What’s the best position to sleep in when you have Tennis Elbow? (Or Golfer’s Elbow?)
Should your elbow be bent or straight? – Should you wear a brace in bed at night around your wrist or elbow – or is it better not to?
If you’ve been struggling with this incredibly frustrating condition for some time, you may already be wondering if a comfortable sleeping position actually exists!?
OR does a Tennis Elbow diagnosis inevitably curse you to sleepless, painful nights of fitful tossing and turning?
You may also be wondering WHY your elbow usually feels the WORST first thing in the morning – whether you get any sleep or not! (There’s a simple reason for this…)
If you’re among the unfortunate few who struggle with this dilemma, you end up facing the “double jeopardy curse”…
Not only suffering with the searing pain of Tennis or Golfer’s Elbow during the day while trying to work or enjoy a game of tennis or golf…
But also having your desperately-needed sleep and recovery time constantly sabotaged and robbed by the incessant pain at night.
What can you do?
Sleeplessness “Insomnia” from Tennis Elbow pain
Podcast Episode
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You may have already come across obvious pieces of advice like:
- “Avoid sleeping on the affected arm”
- “Try to keep your arm straight / bent / at your side”
- “Don’t sleep with your arms overhead”
And other marginal – if not useless suggestions.
And, driven to desperation, you may have already found yourself relying on medications to relieve the symptoms enough to get some rest.
So, let’s look a little deeper at the underlying dynamic and see if there’s anything you can do about it.
Let’s get real. This thing can be a total BEAST!
And there is seldom a simple, easy answer.
(Here’s my overall strategy for treating Tennis Elbow, by the way.)
But let’s “work backwards” a little. Think about what your mornings are like…
Why Is Tennis And Golfer’s Elbow So Painful At Night And/Or In The Morning?
One of the most common experiences with Golfer’s and Tennis Elbow is that it’s almost always at its worst first thing in the morning.
If you’re lucky enough to sleep through the night, in the first place, the minute you go to lift the bed covers…
A stabbing, searing “wake-up call” will likely greet you!
Typically, to be followed by a shocking amount of elbow stiffness as you start going about your morning routine.
Punctuated by jolts of sharp pain as you’re brushing your teeth and hair, buttoning your shirt – and even lifting your coffee mug!
This is such a frequently-reported cause of concern among sufferers that a study was conducted last year about it.
We’ll cover that study later on…
But, as alarming as it may feel to you – It’s so common, it’s almost a universal symptom of Tennis and Golfer’s Elbow!
So, try not to worry about it.
It’s part of the basic nature of our bodies to stiffen and tighten somewhat as we sleep – (especially as we get older.)
When there’s little bodily movement to keep tissues loose and circulation drops, muscles and tendons tend to stiffen.
This is normally not a big deal if you’re reasonably healthy and not injured.
You feel a little stiff here and there in the morning but your muscles quickly loosen up as you start moving around, however…
When you have a chronic tendon injury, like Golfer’s or Tennis Elbow, this general stiffening that happens overnight can dramatically exacerbate your symptoms.
The lucky ones mostly sleep through this and perhaps only occasionally wake up in pain, when rolling onto their elbow, for instance.
For the unlucky sufferers, this effect seems to be more dramatic.
It may start kicking in the minute your head hits the pillow, your circulation slows and you stop the regular movements that prevent the stiffening of your muscles.
The key to increasing circulation and comfort is heat.
Yes, HEAT – Forget the ice – Not only during the day but especially in the evening.
Here’s why ice is not the right way to treat Tennis and Golfer’s elbow in general.
The last thing you would want to do is ice your elbow before bed. Instead:
- TIP ONE: Warm your elbow/forearm up at night before bedtime to at least slow down the stiffening effect, perhaps by soaking in a warm bath.
- TIP TWO: Wear a loose-fitting neoprene sleeve over the elbow area at night – Or a ‘leg warmer’ – OR a couple of layers of heavy socks with the toe ends cut off (as long as they’re loose-fitting.)
- TIP THREE: Get up and heat your elbow area with hot water under the faucet – If you wake up in a lot of pain at night. Try gradually turning the water up to as hot as you can stand it for a minute or two. (You may need to repeat this, of course.)
Also, first thing in morning: Take a shower and run bursts of really hot water over your whole elbow and forearm area, alternately rubbing your elbow and forearm muscles vigorously.
This only takes a couple of minutes and immediately counters the low blood circulation / muscle stiffening effect and starts loosening things up.
And it can have a pretty significant, positive effect, some Tennis and Golfer’s Elbow sufferers have reported to me.
(You can’t expect it to last all day but it can get you off to a good start.)
Don’t fall prey to the temptation of using a heating pad at night, though – Unless, perhaps it has a timer that you can rely on to shut it off automatically.
There’s too high a risk of burning yourself and doing irreversible damage to your tissues if you fall asleep with a heating pad that doesn’t shut off on a timer.
(Personally, I wouldn’t trust a timer either, though. What if it fails?)
Can Pain Meds Or Liniments Help?
Medications for Tennis Elbow night pain: Pills or topical creams?
It might also help to apply some type of lotion, cream or liniment to your forearm and elbow area right before bed.
Especially the “IcyHot,” Tiger Balm and other liniment types of creams that “warm” the area by increasing circulation.
Just don’t expect your healing process to benefit much if at all from these topical remedies.
Read more about Topical Tennis Elbow remedies in this article
I’m not a fan but if you’re really desperate, there are topical anti-inflammation drugs, like Voltarin Gel, that may help relieve symptoms enough to help you sleep.
Anything that decreases circulation and suppresses inflammation, which is what all types of anti-inflammatories do, interferes with your healing process.
But at least a topical drug applied in just one small area is better than taking pills that circulate through your whole body.
There are considerable risks involved with the long-term use of anti-inflammatory medications use – Even the over-the-counter ones.
If you’re desperate for sleep, it’s understandable, of course. At some point, you have to ask “what else can I do!?”
IS There A Pain-Free Position That’s Best For Sleeping With Tennis Or Golfer’s Elbow?
Sadly, there probably isn’t.
I think the idea there’s some “perfect” position that will allow you to sleep without bothering your Golfer’s or Tennis Elbow is basically a myth.
Sure, you may be able to fall asleep in one position, but you inevitably shift or roll in your sleep and then what?
You find yourself waking up in pain!
Are there less-than-ideal or even terrible sleeping positions when you have this kind of elbow injury?
Absolutely…
What Are The Worst Positions To Sleep In?
Undoubtedly, the worst positions for sleeping with Tennis or Golfer’s Elbow are:
- Sleeping with the affected arm overhead and under your head/pillow.
- Lying on the affected arm. (I know! Face-palm obvious – Right?)
And what if you have Golfer’s or Tennis Elbow in BOTH your arms?
(That can really be a challenge!) Are you able to sleep on your back?
In the study mentioned earlier, researchers evaluated sleeping positions as sources of aggravation and potential healing delay.
“Tennis Elbow symptoms are reportedly most severe in the morning, which prompted a search for a pathological process while asleep.”
“A ‘pathological sleep position’ was hypothesized that repetitively aggravates an elbow lesion if the arm is overhead and pressure is on the lateral elbow.”
Evaluation of Sleep Position for Possible Nightly Aggravation and Delay of Healing in Tennis Elbow
J Am Acad Orthop Surg Glob Res Rev. 2019 Aug; 3(8): e082.
The patients in the study wore a restraint to keep their arms down close to their sides while asleep.
After one month improvement was reported by two-thirds of the compliant patients.
And the researchers concluded that:
“Sleep position should be considered as a possible aggravating factor that delays healing of an acute injury and results in chronic pain.”
And that keeping the arm down at night may be recommended for Tennis Elbow.
One of the limitations with this study is that it didn’t seem to address sleep disruption.
It seemed to be focused on how much the patients’ elbows hurt in the morning – NOT whether they were able to sleep in the first place.
So, it seems safe to assume, if these people needed a restraint to keep them from sleeping with their arms overhead…
Then they must not have been waking up constantly in terrible pain from the bad arm position.
The other problem is this idea of an “acute elbow lesion”
The researchers speculated that the mechanical pressure could aggravate the initial lesion, night after night, while the sufferer was asleep.
And that aggravation could delay the healing of the “lesion” and explain the severity of the morning pain.
The problem with this is that there really is no such thing as an “Acute Lesion” when it comes to Tennis and Golfer’s Elbow – at least in the vast majority of cases.
(‘Acute’ has to do with sudden trauma and ‘lesion’ means wound or sore or ‘pathological’ / abnormal area of tissue.)
The medical research does clearly show there is a ‘pathology’ in the tissues in moderate to severe cases.
This pathological tissue can be seen and some of it is routinely removed in Tennis Elbow Surgeries
Evidence of it can also often be seen in MRI scans and in Sonograms.
But the nature of that pathology is one of gradual, chronic degeneration – Not an acute lesion, like a tear.
And it’s very hard to imagine that a little pressure against a bed or pillow is going to exacerbate that degenerative process.
So, unfortunately, there doesn’t seem to be much, if anything, in this study to help those of you who can’t sleep through the night.
Again, you may need to focus on keeping your elbows and arms warm and not focusing so much on sleeping positions that you can’t stay in or out of the minute you fall asleep.
Should You Wear A Brace At Night?
You’ll likely find many opinions that endorse wearing a brace at night (and during the day) when you have Tennis Elbow.
One school of thought suggests that wearing a brace most of the time day AND night will help your Tennis or Golfer’s Elbow heal.
Unfortunately, this opinion is based on a misunderstanding of the nature of this injury.
See this article on braces for more about why this is not the way to encourage healing.
Some will suggest that wearing a brace to keep either your elbow or your wrist straight will help prevent pain at night while you sleep.
This may work – but it may also have negative consequences.
It doesn’t take much compression or restriction to impede your circulation – Especially when you’re just laying there not moving all night.
Even a fairly loose-fitting brace can become an impediment to your circulation.
Could it be worth the trade-off IF it actually helps you get a restful nights sleep?
Perhaps!
All the more so if you’re able to avoid taking pain meds or anti-inflammatories.
Just don’t make the mistake of wearing it around during the day.
Better yet, avoid any kind of brace that has any rigidity and stick with a loose-fitting neoprene sleeve, as suggested in Tip #2.
Well, that’s all I have for you on this aspect of Tennis and Golfer’s Elbow.
But I do have dozens more articles (most with videos) on just about every aspect of Golfer’s and Tennis Elbow you can imagine.
Here’s the homepage with a list, starting with my most recent articles.
Learn To Treat And Heal Your Own Tennis Elbow Or Golfer’s Elbow At Home With This Video Program
You’ll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of pain and frustration!…I’ll be your personal tutor guiding you through step-by-step video lessons, where you’ll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)
Tennis Elbow sufferers: Learn more about the home program here
Golfer’s Elbow sufferers: Learn more about the home program here
An occupational therapist recommended wearing a wrist brace with a slight rigidity to it so that it keeps the wrist in slight extension at night, theoretically putting the extensors in a more relaxed or favorable position while you sleep. She said most of us curl our wrists into flexion when we sleep, stretching the extensors and favoring the already stronger flexor muscles, creating an imbalance that puts more strain on the extensor muscles and tendon. Any thoughts on this?
I pretty much covered this as the last question of the article: “Should You Wear A Brace At Night?” (Although I didn’t mention that, yes, we do tend to curl our fingers when we sleep.) If wearing a brace helps you sleep and you can avoid pain meds, then it makes sense. Just keep it as loose as possible so it doesn’t restrict your circulation.
Thank you so much for your very informative articles. Especially the part about heat. Seems I have been icing my elbow in error. It hasn’t been helping. Even my hair hurts.
I would like to share the low tech way I apply heat to my aches and pains. I partially fill an old sock with plain white rice and tie off the end. Place it in the microwave and heat for 2-4 minutes depending on the microwave. The longer you heat it the longer the heat will last but you will need to wrap the sock in a towel till it cools off. You don’t need a timer since the rice naturally cools off. I like this method because it conforms to your body. Hopefully it will work on my elbow.