Tackle Your Morning Joint Stiffness

Waking up with ache and stiffness in our joints is something most of us have experienced. It is easy to blame it on age, but that may not be the whole story; you may also feel stiff when standing up from sitting for too long, or when moving your joint after staying in the same position for a while, like after sleep.

The stiffness generally resolves once you start moving or after a hot shower, however, there are ways to ease it even before you start your daily routine. Before we suggest some in-bed exercises, let’s look at understanding why the stiffness occurs in the first place. There are 2 main components within our joint structure:

Articular cartilage is a smooth, white connective tissue that covers the end of our bone within the joint and allows the 2 bones to glide smoothly over each other.

Synovial fluid is the thick, colourless liquid inside the joint. It plays an important role in contributing to low friction within the joint, providing nutrients to articular cartilage, and facilitating clearance of waste from the joint.

What Causes Morning Joint Stiffness?

1. Age Related Changes To Joint Structure

With age, all joints eventually start showing a degree of degeneration. Our articular cartilage surface becomes rough and less elastic. Synovial fluid inside the joint becomes less thick as well, losing some of its effectiveness as a lubricating agent. The combination of these changes increases the amount of friction inside the joint, leading to the feeling of stiffness.

2. Reduced Anti-Gelling Agent In The Joint

On the surface of the joint, there is a lining of surface-active phospholipid, which is an anti-gelling agent for synovial fluid. With articular cartilage degeneration, we start losing this layer and as a result, it is easier for the synovial fluid to become more solid – like when not moving. We can compare this gelling phenomenon to making gelatine. Stirring a hot gelatine keeps it in liquid form thoroughly, but when you stop moving it, it starts to gel together and becomes more solid.

3. Higher Joint Volume

Our body removes excessive synovial fluid through its lymphatic system, assisted by joint movement. For most of us, sleep is the longest time where our joints stay inactive and the flow of fluid out of our joints is sluggish. As a result, there is increase in joint volume in the morning, making it harder to get moving.

How Do I Ease My Morning Joint Stiffness?

The draining the fluid out of your joints or “stirring” of the synovial fluid to break its gelling effect can help ease some of the stiffness that you experience. This can be achieved by doing simple range of motion exercises that are light on the back and knee joints, making them a great choice to start your day.

Knee rolling in bed: Roll to one side and hold for 3 seconds. Repeat this for 10 times each side. You should feel a gentle stretch over your back or hip while doing the exercise.

Single knee hug: Hug your knee and hold it for 10 seconds. Repeat 3 times for each side.

Cycling in bed: Imitate cycling movement on the bed for 1 minute. The further your leg is from your body, the harder it will be. Do as you can tolerate.

Shaking your legs in sitting: Lift your leg alternatively on each side while you sit over the edge. Do this for 1 minute.

Written By: Anson Wong, B.Sc. (Hons) Physiotherapy (MY)

Anson has 9 years of experience in physiotherapy, and specialises in musculoskeletal and sports injury rehabilitation. His main areas of focus include the shoulders, knees, and ankles. He is also a Certified Mulligan Practitioner.

You Can’t Go Wrong By Being Strong! Strength Training For Sports Injury Prevention

Whether you’re a gym buff, a marathon runner, a cross-fit enthusiast or a bodybuilder, it’s statistically probable that you have been or will at one point be injured. Although injuries are never completely unavoidable, there are clear evidenced-based ways to reduce the risk.

When playing sports, there is always a risk of injury, but it can be proactively minimised.

What Does The Evidence Say?

The utilisation of strength training for injury prevention is not a new concept in the sports community, but many coaches, trainers and athletes still don’t see it as a necessary part of a workout plan. Recent high-quality studies have shown that  incorporating strength training into athletic or fitness training decreases the risk and/or severity of injury over and above other modalities for injury prevention. A systematic review of all high-quality studies investigating the effect of various injury prevention strategies concluded that strength training reduces acute sports injury risk by ⅓ and the risk of overuse injuries by almost 1/2. Static stretching did not provide any meaningful injury prevention benefit1. Simply put, you’re less likely to get injured if you have a strong muscle rather than a long muscle!

Marathon runner
Research indicates that strength training reduces acute sports injuries risk by 1/3.1

What Is The Physiological Basis Of Strength Training To Reduce Injury?

Resistance training provides dynamic loads on the body, creating physiological adaptive changes in the bone, muscle, and connective tissue (tendons and ligaments). Bone has an incredible ability to rebuild itself, so when a load is added, it triggers a genetic expression to activate the cells that produce new bone. The bone is then remodelled, increasing its density and therefore making itself stronger and more resilient. This decreases the chances of a future bone injury.

As muscles, tendons, and ligaments are the support system of every joint, they are at high risk for being injured with the complex, dynamic movements associated with sports and exercise. Resistance training helps strengthen muscle and tendons, enabling them to resist and generate greater forces, while increasing the stability of the ligaments which decreases their risk of becoming injured.

weight lifting
There is a clear dose-response effect between strength training and its injury prevention effect.

How Much Resistance Training Needs To Be Included In A Training Program To Be Effective?

Authors of a recent systematic study concluded that there is a clear dose-response effect between strength training and its injury prevention effect. This means that the greater the volume and intensity of strength training undertaken, the greater the injury preventative effects experienced2.

In addition, there was no significant difference among the types of strength exercises performed and their preventative effects. It’s recommended to have a full-body resistance training regime to lower the risk of injury, and improve sports performance regardless of skill level and activity type. This may equate to 2-3 short sessions a week containing 4-6 exercises.

Get Your Physio To Build You A Tailored Strengthening Program!

Your physiotherapist can specifically design a strength training program suitable for your fitness and sporting goals. We typically follow this process:

  1. Initial assessment: One-on-one consultation to understand your current fitness, lifestyle, needs, and goals.
  2. Training plan: A customised and detailed program aimed at helping you increase your strength and reduce the risk of injuries.
  3. Progress review: A regular review to assess your progress and fine tune your training plan based on your body’s condition and latest goals.

So what are you waiting for? Chat with your physio about your sporting needs. You can’t go wrong by getting strong!

Written By: Michael Bushell, B.Sc. Physio (Aust); M. Manual Therapy (Aust); M.S.P.A

As an Australian Physiotherapy Association (APA) Titled Musculoskeletal Physiotherapist with over 24 years of clinical experience, Michael is a highly qualified physiotherapist with expert knowledge and skills in all areas of musculoskeletal and sports physiotherapy.


  1. Lauersen, Bertelsen & Andersen, The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials, 2014.
  2. Lauersen, Andersen & Andersen, Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis 2018

How to be more active at work ? Try out some light exercises in the office

In previous article, we discussed the importance of being physically active. So how to be more active at work? Here are some suggestions by our physiotherapist:

1. Break down sitting time, take active break from the computer
2. Standing up when you are talking to your colleague or talking in phone
3. Alternate sitting and standing workstation
4. Try out the below light exercises in the office!

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Pregnancy Exercise and Physiotherapy – some key benefits (Part 1)

shutterstock_405029551So many soon to be mums are unsure about exercising in pregnancy and what they can do safely in pregnancy.

Pregnancy can cause havoc on the body with extra weight that the muscles and joints have to handle, the associated hormones which have an affect on ligaments becoming more flexible and more pressure on joints due to the loss of ligament support, plus changes to our centre of gravity, just to name a few!

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To CrossFit or not to CrossFit?

That is the question that regularly pops up during our Physiotherapy sessions from clients.

CrossFit (CF) is a workout methodology created by former gymnast Greg Glassman in 2001. It consists of a variety of exercises such as Olympic-like lifts, cardio training and multi-joint movements (like box jumps, pull-ups and jumping rope). This method of training and community has exploded worldwide over the last ten years and definitely in the last 5 in Singapore. This can be reflected by the amounts of CF ‘boxes’ which have propped up in Singapore and a number of people we encounter in the clinic who are now doing CF. Read more