Tips to Relieve Polymyalgia Rheumatica Morning Stiffness

While morning stiffness can be frustrating, small changes to your routine — from warming up the muscles before you get out of bed, to adjusting when you take your medication — may reduce discomfort and improve mobility.

“If you take it at night, sometimes it can make it difficult to sleep. You don’t have a good night’s rest and you end up more tired,” Dr. Bose says. “I always recommend taking steroids in the morning.”

The morning is ideal because it replicates the timing of your body’s own production of cortisol, says Scott Zashin, MD, a rheumatologist in Dallas and a coauthor of several books about arthritis management, including Natural Arthritis Treatment. “There are fewer potential side effects when you take it once a day in the morning, for example, rather than taking it once a day at night,” Dr. Zashin says.

But medication timing should never be changed without speaking to your rheumatologist first, Bose says.

When stiffness is severe, jumping straight out of bed can feel overwhelming. Gentle range-of-motion exercises before standing may help loosen muscles and improve circulation, according to Kimberly Steinbarger, an assistant professor in the school of physical therapy at Husson University in Bangor, Maine, where she focuses on patient education for rheumatic diseases.

“If we do some movement exercises, we’re getting a jump start before we even get out of bed. Think of it as just lubricating the joints, and getting everything moving,” she says.

• Shoulder rolls
• Circling your wrists
• Slowly stretching your arms overhead
• Gentle twists from side to side
• Gentle knee bends and ankle pumps

These movements are designed to wake the joints up gradually rather than forcing stiff muscles into sudden movement.

“I, myself, just do [these exercises] all while I’m still lying in bed before I even get up. And that makes a big difference when I get out of bed,” says Steinbarger, who’s had rheumatoid arthritis since 1991.

• Start your day with a warm shower.
• Use an electric blanket or heated mattress pad on a timer so the bed is warm before you wake.
• Apply heat packs to the shoulders or hips before getting up.

If you have access to a heated pool, hot tub, or sauna, these can be a great addition to your morning routine, too, says Neal Birnbaum, MD, a rheumatologist in San Francisco and past president of the American College of Rheumatology.

You could sign up for a morning arthritic aquatic physical therapy class. Also known as hydrotherapy, or pool therapy, time in warm water can help muscles feel looser while providing aerobic exercise and strength training without hurting the joints, he says.

Try a few ways of warming your body up to see which works best for you, Bose says. “Patients usually figure out what they prefer. They’ll tell you a warm shower or running their hands under hot water helps them loosen up,” she says.

Small adjustments at home can make mornings less physically demanding, especially during flare-ups or periods of severe stiffness.

• Installing grab bars near the bed or shower
• Using a higher bed or firm mattress to make standing easier
• Using assistive tools like door openers, jar openers, or walking aids

If you’re not sure where to start, connect with an occupational therapist (OT), Steinbarger says. She says an OT can assess your home and work environment to recommend adaptive equipment with a focus on your functional independence.

While morning stiffness is often the worst part of PMR, staying still for long periods during the day can also cause muscles and joints to tighten up again. Gentle, regular movement throughout the day may help reduce stiffness, maintain mobility, and prevent muscles from becoming deconditioned, Birnbaum says.

Birnbaum, who was diagnosed with PMR in 2000, suggests short walks, light stretching or changing positions to keep the body moving without overexertion. You could even set an hourly timer to remind yourself to get up for a pace around the home, Steinbarger says.

Yoga and tai chi also help maintain flexibility over time for people with PMR, says Aixa Toledo-Garcia, MD, a rheumatologist and the chief medical officer at the Center for Rheumatology, which has several locations in New York state. “[They] can help mitigate steroid-associated muscle atrophy, improve flexibility, and reduce stiffness and pain,” she says.

They’re also great for mobility, balance, and reducing the risk of falls, Steinbarger notes.

PMR typically responds very quickly to prednisone, and many people experience a dramatic improvement within days of starting treatment, Zashin says.

“Most people respond exquisitely well to the steroid. If they’re taking 20 mg and they’re not feeling like a new person, you have to question the diagnosis,” says Zashin.

It may be a matter of adjusting the dose or slowing down the taper, Birnbaum says. “What I want to do is get to the lowest dose of prednisone that gives you symptoms that are no worse than readily tolerable. You don’t necessarily have to be 100 percent symptom-free to function normally and get through the day comfortably,” he says.

Note that prednisone should never be increased, decreased, or split into multiple doses without medical guidance.

• Morning stiffness is one of the most common symptoms of PMR, making everyday tasks like getting out of bed, brushing your hair, or putting on socks difficult at the start of the day. Basic adjustments to your morning routine can ease discomfort.
• Gentle movement — including simple exercises in bed, walking, stretching, and yoga during the day — can reduce stiffness, maintain mobility, and keep joints from tightening up.
• Your daily dose of prednisone each morning may help with side effects like jitteriness and insomnia. People who experience persistent stiffness should speak with their rheumatologist about whether their steroid dose or taper needs adjusting.