Sleep and Injury Recovery: More Important Than You Think

Sleep is the most underutilised recovery tool in musculoskeletal rehabilitation. We spend enormous effort on exercise prescription, manual therapy, and load management while often ignoring the factor that underlies all of them. If you're not sleeping well, your recovery will be slower, your pain will feel more intense, and your risk of re-injury will be higher.

What happens during sleep

Growth hormone - the primary driver of tissue repair and protein synthesis - is secreted almost entirely during deep (slow-wave) sleep. Inflammatory markers clear, metabolic waste products are removed from the central nervous system, and the pain modulation system is reset. Athletes sleeping less than seven hours show elevated markers of muscle damage, reduced muscle protein synthesis, and impaired reaction times.

Sleep deprivation and pain

The relationship between sleep and pain runs in both directions. Poor sleep increases central sensitisation - the nervous system's amplification of pain signals - which makes existing pain feel worse. Pain then disrupts sleep further. Breaking this cycle is often one of the most impactful things a clinician can help with.

Practical sleep improvements for injured athletes

• Fix your sleep window: go to bed and wake up at the same time every day, including weekends
• Dim lights and avoid screens for 60 minutes before bed
• Keep the bedroom cool (around 18°C) and dark
• Limit alcohol: it sedates but severely fragments deep sleep architecture
• If pain wakes you, address the positioning issue - pillows, offloading devices - before relying on analgesia
• Aim for a minimum of 8 hours in bed during the acute phase of injury

Sleep is free. Optimising it should be the first conversation in any rehabilitation plan, not an afterthought.