Sleep Well to Feel Well

When you think of physical therapy, sleep probably isn’t the first thing that comes to your mind.  Although hands-on therapy and exercise are often keys to a successful outcome, your body is more complex and other aspects of your overall health should be taken into consideration. In addition to your diet and exercise, rest is an important component of your well being.   If you would like to sleep and feel better, this article is for you.

The Centers for Disease Control & Prevention report that 1/3 of US adults get less than the recommended amount of sleep. When lack of sleep becomes a long term issue it is associated with chronic diseases.  This includes type 2 diabetes, heart disease, obesity, and depression.  The American Academy of Sleep Medicine recommends that you get 7 hours or more each night.

Effects of Sleep on Bodily Systems

In regards to your cardiovascular health, sleep deprivation can increase the activity of your sympathetic nervous system.  This leads to more variability in your heart rate and blood pressure.  Sleep apnea is associated with arrhythmias, ischemic heart disease, and stroke. Impaired cognitive function is also a result of sleep loss causing difficulty with memory and your ability to learn.  It also plays a large role with your immune system and tissue healing.  While you are at rest your immune system gets to work and helps to fight illness and heal tissues in your body.  Without the proper amount of rest, your immune system cannot do its job properly.  This leads to delayed healing.

Pain-Sleep Relationship

Lack of sleep can affect how you perceive pain.  Although not well understood, pain and sleep are in some ways controlled by similar mechanisms.  Those who lack sleep have heightened pain sensitivity.  According to the National Sleep Foundation nearly 1/4 of people with chronic pain have been diagnosed with a sleep disorder. They also report less control over their sleep and worry more about it.  The pain-sleep relationship is a tricky one. If you have pain you have a harder time sleeping and if you are not sleeping you can have more pain. Don’t let this panic you.

If you are under the care of a physician or physical therapist for your pain continue the process.  However, don’t underestimate what a few good nights of rest can do.  Some studies have shown that sleep hygiene and education have been associated with improved pain in patients with low back pain, fibromyalgia, and knee arthritis.

Sleep Hygiene

Sleep is a behavior.  Therefore, behavior or habit changes can improve your sleep.  Most people have a dental hygiene routine that they follow yet they have not considered having a sleep hygiene routine.  Practicing some of these simple habits can help:

  1. Go to bedtime and wake up at the same time every day.
  2. Use your bed only for sleeping.
  3. Develop a relaxing bedtime routine.
  4. Exercise to improve sleeping at night but avoid vigorous exercise 2-3 hours before bedtime.
  5. Avoid caffeinated foods and drinks 4 hours before bedtime.
  6. Refrain from drinking alcohol or smoking 3 to 4 hours before bedtime.
  7. Do not take unprescribed or over-the-counter sleeping pills.
  8. Avoid daytime napping or limit naps to 30 minutes with no naps in the evening.
  9. Make your sleeping environment comfortable and relaxing.  Stop using light emitting electronics at least 30 minutes before bedtime and minimize noises.
  10. Avoid eating a large meal or spicy food 2-3 hours before bed.

Final Thoughts on Sleeping Well

If you implement these behaviors and feel you are still struggling with your sleep please discuss this with your physician and/or physical therapist.  In addition, there are tools medical professionals use to screen for more serious conditions.  Meet with your physical therapist to see if a referral to a sleep specialist is needed.


  1. Vitiello M et al.  Short-term Improvement in Insomnia Symptoms Predicts Long-term Improvement in Sleep, Pain and Fatigue in Older Adults with Co-morbid Osteoarthrits and Insomnia
  2. Cho S, Kim GS, Lee JH.  Psychometric evaluation of sleep hygiene index:  a sample of patients with chronic pain. Health Qual Life Outcomes. 2013;11:213
  3. Orlandi AC, Ventura C, Gallinaro AL et al.  Improvement in pain, fatigue, and subjective sleep quality through sleep hygiene tips in patients with fibromyalgia.Rev Bras Reumatol. 2012;52:666-678.


Are Your Health Care Providers Helping You Be As Healthy As You Can Be?

The leading cause of morbidity and mortality in the United States is chronic disease.  Heart disease, stroke, cancer, diabetes and lung disease are chronic diseases which can be caused by a person’s lifestyle.  Behaviors like physical inactivity, unhealthy diet and tobacco use are all associated with chronic diseases.  These diseases are preventable.   However, the medical system in the United States is more prone to treating these illnesses after they’ve occurred.  Ideally, health care providers should look towards prevention first.  The World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have labeled lifestyle diseases an epidemic.  In response to the epidemic, health care providers are stepping up to the plate to take the first step towards lifestyle disease prevention.

Health: How a Physical Therapist can Help

Physical therapists are the most ideal providers to promote health and wellness in their patients.  A patient may see their physician only periodically for well visits or for the occasional illness.  When a patient attends physical therapy they typically spend an hour with their therapist 2-3 times per week for several weeks.  It is easy to build a strong patient-provider relationship this way.  Physical therapists are well positioned to have dificult lifestyle choice conversations with their patients and establish a system to monitor accountability.

Did you know that physical therapists have basic knowledge and skills to promote health and wellness in five important areas?  Physical therapists can screen for and identify problems with:

  • Physical inactivity
  • Nutrition and weight management
  • Smoking
  • Sleep
  • Stress

Physical therapy patients may be surprised to learn that it is possible their unhealthy behaviors or habits contributed to the pain or injury for which they were seeking physical therapy.  Physical therapy can reduce or eliminate pain.  If patients continue previous behaviors such as poor diet or sedentary lifestyle and do not incorporate some exercise or physical activity into their life it is likely the pain will return.  Sleep and stress also play a vital role in healing and recovery and should be addressed if problematic.

Take Action

Physical therapists are equipped with tips, tricks and resources to help their patients in the areas above.  They can provide education, help with accountability, motivation and support.  If you have a trusting relationship with your physical therapist they can be there to help reinforce your healthy habits along the way.  Ask yourself “Do I engage in health promoting activities?”.  If the answer is “no”, then your physical therapist can be your guide and your way to get started, just ask.


  1. Bezner JR. Promoting health and wellness: implications for physical therapist practice. Phys Ther. 2015;95:1433-1444
  2. World Health Organization.  Global action plan for the prevention and control of NCDs 2013-2020.  Available at:

Finished Your Physical Therapy: What’s Next?

The day has come.  You’ve dedicated your time and put in the work now you and your physical therapist have decided you’re ready for discharge.  So what happens after you have completed physical therapy?

Some patients leave physical therapy feeling 100% and return to their regular active lifestyle and prior fitness routine.  In many cases, though the patients we see are ones that do not live an active lifestyle and have no prior fitness routine. Some patients may only feel 80% better and insurance benefits or financial limitations will not allow continued care. These patients, in particular, are the ones who may leave therapy feeling uneasy or unsure.  They may have many questions they are asking themselves:

  • What if I never feel 100%?
  • When will I find time to continue the home exercises on my own?
  • How long will I have to continue these exercises for?
  • What if the exercises feel like they aren’t helping me anymore?
  • Will I be disciplined enough to do them?
  • What if the pain starts to come back?
  • What if I stop doing the exercises?

Exercise After Physical Therapy

Chances are if you are asking yourself any of these questions, you may be someone who requires or would benefit from more guidance moving forward.  Ideally, you would benefit from a long-term fitness routine or group exercise program.  If you are someone who did not exercise regularly prior to staring physical therapy there is a good chance that you will not continue to do the exercise once you are done.  The intentions may be good but many people do fall short.  Some people are disciplined self-motivators but many are not.  Also, it is easy enough to say “I can’t find the time” or “life just got in the way”.   Anyone at anytime can find the excuse as to why they haven’t been able to continue with a routine.

Building Healthy Habits

Most of the time patients attend physical therapy for 2 or 3 visits a week for a few weeks, most commonly between 4 and 8 weeks.  Research says it can take 2 months or more (66 days on average) to form a new habit.  It takes repetition for the new behavior pattern to become imprinted in your neural pathways. In fact, research by Kaushal and Rhodes suggests it takes at least 4 gym sessions per week for 6 weeks to establish an exercise habit. That doesn’t mean you can’t develop an exercise habit by going less frequently; it just means it will probably take longer for it to become automatic.

If you have already been attending physical therapy 2-3 times per week DO NOT stop dedicating that time to yourself when you are done. DO NOT take a week off and decide to figure out the next step later. DO NOT lose your momentum! If you know that you are someone who needs that continued guidance and motivation ask your physical therapist to help you find the right exercise program to start with.  Depending on your fitness level, behavior characteristics and health goals there will be options that are better for some than others.  Fitness is a booming business right now and there are plenty of options out there.  Some people don’t know where to start.  Your physical therapist will have a general knowledge of what types of exercises are done at different fitness facilities, however, depending on where you live these places vary.

Local Recommendations

The physical therapists at BSR Physical Therapy have been doing the research locally here in the Manahawkin, NJ area.  We are helping to build a library of long-term fitness options for our patients.  We want you to succeed in your health goals.

Most recently Dr. Amanda Higgins, Morgan Gamble and I attended a barre class at Black Sheep Studios on LBI.  The fitness studio had a welcoming earthy vibe.  We met with one of the owners Devon who was as personable as they come and full of energy.  It only took one class to know that this is a place where you won’t get lost in the numbers as the class sizes are small and intimate and everyone called everyone else by name.  The instructors paid close attention to form and corrective technique which is a must to get the recommendation from a physical therapist.  Their instructor Wendy provides individualized programs for people with the use of pilates transformers which is a hard find in this area.  They also provide a menu of other unique exercise classes that may be the perfect fit for some of you.

This place is one of many that can help you stay on track.  We want to see you succeed with your health and fitness long term.  Let us help you transition from physical therapy to fitness.

-Dr. Amy McMahon