Sleep posture: side-sleeping (updated)

Let's break sleeping down into three categories:

1. Side sleeping
2. Sleeping on back (or "supine")
3. Stomach sleeping

It's likely you are a combination-sleeper but I aim for this information to be of use with any sleep posture.

A number of years ago, my chiropractor and I chatted (very briefly) about sleep positions, and she told me that  sleeping on your back is considered best, side-sleeping is in the middle, and sleeping on your stomach is the worst for alignment. I'm inclined to agree.

Here are some potential joints and areas that can be stressed by certain positions, and tips for relieving the pressure. This post is about sleeping on your side.

Side-sleeping; the most common way to sleep worldwide. The biggest issues I see are shoulders and hips.

HIPS

When on your side, you want your legs lined up. If one leg is in front of the other, this is excess strain on your spine.

In this position, however, our top leg is going to be at an angle without the proper support. Also, having your knees resting on one another can be uncomfortable in and of itself. In standing posture, this inverted leg angle is called "knock knees" or a valgus position/posture.

left = "varus" / right = "valgus"

By aiming for the neutral stance, you will bring the most balance and relaxation to the leg muscles and the overall structure.

Do you have low back pain? Leg issues of any sort? Hips hurt? Get a small pillow for between your knees when you sleep, side-sleepers. I've gotten great relief from doing so. In fact, I've been using the same one for so long it's flattened out and I need a new one that will lift my leg higher!

It's likely that if you're always sleeping in this valgus posture that you have tightness on the outer leg and inflexibility in the inner thigh muscles (adductors). In addition to affecting the leg, this can make your pelvis sit at an angle, where dysfunction can branch out to the abdomen, back, and further.

UPDATE: A friend of mine pointed out two more muscles that give people a ton of problems, that could be contributing to a multitude of problems - Tensor Fascia Latae and Psoas, seen below.

TFL is a small, typically overworked and/or misused muscle. An instructor of mine told us a story of when he had to retrain the way he walked for maximum efficacy because while you should actually be using Gluteus Medius (underneath glute max) to start lifting your leg up and out with each step, that he was using his TFL. This muscle is much smaller than the glutes and ill-equipped for such a frequent intense use. I suspect many other people are misusing their TFL as well due to a weakness in the glutes or a postural deviation of sorts. If you sleep in a highly curved, fetal position, there's a chance you are keeping TFL in a shortened state so frequently that it becomes bound and problematic. If you experience pain at the side of your hip nearing the front side, this muscle may be a contributing factor!

Shown here is psoas major. Again with the fetal position this is kept in a shortened position (any time the hips are bent up or the torso bent down), and is a stealthy bugger in terms of contributing to back pain. There is a lot of "my low back hurts, massage my low back" out there when in reality many of these people may need a release in the psoas. 

SHOULDERS

By default your shoulders are forward - the humerus (bone of your upper arm) is forward of the rib cage in order to be comfortable on one's side. This is lengthening back & shoulder muscles, while shortening pectoral (chest) muscles for a long period of time. Ideally we want the arm and shoulder lined up as much as possible, but therein lies an issue with lying directly on your arm.

Pain between your shoulder blades? Tight pec muscles? Try hugging a pillow when you sleep. I go so far as to turn a regular pillow sideways (perpendicular to my body) to get enough width for relatively level shoulders. Just be careful not to curve too much into the fetal position, as that will cause it's own back issues.

fetal position, while comfortable,  is too much curve for your upper back

Lastly, there's the neck. Pretty straightforward: keep your head level.

left = excess strain / right = thumbs up

Here's an article with some other outside sources I found when searching for these images:
http://www.marksdailyapple.com/improve-sleep-posture/#axzz2LwqPhxXD

Sound sleep to you all!

Treating carpal tunnel syndrome, week 5

The fifth and final treatment session occurred, and here are the before and after sensation maps I drew up. The left picture is the palm side of the hand.

Before any massage:


Before the final session:


It's important to note that except for that little band of sensation loss, the hand had full sensation in it, before the final massage (meaning it had been a week since the last session). Post-massage the sensation was always present, but it tended to fade back to normal over the week. This is great news, suggesting that regular massage can treat carpal tunnel syndrome (although this is dependent on what is causing the syndrome). We will have to see how well it lasts in the long-term. It's been eleven days or so and has only woken her up a few times.

Update to carpal tunnel treatment week 4

Following the night of the fourth treatment, my client was able to sleep through an entire night soundly. It has been at least two years since she's been able to make it through a night's sleep without waking due to numbness, tingling, or throbbing pain sensations.

With just four 1-hour massages!

Superb. Here's hoping the change lasts in the long-term.

Treating carpal tunnel syndrome, week 4

Treatment is going well. I finished the fourth session tonight (it's been one hour of massage every Tuesday for four weeks now), and there is noticeable improvement. As mentioned before, I've been mapping sensation loss: once before the massage; once after the third; a last one planned for the end (treatment #5 or #6). Directly following the massage, all sensation is back in the hand. However, I'm more interested in long-term change. Here's some relevant results.

Before treatment
palm side:
- thumb almost 100% numb, ranging down close to the wrist
- index finger numb clear down past the knuckle
- middle finger numb down to palm
- ring finger numb down to palm

dorsal side (back of hand):
- thumb numb 'til just above the second knuckle
- index finger numb more than halfway down hand
- middle finger numb more than halfway down hand

Before treatment #3
palm side:
- thumb numbness starts below first knuckle and ends around the wrist
- index finger numbness no change
- middle finger numbness just down to above second knuckle
- ring finger no sensation loss!

dorsal side:
- thumb only has two small spots where sensation is not felt!
- index finger sensation loss stops above first knuckle
- middle finger sensation loss stops below first knuckle

The sensation tends to be much improved for a day or two, then slowly decline back toward paresthesia (numbness & tingling). There's been a rather perplexing change this week, however. Numbness is very frequent, but more importantly, the speed at which this happens has drastically increased. So while it's going numb quite frequently again, the entire process of starting to go numb, being numb, and recovering, is only taking about 30 seconds.

Previously it would take several minutes just to go numb, and stay numb for much longer depending on what she was doing and if she was able to rest her wrist. Very strange results, and I honestly don't know what could be happening physiologically here. I am very interested to see how week four goes.

There are several special tests in bodywork that test areas for nerve compression - my client had positive results for all the carpal tunnel impingement tests. However, she also had a recreation of symptoms when testing for nerve compression at the brachial plexus (clavicle aka collar bone). This strongly suggests that not only is the median nerve of the wrist cramped in the carpal tunnel, but also further up the arm/shoulder/neck. I think it is crucial for massage therapists treating such conditions to do a thorough investigation of all the places the nerve impingement could be happening.