Going Beyond the MSK System

When most people think about physical therapists, they might picture someone helping a patient out of bed after surgery or guiding them through stretches and strengthening exercises. While these aspects are part of the job, physical therapy is not just about movement—it's about treating the whole person.

As musculoskeletal experts, we focus on restoring function, but our role extends beyond what happens in the clinic. The reality is that patients spend far more time outside of our care than within it, and what they do during those hours plays a crucial role in their recovery. One of the most impactful, yet often overlooked factors in this process is sleep.

Quality rest is essential for healing, performance, and overall well-being. In this edition of our newsletter, we’ll explore how sleep influences recovery and why optimizing it should be a priority in patient care.

Current Sleep Quality

Before we examine the state of sleep in our population, we first need to define what constitutes quality rest. According to the Centers for Disease Control and Prevention (CDC), adults aged 18 and over should aim for at least seven hours of sleep per night, while those 65 and older are recommended to get between seven and eight hours. In younger populations, the sleep requirement progressively increases, with school-age children needing a minimum of nine hours and infants requiring up to fourteen hours. However, meeting these numerical recommendations is only part of the equation; sleep quality plays an equally important role.

Subjective measures often help gauge sleep quality, including how easily a person falls asleep, how frequently they wake up during the night, their sense of restfulness upon waking, and their overall energy levels throughout the day. Despite knowing these benchmarks, the question remains: Are we actually meeting sleep recommendations?

Technically, yes—but with a significant caveat. According to the most recent data from 2022, 36.8% of surveyed individuals reported inadequate sleep⁷ . While this may suggest that the majority of people are getting enough rest, these statistics don’t fully capture the reality of those we see in the clinic. Our patients often face additional challenges—whether from primary conditions or comorbidities—that make quality sleep even harder to achieve. In practice, these numbers suggest that at least one in three patients is likely experiencing impaired recovery due to sleep deficits, even before considering the influence of their underlying health conditions.

Understanding the Effect of Sleep on Recovery

In short, across all systems of the body, but very notably in the ones that we are most familiar with from physical therapy education, insufficient sleep is a prominent risk factor that we need to identify and mitigate.

Patient Education and Current Best Practices for Sleep

With the multitude of effects described above it is true that there is quite a battle ahead to make a meaningful difference in sleep deficits. Approaching this topic with patients may not be the most intuitive compared to other topics that we have more education on. However, with a few helpful points included in patient education, we can make a meaningful difference in our patient’s sleep habits. Included below is a list of ideas to include while educating your patients². 

• Designating the bed for sleep only

• Try to avoid bed until feelings of sleepiness 

• Eliminate sources of light including TV, sunlight and phone screens

• Minimize noise during bedtime

• Setting the thermostat between 65 and 68 degrees (or to the most comfortable temperature for the individual)

• Keeping a consistent alarm schedule to establish a circadian rhythm 

• Keep naps to 20 minutes long and avoid napping after 3pm

• Exercise to increase feelings of tiredness

• Limit caffeine after 2pm

• Alcohol use before bed may increase feelings of drowsiness but actually impairs the body’s ability to achieve quality sleep

• Reduce nicotine and tobacco use 

• Consult a physician about medications to improve sleep if necessary

Undoubtedly, the most impactful way that we can influence patient sleep inside the clinic comes from participating in exercise. However, with a strong patient rapport established we can advocate for many of these changes to be made outside the clinic.

Parting Words

As physical therapists, our role extends far beyond the exercises we prescribe and the mobilizations we perform in the clinic. We are uniquely positioned to guide our patients toward holistic recovery, and sleep is an essential but often overlooked pillar of that process. The science is clear: insufficient sleep can significantly impair musculoskeletal healing, metabolic regulation, neurological function, and overall well-being.

By integrating sleep education into our patient interactions, we can help bridge the gap between clinical interventions and real-world outcomes. Whether it's through simple habit adjustments, environmental modifications, or structured exercise regimens that promote restorative rest, we have the opportunity to make meaningful contributions to our patients' health. At the end of the day quality sleep isn't just a luxury, it's a necessity for optimal function, performance, and recovery. Let’s empower our patients to take control of their sleep so they can maximize the benefits of our care, both in and out of the clinic.

References:

1. Kalmbach DA, Conroy DA, Falk H, et al. Poor sleep is linked to impeded recovery from traumatic brain injury. Sleep. 2018;41(10):zsy147. doi:10.1093/sleep/zsy147

2. 20 Tips for How to Sleep Better. Sleep Foundation. April 17, 2009. Accessed March 2, 2025. https://www.sleepfoundation.org/sleep-hygiene/healthy-sleep-tips

3. Bishir M, Bhat A, Essa MM, et al. Sleep Deprivation and Neurological Disorders. Biomed Res Int. 2020;2020:5764017. doi:10.1155/2020/5764017

4. Dáttilo M, Antunes HKM, Galbes NMN, et al. Effects of Sleep Deprivation on Acute Skeletal Muscle Recovery after Exercise. Med Sci Sports Exerc. 2020;52(2):507-514. doi:10.1249/MSS.0000000000002137

5. Smith PC, Mong JA. Neuroendocrine Control of Sleep. Curr Top Behav Neurosci. 2019;43:353-378. doi:10.1007/7854_2019_107

6. Sharma S, Kavuru M. Sleep and Metabolism: An Overview. Int J Endocrinol. 2010;2010:270832. doi:10.1155/2010/270832

7. FastStats: Sleep in Adults | Sleep | CDC. Accessed March 2, 2025. https://www.cdc.gov/sleep/data-research/facts-stats/adults-sleep-facts-and-stats.html

Disclaimer:

We are current Doctor of Physical Therapy (DPT) students sharing information based on our formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While we strive to provide accurate and up-to-date information, our knowledge is based on our current academic and clinical rotations and ongoing learning, not extensive clinical practice.