Have you heard of the book, Supple Leopard by Kelly Starrett? Or Built to Move? If not, read up!
If so, you know Dr Starrett (a physical therapist himself) sees top athletes from all over the world, from multiple sport and fitness domains.
He’s said that before he sees an athlete/client, he asks about their sleep. If their sleep isn’t dialed in, he won’t see them as a new client. Get your sleep figured out - then go to him for physical therapy.
This isn’t a plug to go see him for physical therapy :) BUT, it highlights that top health care practioners KNOW that sleep does a body good.
You can do everything right in the clinic and in the gym, but if your sleep is poor, you are working against your own progress. Sleep is when your body does much of its repair work, and it plays a bigger role in how well you recover, perform, and stay injury-free than most people realize.
Why Sleep Matters for Injury Prevention
Your tissues repair while you sleep. Muscle, tendon, ligament, and bone all rely on sleep for recovery. Deep sleep is when your body releases growth hormone and does much of its rebuilding after training and daily stress.
Poor sleep is linked to higher injury risk. Research in young athletes has found that those who regularly slept less than eight hours a night were significantly more likely to be injured than those who slept more. The same pattern shows up in adults who train, work physically demanding jobs, or are returning to sport after an injury.
Sleep affects how your body moves. When you are tired, your reaction time slows, your coordination and balance get worse, and your movement quality drops. Those small changes are exactly what leads to a rolled ankle, a tweaked back, or a poor landing.
Sleep loss reduces muscle strength. A 2025 systematic review found that both short-term and ongoing sleep loss lowered some measures of muscle strength, power, and muscular endurance, and that tired people showed more fatigue and poorer neuromuscular function. Results varied from study to study, but the message is consistent: strength work and rehab exercises go better when you are rested.
Sleep changes how pain feels. Short or broken sleep makes your nervous system more sensitive. The same activity can feel harder and more painful, and pain can feel more threatening than it really is. Pain also disrupts sleep, which can create a frustrating cycle.
Sleep supports healing after surgery or injury. If you are rehabbing an ACL, shoulder, or tendon, consistent sleep helps your body adapt to the work we are asking it to do.
How Much Sleep Do You Need?
Most adults: 7 to 9 hours per night
Teens and young athletes: 8 to 10 hours per night
During heavy training or rehab: aim for the higher end of your range
Quality matters as much as quantity. Waking up often, or lying awake for long stretches, can leave you under-recovered even if you spend enough hours in bed.
Sleep Hygiene: Habits That Help
Keep a consistent schedule
Go to bed and wake up at about the same time every day, including weekends.
Try to keep your schedule within an hour of your usual times.
Set up your bedroom
Keep it cool (around 65 to 68°F works well for most people), dark, and quiet.
Use blackout curtains or an eye mask, and earplugs or white noise if needed.
Keep your bed for sleep. Try not to work or scroll in bed.
Manage light
Get bright light, ideally outdoors, within the first hour after waking. This helps set your body clock.
Dim the lights and reduce screen use for 30 to 60 minutes before bed.
If you do use a device, turn down the brightness and avoid stimulating content like work email or social media.
Watch caffeine, alcohol, and food
Cut off caffeine by early afternoon. It can stay in your system for 8 hours or more.
Alcohol may make you drowsy, but it fragments sleep and reduces its quality. Limit it close to bedtime.
Avoid heavy meals within 2 to 3 hours of bed. A light snack is fine if you are hungry.
Time your training
Regular exercise improves sleep quality.
Very intense training late at night can make it harder to wind down for some people. If that is you, try shifting hard sessions earlier or adding a longer cool-down.
Build a wind-down routine
Spend 20 to 30 minutes on something calming: light stretching, reading, a warm shower, slow breathing, or journaling.
If your mind races, write down tomorrow's to-do list before bed.
If you can't fall asleep
Do not lie in bed frustrated. After about 20 minutes, get up, go to another room, and do something quiet in low light until you feel sleepy.
Avoid checking the clock repeatedly.
Limit naps to 20 to 30 minutes, early in the afternoon.
Sleeping With Pain or an Injury
Pain that makes it hard to get comfortable is common. A few starting points:
Shoulder: Try sleeping on your back or on the opposite side with a pillow hugging your arm in front of you. Avoid lying on the painful shoulder.
Low back or hip: On your side, place a pillow between your knees. On your back, place a pillow under your knees.
Knee (including after surgery): Support the leg with pillows so it rests comfortably. Follow any positioning guidance from your surgeon or therapist.
General: A short walk or gentle movement before bed can reduce stiffness. Ask us about timing of any pain medication.
If pain regularly wakes you at night, let us know. It helps us adjust your plan.
Quick Daily Checklist
Same bedtime and wake time
Morning light exposure
Caffeine cut off by early afternoon
Screens dimmed before bed
Cool, dark, quiet bedroom
Calming wind-down routine
Supported, comfortable sleep position
When to Talk With Us or Your Doctor
Tell your physical therapist if you notice:
Trouble falling or staying asleep most nights for more than a few weeks
Pain that consistently wakes you up
Loud snoring, gasping, or pauses in breathing during sleep, or feeling exhausted despite a full night in bed
Excessive daytime sleepiness, including while driving
Sleep problems alongside low mood, anxiety, or significant stress
These can have causes that benefit from a medical evaluation, and we are happy to help you figure out next steps.
The Bottom Line
Training and rehab create the stimulus. Sleep is where your body adapts to it. Even small, consistent improvements in your sleep can help you recover better, move better, and stay healthier.
References
Milewski MD, Skaggs DL, Bishop GA, Pace JL, Ibrahim DA, Wren TAL, Barzdukas A. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-133. doi:10.1097/BPO.0000000000000151
von Rosen P, Frohm A, Kottorp A, Fridén C, Heijne A. Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports. 2017;27(11):1364-1371. doi:10.1111/sms.12735
von Rosen P, Frohm A, Kottorp A, Fridén C, Heijne A. Multiple factors explain injury risk in adolescent elite athletes: applying a biopsychosocial perspective. Scand J Med Sci Sports. 2017;27(12):2059-2069. doi:10.1111/sms.12855
Gao B, Dwivedi S, Milewski MD, Cruz AI Jr. Lack of sleep and sports injuries in adolescents: a systematic review and meta-analysis. J Pediatr Orthop. 2019;39(5):e324-e333. doi:10.1097/BPO.0000000000001306
Dwivedi S, Boduch A, Gao B, Milewski MD, Cruz AI Jr. Sleep and injury in the young athlete. JBJS Rev. 2019;7(9):e1. doi:10.2106/JBJS.RVW.18.00197
Wang YB, Guo ZL, Zhang F, Zhang Y, Wang SS, Zhao Y. Sleep problems and injury risk among juveniles: a systematic review and meta-analysis of observational studies. Sci Rep. 2017;7(1):9813. doi:10.1038/s41598-017-10230-3
Watson A, Johnson M, Sanfilippo J. Decreased sleep is an independent predictor of in-season injury in male collegiate basketball players. Orthop J Sports Med. 2020;8(11). doi:10.1177/2325967120964481
Easow J, Bommasamudram T, Munnilari M, Adhikari R, Edwards BJ, Nayak KR, Vaishali K, Ravindrakumar A, Gallagher C, Pullinger SA. Implications of sleep loss or sleep deprivation on muscle strength: a systematic review. Sleep Breath. 2025;29(4):242. doi:10.1007/s11325-025-03413-0
Note: Most of this research is observational, so it shows that short sleep and injury go together rather than proving that poor sleep directly causes injury. The strongest evidence so far is in adolescent and young athletes.
