Sleep is probably one of the last things you think about when you are trying to recover from your back pain or injury, and it might well be something most therapist don't think too much about when working with their clients or patients. However it is such an important part of the puzzle of recovering from injury but also in preventing getting injured in the first place.
We spend roughly a third of our life asleep and this is the time when our bodies do the vast majority of its healing. So why do we pay so little attention to it? Maybe we take it for granted and get too hung up on the sexy stuff like biomechanics, exercise programming and the like but ultimately these are mid way up the pyramid of things we can change for me, sleep and nutrition are the absolute bedrock from which to build a healthy, vital injury resistant body.
The effects of sleep deprivation and recovery have been well documented in the scientific literature for example Schwartz et al found that just 8 hours of sleep deprivation acutely downregulates makers of muscle repair alongside contractile function of the muscle itself, showing that reduced sleep will also affect performance. Furthermore Datillio found that sleep debt reduces protein synthesis and increased cortisol favouring the breakdown of muscle, therefore potentially making any injury worse, alongside altering feeding behaviour which has implications on our health in general.
Olivia et al and Engle-friedman also found a strong link between sleep debt and a reduction in muscle function. This has implications on preventing injuries and really opens up the idea that it may not be best to push yourself hard on days that you are feeling over tired or sleep deprived. That's not to say that you shouldn't do anything instead try to develop a relationship with your body that allows you to get a better understanding of when you should and shouldn't push yourself. For example a simple technique I use myself and I teach my patients is a traffic light system of exercise. This is a great technique I learnt from world renown rehabilitation expert Paul Chek.
Red: If you are feel exhausted and the idea of exercise or any kind of movement makes you want to curl up in ball then you would probably benefit from either taking a day off or doing some work-in exercises I further concept developed my Paul. In essence do an activity that gives you energy like yoga, tai chi, walking or a simple stretching routine, also using this time to really focus on diaphragmatic breathing can go a long way in making you feel more energetic. Also, if you are ill or have an extreme case of DOMs (delayed onset muscle soreness) if would be wise to give that body part a rest.
Yellow: Yellow is probably where most people live when exercising or training on a regular basis these are the days that you don't feel amazing but you are not so exhausted that the idea of training makes you want to curl up into a ball. on these days make sure you have a really thorough warm up. Most of the time a really good warm up will make you feel like you want to really get at it in the gym if however you still feel off then either train with reduced volume or intensity, so for example if you had a deadlift based workout where you had say 6 sets to do then instead of the 6 sets drop it to 4. Remember it is always better to under train then over train and one session is not going to make much of a difference.
Green: These are the days you are feeling great and you may even feel excited about working out hard. These are the days to try and push yourself that little bit further. Get at it!
Getting a good night sleep general guide on sleep hygiene
1. We are creatures of habit and routine so set a time to go to bed and get up and stick to it, no matter if its a weekday or weekend. Preferably around 10pm and 6am as this helps regulate your circadian rhythms throughout the day.
2. Avoid Blue light or light in general at least an hour before bed. Light stimulate the secretion of cortisol which keeps you awake and stops you from getting a deep restful night's sleep.
3. Watch your caffeine intake. We all know by now that caffeine keeps you awake and prevents you from getting a good night sleep. You you drink coffee or tea try to avoid drinking it after mid day. This is because caffeine has a 6 hour half life.
4. Supplement with zinc and magnesium just before bed. These two minerals are some of the more common deficiencies in people but also nourish the nervous system. This one has had a big impact on my own sleep quality.
5. Try eating some carbohydrate at night (not junk food) something like an apple or oatmeal this is because carbohydrate stimulates serotonin and down regulates cortisol helping you get a better nights sleep. It important to not eat high glycemic foods as this will cause an insulin spike and may lead to you waking in the night as your blood sugar drops.
Well there we have it, I hope this has helped you realise that whether you are injured or not sleep is vitally important in the rehab process as well as the prehab!
Should you have any questions please leave a comment or email me direct via the contact page.
Andrew Graves, M.Ost
Dattilo, M., Antunes, H., Medeiros, A., Mônico Neto, M., Souza, H., Tufik, S. and de Mello, M. (2011). Sleep and muscle recovery: Endocrinological and molecular basis for a new and promising hypothesis. Medical Hypotheses, 77(2), pp.220-222.
Engle-Friedman, M. (2014). The effects of sleep loss on capacity and effort. Sleep Science, 7(4), pp.213-224.
Knowles, O., Drinkwater, E., Urwin, C., Lamon, S. and Aisbett, B. (2018). Inadequate sleep and muscle strength: Implications for resistance training. Journal of Science and Medicine in Sport, 21(9), pp.959-968.
Schwarz, P., Graham, W., Li, F., Locke, M. and Peever, J. (2013). Sleep deprivation impairs functional muscle recovery following injury. Sleep Medicine, 14, p.e262.
Andy has been involved in the health & fitness industry for over 10 years, specialising in corrective exercise, injury prevention and rehabilitation of low back, neck and shoulder pain. He also has an interest in the use of Osteopathy for the management of headaches.