exercises, and popping pills like M&M’s, the morning stiffness and discomfort is still there and just won’t go away. The only relief you feel is when you are moving around during the day, and only at those times can you forget that you have stiffness.

Well, there is your answer! You finally found one of your own solutions to your morning stiffness:

MOVEMENT!!!

Before I get into more depth about movement, let’s just explore 3 possible causes of your stiffness:

1. Increased Intervertebral Disc Size

Research has shown that morning stiffness may be due to an increase in fluid concentration within our intervertebral discs. As we sleep, gravity is eliminated on our spine and with that, throughout the night, synovial fluid and other nutrients enter the discs in our spine and they expand in size. This is why you are a little taller in the morning, but a tad shorter as the day goes by. So, when the discs are expanded, it may be a little harder to move around until all the fluids have been drained out of the discs.

2. Obstructed Airway

In our generation, we see a lot more airway issues than we have in older generations. One reason is because with the rise of technology, babies are now fed with baby bottles more often than in previous eras of human history. That in turn can shape our mouths in a way where they become smaller at an earlier age due to the slimmer form of the bottles. The face becomes narrower and long, palates are a lot deeper and we develop an overbite (jaw positioned behind the top teeth). Especially when it comes to diets, we as Americans have shifted more into the western diets and even better, vegan diets, with a focus on soft foods that feel comfortable to chew and fast to swallow. Historically for both men and women, jaw lines where a lot stronger, wider, and better positioned in relation with the skull. That is because they were fed differently as babies and were raised to eat meat and other hard-textured foods that strengthen the jaw and create a different shape. In the book “GASP”, Dr. Michael Gelb DDS dives into this a lot deeper and explains how the shape of the jaw causes obstruction in our airways.

When we lay in bed at night and usually on our back, our jaw then retracts back due to gravity. Now if you are like me with a slight overbite, the jaw is already retracted to begin with. When we are on our backs, the jaw retracts even further and that in turn will narrow your airway to breath. Imagine your jaw is your own hand wrapped around your throat and pushing it slightly back. That is what your jaw is doing all night, which is also one of the causes of snoring.

There is now an increased resistance during inhalation as well as trapped airflow during exhalation. With increases in resistance breathing in, secondary inhalation muscles such as the lumbar erectors, scalenes, and SCMs become overactive to pull air into the lungs. Hence, the stiff neck and lower back additionally.

With a jaw that obstructs your airway, there is now poor O2, NO2 and CO2 gas exchange. Large amounts of CO2 are increased within our airway followed by low O2 and NO2. So, the more CO2 within our system, the more we would feel like complete crap in the morning such as feeling tired, lethargic, thirsty, have muscle stiffness, and soreness.

3. Lack of Mobility

Many people turn to intense stretching, foam rolling, lacrosse ball release and more, in order to relieve stiffness or release those “knots” they have on their backs. Please understand that there is no such thing as knots in our muscles. Muscle fibers don’t tangle themselves when you have that bumpy feeling as you you roll over it. That is just a muscle belly, tendon, or some other tissue that is naturally there. So, no need to roll the crap out of those areas, you’re just wasting your time and probably making matters worse since you are inducing pain to yourself. If it is not foam rollers or lacrosse balls, then we turn to stretching. Although I do approve of dynamic or ballistic stretching for warm-up purposes, I am no advocate of static stretching.

There is no research paper out there that shows great positive results in relieving muscle tension or if it helps with recovery. In fact, they show a decline in strength and reflexes, decreased neuromuscular responses, and may even cause further stiffness if stretched too much. I would personally use static stretching for those who underwent surgery, yet it would still not be one of my top methods of treatment.

I see many people also lean towards Yoga, which for some reason is now a form of controlled stretching. We must understand that Yoga is form of meditation through poses, not stretching poses. Especially now with more fancy types of yoga such as Power Yoga, Hot Yoga etc., they are still not the most recommended methods for relieving stiffness.

Mobility on the other hand is different than stretching. In stretching, muscles are being lengthened, while mobility is the movement of joints within the available ROM they have. Mobility is what we need to be more concerned with because joints are structures that pay the toll of pain and stiffness.

Within our joint, we have these receptors called mechanoreceptors (Type I, II, III and IV). They basically sense the position of the joint in space. They send signals to the brain informing it that it is moving and how much. When there is lack of mobility, mechanoreceptors die down and that in turn will increase the number of other receptors called Nociceptors.

Nociceptors are relatively unspecialized nerve cell endings that initiate the sensation of pain. They send signals to the brain, and then the brain interprets the signal as painful or not. So, the surrounding muscles around that joint would most likely stiffen up to PROTECT the joint from any further harm. When muscles stiffen up to protect, then less movement occurs and we become less mobile in our daily life.

Lastly, with decreased joint mobility, there is also decreased proprioception, which is our brain’s awareness of the joint in space. The less mobile we become, the more we lose the sense of our joints and body in space. Because of this, we start to move less and less. The less we move, the stiffer we get. Or, better yet, if you don’t use it, you’ll lose it.

CONCLUSION

So there you have it! Those are my top reasons as to why we experience morning stiffness. I see this stuff with my patients all the time! The moment they tell me about poor sleeping and morning stiffness, these 3 reasons are what I need to assess and attack.

So stay put for Morning Stiffness Part 2, where I will be discussing possible solutions and strategies to keep your mornings loose, feeling fresh, and where you are ready to comfortably start your day.

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Can’t make it into the gym in person or live far away? Schedule an online PT Session! Sessions are performed over video chat using Zoom or Skype, and Andreas can help you from anywhere in the world!

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