Why your pain can be worse first thing in the morning

We’ve all experienced the unpleasant sensation of waking up with heightened pain from an injury. Whether it’s a sprained ankle or a sore back, the early morning hours seem to amplify our discomfort. This phenomenon can be puzzling, as one would expect restorative sleep to alleviate pain. However, there are several factors at play that contribute to increased pain levels upon waking. In this blog, I will delve into the reasons behind this common experience and discuss the reason why injuries can often be more painful first thing in the morning.

Reduced Blood Circulation:
One of the primary factors that contribute to increased pain in the morning is reduced blood circulation during sleep. When we lie down for an extended period, blood flow slows down, leading to diminished oxygen and nutrient supply to the injured area. Consequently, waste products like lactic acid accumulate, triggering inflammation and exacerbating pain. Additionally, reduced circulation hampers the removal of metabolic by products and inflammatory substances, further intensifying discomfort.

Stiffness and Immobility:
Another reason for heightened pain in the morning is stiffness and immobility. During sleep, our body enters a state of relative inactivity, and the affected area receives little to no movement. As a result, joints become stiff, and muscles around the injury can tighten. This lack of motion can cause muscle fibres to become less pliable, leading to increased pain when attempting to move the injured body part upon waking up.

Fluid Accumulation:
Fluid accumulation is yet another factor contributing to increased pain in the morning. Throughout the day, gravity assists in draining fluids away from injured areas. However, when we lie down for an extended period, fluid can accumulate around the injured site. This accumulation increases pressure on surrounding tissues, leading to heightened pain upon waking up. Conditions such as sprained ankles or swollen joints are particularly susceptible to fluid accumulation during sleep, resulting in morning discomfort.

Overnight Inflammatory Processes:
Inflammation is a natural response of the body to injuries as it aids in the healing process. However, overnight, the body’s natural inflammatory response can intensify. Inflammatory markers and chemicals accumulate around the injured area, causing increased pain and discomfort. The combination of reduced blood flow, stiffness, and fluid accumulation exacerbates this inflammatory response, amplifying pain levels in the morning.

Specific injuries:

In addition to the factors mentioned earlier, tendons can also become irritable and cause increased pain in the morning. Tendons are dense connective tissues that attach muscles to bones, and they play a crucial role in transmitting forces and facilitating movement. However, tendons are known to be less elastic and more prone to stiffness in the morning.

Upon waking up, tendons that have been immobile during sleep can experience a phenomenon called “tendon stiffness.” During sleep, tendons can become dehydrated and lose some of their elasticity. This can lead to increased tendon stiffness and reduced flexibility, causing heightened pain and discomfort in the morning.

Furthermore, tendons have a lower blood supply compared to muscles, making them more susceptible to inadequate oxygen and nutrient delivery during periods of reduced blood circulation, such as during sleep. The combination of reduced blood flow and dehydration can further contribute to tendon irritability upon waking up.

Ligament sprains:
When you sustain a ligament sprain, the morning hours can bring about increased pain and discomfort. Ligaments are strong, fibrous tissues that connect bones and provide stability to joints. Upon waking up, you may experience heightened pain following a ligament sprain due to several factors. Firstly, during sleep, the lack of movement and weight-bearing allows the injured ligament to rest, leading to a temporary reduction in pain perception. However, once you get up and start moving, the ligament is subjected to stress and weight-bearing activities, causing the pain to resurface.

Additionally, ligament sprains often lead to inflammation in the affected area. Overnight, the body’s natural inflammatory response can intensify, resulting in increased swelling and pain upon awakening. This inflammation can cause stiffness and restricted range of motion, further exacerbating morning discomfort.

Muscle spasm:
Muscle spasms, such as in the low back or neck, can result in increased morning pain and tightness. During sleep, the affected muscles experience prolonged periods of rest and immobility. This lack of movement can lead to muscle stiffness and increased muscle fatigue. The combination of muscle fatigue and inactivity can exacerbate muscle spasms, making them more pronounced and painful upon waking up.

Muscle spasms often occur because of muscle tension and the presence of trigger points, which are hyperirritable areas within the muscle fibres. Overnight, the tension in these muscles can intensify due to stress, poor sleep posture, or other contributing factors. This heightened tension can increase the frequency and severity of muscle spasms in the morning.

During sleep, blood circulation to the muscles decreases. This reduction in blood flow can result in a decreased supply of oxygen and nutrients to the affected muscles, impeding the healing process and prolonging muscle spasms. The lack of adequate circulation can also contribute to the accumulation of waste products, such as lactic acid, in the muscles, exacerbating this morning discomfort.


While waking up with increased pain following an injury can be frustrating, understanding the underlying reasons can provide valuable insights. Reduced blood circulation, stiffness and immobility, fluid accumulation, and overnight inflammatory processes are the key factors contributing to this phenomenon. By comprehending these mechanisms, we can take proactive steps to manage and alleviate morning pain. Try starting your day with some movement, whether that be a small walk, mobility exercises or activation exercises. Hot showers or heat packs can also aid in reducing spasm through tight muscles if you are experiencing a flare up. If you are experiencing morning pain or tightness, book in with one of the physiotherapists at the Double Bay or Coogee clinics to have your pain assessed and a treatment plan created.

Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Phoebe has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.

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