In part one of this blog we said that our sleeping position matters because fascia stitches us into positions we maintain for long periods of time. When we are dealing with an “orthopedic ouch” like low back, neck, or shoulder pain, the position we choose to sleep in could up the pain ante. For this reason it may be wise to sleep in a position that places your body in a “pseudo-neutral” position for most of the night.
Warning!
We must carefully qualify this idea. Strict proponents of natural movement say that we should be able to sleep in a variety of positions, even on the floor with no support from a mattress or pillow. [1,2] If this sounds crazy to you, hold that thought- we will clarify inna sec. But for now, we will explain by repeating what we said in part one of this blog: You could actually sleep in just about any position with no negative consequences IF your waking hours included lots of movement variation and interaction with a wide variety of loads and surfaces.
If you spend many nights in pain or you are in lots of pain during your morning waking routine, that statement won’t satisfy you. So, why is your sleeping position be causing you pain? We will discuss one reason here and 4 more in subsequent blogs.
The body hugs the lesion
People who work in the osteopathic world use this phrase frequently. It was reportedly coined by Osteopath, teacher and writer Jean-Pierre Barral [3] What does it mean?
To understand what we mean when we say “the body hugs the lesion” it’s helpful to use an extreme example. Imagine the posture someone would take if they received a strong, painful blow to the abdomen. If they were not trained to handle sudden forces, you would expect them to double over; right? Their body would quickly shorten around or “hug” the innocuous force. Understanding that this is a common behavior on a body-wide scale helps us understand how this can happen on a local level.
To use a more sophisticated example, we could look at a common structural behavior related to shoulder pain. Without getting lost in the anatomy-weeds, we can say that the nerves that exit your cervical spine and dive south toward your hand snake their way between the top of your rib cage and under your clavicle (collar bone). Describing things generally: some of these nerves course down the inside of your upper arm between your biceps and triceps muscles.
Now, while we want to lay down some convincing ideas about the benefits of sleeping without the support of your favorite pillow and and the perfect mattress, ironically your nerves absolutely have to have a soft and supportive “bed.” We do in fact call the immediate environment of nerves (remember, nerves are collections of neurons wrapped in connective tissue) their “bed.” Nerves like to-nay, have to- slide well in their bed. [4] Their bed needs to support them but also remain soft and open so the nerve can receive nutrients and move as much as they need to accommodate full ranges of motion. So, picture what those nerves running down the inside of your upper arm have to be able to do when you transition from elbows bent to extended as you, for example, prepare to give a giant hug.
Imagine that you develop some tension or a little extra fascia gets laid down in or around the bed of the nerves traveling down your arm. Those nerves will not be happy. What could happen? The body hugs the lesion. The lesion, in this case, could be the sticky point in that nerve bed. This creates an undesirable tension for the nerve. But, if we tilt our scapula (shoulder blade) we could send some slack into the arm thereby relieving the inimical tension. Problem solved! But wait! What about the tilted scapula. That’s no way to live. And yet- loads of people do! And loads of people suffer from the altered bio mechanical forces that tilted scapulae create. Loads of people have shoulder pain, neck pain, pain that radiates down the arm, and...etcetera. We can’t get too “cause-and-effecty” about these things. But in a case like this, we won’t get any relief in that shoulder until we resolve the unwanted tension on the nerve on the inside of the arm. How does this relate to sleeping position?
We all like hugs! Well, most of us like hugs. And now we know when there is a problem in our neuro-myofascia, our body likes to hug that too. It often does this by shortening what’s already shortened. This is a sort of a “moving into” or toward a problem. In the case of the messy neural bed on the inside of your arm- your body could hug the lesion by rounding your shoulders; tilting your scapulae. You could also show a preference for this behavior. But this preferential structural behavior doesn’t just show up in your waking life- you will tend to sleep in positions that shorten what is already shortened too.
Let’s go back to the snails we talked about in part one of this blog (link here). Remember we said when you maintain a shape for any length of time, fibroblasts, the cells that make fascia, begin laying down tiny strings of collagen to support you. They are like traveling snails leaving a slimy supportive string as they go. When you come out of whatever shape you’re in, some of those tiny “strings” are dissolved. [5]
If you repeat the same shape over and over again, fibroblasts lay down strings of collagen over and over again. It's as if they say; "She must like this shape. Let's support her!" When you habitually repeat a shape, fewer and fewer strings are dissolved or stretched out.
If your body is hugging a lesion and you habitually repeat a shape or show some shape bias/preference, the pattern will be reinforced by the fascia making process. What is shortened will become shorter. What’s sticky will likely get stickier. In the case of the unhappy nerve in your arm, you may begin to sleep with your elbow always bent. Your wrist may stay flexed through most of the night.
Left unchecked, all these patterns could lead to bigger problems. So, what we are saying about sleeping position here is this: keep in mind that your body will likely shorten what’s shortened. If you are dealing with some orthopedic pain, it may be a good idea to try to sleep in a position that discourages these compressive behaviors. For ideas about how to do this check out our do’s and don’t list in the first part of this blog. This, of course is a temporary and unsustainable approach to solving neuromyofascial problems. We’ll describe a better approach in an upcoming blog.
To read about another reason your sleeping position may be causing you pain, read our next blog in this series click here.
[1] Bowman, Katy. Move Your DNA: Restore Your Health through Natural Movement. Propriometrics Press, 2017.
[2] Tetley, M. “Instinctive Sleeping and Resting Postures: an Anthropological and Zoological Approach to Treatment of Low Back and Joint Pain.” Bmj, vol. 321, no. 7276, 2000, pp. 1616–1618., doi:10.1136/bmj.321.7276.1616.
This article can be accessed by clicking here.
[3] Barral, J. P., and Pierre Mercier. Visceral Manipulation. Eastland Press, 2005.
[4] Bove, Geoffrey M., and Alan R. Light. “The Nervi Nervorum.” Pain Forum, vol. 6, no. 3, 1997, pp. 181–190., doi:10.1016/s1082-3174(97)70011-4.
[5] Stecco, Carla, et al. Functional Atlas of the Human Fascial System. Churchill Livingstone Elsevier, 2015.