Night Splinting

What It Is

Night splinting refers to the use of a specially designed brace or splint that holds a joint—most commonly the ankle, wrist, elbow, or fingers—in a specific position during sleep. The goal is to maintain the joint in an extended or neutral position throughout the night to promote healing, reduce pain, and prevent the tightening of muscles, tendons, or connective tissue.

Night splints are frequently prescribed for conditions such as plantar fasciitis, Achilles tendonitis, carpal tunnel syndrome, elbow contractures, and post-stroke spasticity. The splint is usually made of lightweight, padded material and secured with adjustable straps to ensure comfort while maintaining the desired joint angle.

How It Works

Night splinting works through the principle of prolonged low-load stretching. By holding a joint in a stretched or neutral position for an extended period (such as overnight), it gently lengthens tight or shortened soft tissues—like muscles, tendons, and fascia—without causing microtrauma or discomfort.

For example:

• In plantar fasciitis, the splint keeps the ankle dorsiflexed and the toes extended, maintaining a gentle stretch on the plantar fascia and Achilles tendon. This prevents them from tightening overnight, which reduces the sharp morning pain typical of the condition.
• In neurological conditions (such as after stroke or spinal cord injury), night splints prevent the development of contractures by maintaining the limb in a functional position, counteracting spasticity and muscle shortening.

Over time, this consistent, gentle stretch helps tissues remodel, improves flexibility, and supports better joint alignment and function.

Why It’s Important

Night splinting plays an essential role in rehabilitation, recovery, and prevention. Its importance can be summarized as follows:

1. Promotes Healing and Tissue Recovery: By maintaining a prolonged stretch, night splints encourage collagen remodeling and proper tissue alignment, supporting long-term healing.
2. Prevents Morning Pain and Stiffness: Many musculoskeletal conditions worsen overnight due to shortened tissue positions during sleep. Night splinting counteracts this process, reducing the morning pain and stiffness that many patients experience.
3. Prevents Contracture Formation: For patients with limited mobility or neurological impairments, night splints help prevent or delay fixed deformities (contractures) that can significantly impair movement and function.
4. Supports Post-Surgical Rehabilitation: After surgeries involving tendons or joints, maintaining a specific position during the healing phase is crucial to prevent complications and preserve the surgical outcome.
5. Enhances Range of Motion (ROM): Regular use can gradually improve flexibility and joint mobility without the discomfort or fatigue associated with daytime stretching exercises.

Considerations

When using night splints, several key factors must be considered to ensure safety, comfort, and effectiveness:

1. Comfort and Fit: The splint must be well-fitted and properly padded to avoid pressure sores, circulation problems, or skin irritation. Custom or adjustable designs are often preferred.
2. Duration and Compliance: Consistency is crucial. However, some users find it difficult to tolerate night splints initially. Gradual adaptation—starting with shorter periods—is recommended to improve compliance.
3. Medical Supervision: Night splinting should always be prescribed or supervised by a qualified health professional (such as a physiotherapist, occupational therapist, or orthotist) to ensure proper angle, duration, and application.
4. Skin Integrity: Regular skin checks are necessary, especially for individuals with diabetes, neuropathy, or reduced sensation, as prolonged pressure can cause skin breakdown.
5. Individualized Positioning: The optimal joint position varies depending on the condition. Overstretching can lead to microtears or exacerbate symptoms, so the tension should be mild and comfortable.
6. Contraindications: Night splints may not be appropriate in cases of acute inflammation, open wounds, circulatory disorders, or severe edema. Professional assessment is essential before use.