Tennis elbow (Lateral Epicondylitis) involves inflammation and degeneration of the tendons on the outer part of the elbow. Caused by overuse of the forearm muscles, this condition commonly leads to pain that intensifies at night. Discomfort occurs because the arm is unconsciously moved into positions that compress or strain the irritated tendons. Finding practical strategies to position and support the arm is important for achieving restful sleep and promoting healing.
Optimal Sleeping Positions for Relief
Sleeping on your back is the best position for managing night pain associated with tennis elbow. This posture allows the affected arm to rest in a naturally neutral position, minimizing strain on the elbow joint and attached wrist extensor tendons. You can enhance this by placing a thin pillow or folded towel beside your body to gently support the affected forearm and hand.
If back sleeping is not comfortable, try sleeping on the side that is not affected by tennis elbow. Use a body pillow or a large, firm pillow to fully cradle the injured arm. This prevents the arm from drooping forward or resting against your torso, which can force the elbow and wrist into painful, flexed positions.
The goal is to ensure the elbow and wrist remain in a relaxed, neutral alignment throughout the night. Avoid locking the elbow perfectly straight, which causes tension; instead, aim for a slightly bent, natural resting curve. Maintaining this neutral posture reduces the mechanical load on the injured tendon attachment point, often the source of night pain.
Essential Supportive Devices
Nighttime support devices prevent involuntary movements that aggravate tennis elbow while you sleep. A light, non-restrictive wrist splint is effective because it prevents the wrist from flexing or extending excessively. Since the involved tendons cross the wrist, immobilizing it in a neutral position significantly reduces strain on the elbow’s tendon origin.
These nighttime splints are distinct from the counterforce braces worn during the day. The purpose of a night splint is to provide gentle, sustained immobilization, allowing irritated tissues to rest completely. Choosing a splint made from breathable materials is beneficial for comfort.
Strategic pillow placement is another supportive measure. Elevating the affected arm slightly above the level of your heart helps reduce swelling, which contributes to pain and stiffness. Achieve this gentle elevation using a wedge pillow or a small cushion placed underneath the forearm.
Pre-Sleep Pain Management Routine
Establishing a routine to reduce inflammation and numb the area before bed significantly improves sleep quality. Apply cold therapy, such as an ice pack wrapped in a thin towel, to the painful lateral epicondyle for 10 to 15 minutes before sleep. This decreases localized inflammation and provides a temporary numbing sensation, making it easier to fall asleep without pain.
Following cold application, gentle movement can prepare the arm for rest. Performing very light, non-straining stretches, such as a gentle wrist extension stretch, promotes blood flow without causing irritation. The movement should be slow and pain-free; the intention is to improve circulation.
If over-the-counter anti-inflammatory medications are medically cleared, timing their ingestion is important. Taking a non-steroidal anti-inflammatory drug (NSAID) 30 to 60 minutes before bedtime maximizes its pain-relieving effect during the initial stages of sleep. This timing helps manage the increased pain perception that often occurs when the body is still for long periods.
Movements and Habits to Avoid
The most common habit to eliminate is sleeping directly on the affected side. This compresses the injured tendon against the bone and mattress, restricting circulation and mechanically irritating the tissue. This leads to sharp pain and stiffness upon waking. Sleeping on your stomach should also be avoided, as this position often causes the arm to be tucked awkwardly under the body.
A frequent subconscious movement that worsens tennis elbow is tucking the affected hand under the pillow or resting the arm above the head. These positions force the wrist and elbow into excessive flexion or extension, placing significant tension on the wrist extensor tendons. This prolonged, strained posture is a primary cause of morning pain and stiffness.
Before settling down, minimize activities that require strong gripping or repetitive forearm movements. This includes holding a heavy book, scrolling on a phone with an extended elbow, or opening tight containers. These actions fatigue the forearm muscles immediately before rest, priming the tendons for a painful night. Also, ensure heavy blankets or tightly tucked sheets do not constrict or pull on the affected arm, which can inadvertently cause strain.