In arthritis, how is "morning stiffness" experienced?

October 13, 2014 2:50 PM

I have some sort of arthritis that seems to be systemic and inflammatory. I read that if it's "rheumatoid arthritis" then I should probably have "morning stiffness". But no one seems interested in saying what that is.

The clearest definition I can find is something like "limitation in range of motion" which doesn't sound much like anything that I would call stiffness. A pencil is stiff. A joint that can move freely until it is stopped, say, 10 or 20 or 40 degrees from its normal angular limit is... limited in range of motion. I would think that a "stiff" joint would be locked altogether, which according to what I read is also something that happens for some people. Or, at least, it would be felt to hitch and scrape a lot as it moved, as with a "stiff" part on a machine made of metal that has rusted. But one would think that if your joint were scraping itself up like that, then people wouldn't just casually classify that as some transient "morning stiffness"--they'd be like "go to the hospital dude, and keep that thing straight because you're clearly wrecking it." ...Or is this stiffness a "gummy" feeling, where movement is smooth but cannot be done at normal speed without great force? But things that move smoothly are not really "stiff", are they?

Well, if the word "stiff" has a strange and special meaning in the context of arthritis, then fair enough. But regardless, I'd like to know what "morning stiffness" actually means so that, for instance, I can tell a doctor whether I've been having it. If you have experienced or personally observed this symptom, how specifically did it manifest?

posted by Koray to Health & Fitness (26 answers total)

Well, for me, stiffness = muscles / tendons being somewhat reluctant to move. Even without arthritis, why do you stretch your arms when you wake up? Because you're feeling a bit stiff after sleeping. That's normal. With rheumatoid arthritis, I think it's more of the same.
posted by blue_wardrobe at 2:55 PM on October 13, 2014

resistance to movement
posted by i_am_a_fiesta at 3:05 PM on October 13, 2014

I have an arthritis diagnosis, not RA but on that side of the spectrum, i.e., not osteoarthritis. For me morning stiffness means that my joints move slowly until I've been up and about for a while and/or had a hot shower. Trying to move at regular speed can be painful, or if I'm on the stairs, I feel like moving at normal speed risks a joint collapsing or bending in a wrong way and maybe me falling down. Resistance to movement is also a factor.
posted by immlass at 3:09 PM on October 13, 2014

If you can't bend over and touch your toes at 7 am, but can bend over and touch your toes at noon, that is morning stiffness. People in my house hobble and/or shuffle due to hip pain or lower back pain in the mornings, too.
posted by DarlingBri at 3:14 PM on October 13, 2014 [3 favorites]

Response by poster: "Resistance to movement" by itself is hard to understand, since it can take some drastically different forms, the distinction among which is part of what I'm explicitly asking about.

Also I'm asking about arthritis-related stiffness; touching your toes could be hard because your muscles aren't warmed up, which seems like a totally different thing.
posted by Koray at 3:18 PM on October 13, 2014

In my case morning stiffness has to do with dehydration as well. But it's mild pain and that my muscles are reluctant to move in the way that I want them to. A hot shower, and a big glass of water and I feel much better.
posted by Ruthless Bunny at 3:19 PM on October 13, 2014 [1 favorite]

It depends on the arthritis: for me it can be more like imagining that the tendons are not moving smoothly through the sheaths they are in, and that where the tendons meet the bones, they don't flex as well. Imagine a reluctant brake cable on your bike.
For other types of arthritis it's going to be different.
posted by blue_wardrobe at 3:20 PM on October 13, 2014 [1 favorite]

My morning stiffness due to ankylosing spondylitis goes like this: for the first twenty to thirty minutes after I wake up in the morning, my heels can't touch the floor because my feet and ankles are too stiff, I can't raise my arms above my head, I can't bend over to touch my toes, or even reach my feet to put on socks when sitting down.

I think you're getting overly hung up on the idea that arthritis has to do with joints and joints = bones. The musculoskeletal system is really one entity that works together, and as blue_wardrobe says, the connective tissue like tendons are frequently involved in arthritis.
posted by hydropsyche at 3:29 PM on October 13, 2014 [2 favorites]

Yeah, in autoimmune arthritis in particular, there's a LOT of soft tissue involvement. My husband has psoriatic arthritis, which is another autoimmune arthritis like RA, and before he got treated, he would just have a lot of trouble moving in the morning -- he would get out of bed and shuffle to the bathroom bent over like an old man, he had trouble grasping a coffee cup by the handle, he couldn't always turn the shower on, I had to help him get his shoes on and tie the laces. After a few hours? his range of motion was much more normal, although he still had a lot of pain. The "stiffness" involved is absolutely not just bone/joint stiffness; it's not that dissimilar from your muscles being exceptionally tight.
posted by KathrynT at 3:35 PM on October 13, 2014 [5 favorites]

Do your joints feel sore in the morning? That's morning stiffness.
posted by EmpressCallipygos at 3:46 PM on October 13, 2014

Anecdata: My morning stiffness includes not being able to curl my fingers into a fist or grip anything (e.g., opening pill bottles). My knuckles and toe-knuckles are swollen and painful. I can't fully extend or raise my ankles, making stairs very difficult.
posted by Jacqueline at 3:58 PM on October 13, 2014

Response by poster: > I think you're getting overly hung up on the idea that arthritis has to do with joints and joints = bones.

That helps make sense of this. Maybe part of the problem, also, is that I don't know much about "stiffness" of muscles and tendons, either. I get some bad tension in my upper back, but other than that my muscles just do what I want, morning to night, and have always done so. It doesn't occur to me that they might not do so, until I am told of the possibility.

So when somebody says "I can't bend over" I'm like, why? Does it start to hurt so you need to stop? Does your body's frame just get stuck and refuse to be pushed any further? Does a goblin slip out from under your bed and grab you so you can't move?

But I guess it's probably just a mixture of "my body won't go any further" and "it starts to hurt", without any particular rusted-metal scraping sensation in a joint, or gumminess sensation in a joint. I can understand that. I guess that's probably my answer.

Also yeah it seems like I don't have morning stiffness. (If anything my joints are at their best in the morning.)
posted by Koray at 4:00 PM on October 13, 2014

Unless you're a very flexible person, there are likely some things your body can't do. Can you do splits? What happens when you try? At some point, your body just won't bend that way, right? This is like that, only instead of splits, I can't put on my socks.
posted by hydropsyche at 4:03 PM on October 13, 2014 [14 favorites]

So when somebody says "I can't bend over" I'm like, why? Does it start to hurt so you need to stop? Does your body's frame just get stuck and refuse to be pushed any further? Does a goblin slip out from under your bed and grab you so you can't move?

It's a pain/soreness/cramping kind of thing. Kind of like the pain you get after you've overexerted a muscle, except without having done anything with that muscle.
posted by EmpressCallipygos at 4:24 PM on October 13, 2014

without any particular rusted-metal scraping sensation in a joint

I have this in my knees. While it is an auto-immune/arthritis problem, it is separate to morning stiffness and comes from long-term damage to/disappearance of cartilage in my knees. Also it's less of a sensation than a (sometimes really loud) clicking sound when I walk up the stairs.
posted by immlass at 4:28 PM on October 13, 2014

I will go so far as to say that if you have to ask, you don't have it. It's a highly intuitive term once you've had it, and most people over a certain age have had it - so there's not a lot of need to explain it. Once somebody has a need for the term, they generally already get it.

When I get up at 7am in the morning and get a shower, get dressed, get myself out to the car, I'm moving at about a quarter of the speed I can move when I'm late to a meeting at 2pm. By 2pm, I'm at the top of my stride - literally. Muscles, joints, whatever - it's all properly lubricated and all the kinks have been worked out.

But in the morning, everything is a little harder; everything hurts a little more; everything is a little slower to respond. Standing up for fifteen minutes while I'm prepping my lunch at work feels fine; standing up for fifteen minutes in the shower when I first wake up feels like the outer level of hell.

If you hop out of bed in the morning and can go from horizontal to your 2pm speed in nothing flat, without any more pain than you feel later in the day, you are not experiencing morning stiffness. If it takes you a while to work up to your 2pm speed - because of pain, because things are tighter/tenser, because your range of motion isn't as broad, any of those - that's morning stiffness.
posted by kythuen at 4:33 PM on October 13, 2014 [6 favorites]

I agree with kythuen's statement that if you have to ask, you probably don't have it, but if it helps with your assessment, my morning stiffness (currently mostly in my ankles and knees, due to psoriatic arthritis) is accompanied by pain. It is actually painful to walk around in the morning for me, at least for the first 30 minutes to an hour. I actually don't experience that much, if any, limitation in my range of motion, but it hurts when I stretch my feet as I'm waking up in the morning and as I'm shuffling around trying to get ready in the morning.

Before I was diagnosed, I mainly had problems with my feet, sometimes something like plantar fasciitis (which along with tendonitis, is a very common problem for people with psoriatic arthritis as it does involve inflammation of soft tissue). Sometimes the pain was concentrated in balls of my feet. When I woke up in the morning it felt like I had just gotten off of an 8 hour shift standing on a hard concrete floor in heels. Although I did and still do experience some pain and discomfort during my day to day activities, it is less than I experience upon awakening from a full night's sleep, when I've been off my feet for at least 7 hours.
posted by kaybdc at 5:03 PM on October 13, 2014 [1 favorite]

Also I'm asking about arthritis-related stiffness; touching your toes could be hard because your muscles aren't warmed up, which seems like a totally different thing.

I am describing arthritis-related stiffness. You can't touch your toes because your joints -- specifically, your vertebrae -- won't bend.
posted by DarlingBri at 7:11 PM on October 13, 2014 [2 favorites]

Every rheumatologist I've been to has made me fill out a variety of paperwork and there is always the question about daily habits versus range of motion. I feel like my worst times with my RA, prior to any sort of treatment, were when I couldn't raise my arms above my head to wash my hair. Stiffness isn't even the correct terminology but, I believe, a blanket term that patients use to talk about the pain.

The feeling isn't like a stiff object that has no flexibility. It's more of a point that your joints reach at which they simply will no longer respond to forward or upward or downward motion, whether due to the pain or a feeling of being "locked up."
posted by Merinda at 8:59 PM on October 13, 2014 [2 favorites]

Or is this stiffness a "gummy" feeling, where movement is smooth but cannot be done at normal speed without great force?

The use of "gummy" and "cannot be done at normal speed" resonate here, but movement isn't "smooth." More...stiff.

But things that move smoothly are not really "stiff", are they?

That it is an intuitive term once you've had it is a good way to explain it. Technically I may not be "stiff." Things can move. But in the morning it is very painful to move them, and my body tries to prevent things from being moved, and so feels "stiff."
posted by kmennie at 6:40 AM on October 14, 2014

I have rheumatoid arthritis. I was diagnosed in early 2010. Before the doctor was able to get my disease under control, I had terrible morning stiffness. It rolled in like a fog only clearing slightly in the middle of the day before coming back in the late afternoon. It was like being wrapped in packing tape. If you want to try to experience the stiffness that I am talking about, find a pair of leather gloves that are much too tight, stuff your hands into them and then wear them around for a few hours. Now you know what rheumatoid arthritis stiffness feels like in your hands. Now imagine that stiffness in every joint . You can't take it off like a pair of gloves that are too tight. Add fatigue, like the kind you get when you have the flu then throw in some incredible pain-pain that you had no idea a body could produce-and you have rheumatoid arthritis.

If you really want to know what it is like to have a rheumatoid arthritis flare, you can Google "A Patient's Perspective on RA", an article that was published in the medical Journal "The Rheumatologist Magazine".

I hope this helps you understand how serious this disease is..and if you wonder if you have stiffness, it is highly unlikely that you have rheumatoid arthritis.
posted by lglavish at 8:59 AM on October 14, 2014 [2 favorites]

With my as yet unidentified rheumatological issue that is similar to but probably is not RA, I don't have a lot of pain most mornings (that comes at the end of the day for me), but I feel like my joints/muscles/tendons just won't move the way I'm trying to move them. I feel it mostly in my hands and legs. I hobble like an 80 year old when I first get up because my hips and knees and ankles don't bend smoothly. The movement is jerky and halting and uncomfortable, but most days it doesn't hurt as long as I move slowly for a while. After 20 minutes or so, I can walk fairly normally, but anything involving much coordination doesn't go well until a few hours later (morning yoga is a thing of the past). With my hands, lglavish was right on about the tight (and stiff) leather gloves - my fingers just won't bend as far as they're supposed to, I have very little grip strength, and they're clumsy and fumbly. Making a fist is completely impossible, as is opening a jar or cereal bag, or writing legibly.

Because it's a general inflammation problem, it is difficult to pin down an exact location or motion that is difficult or painful or to precisely describe the sensation. It's hard to move and sometimes it hurts. I just feel "stiff." As others said before, if you don't have quite a bit more trouble moving in the morning than later in the day, you don't have morning stiffness.
posted by Dojie at 10:52 AM on October 14, 2014

Response by poster: > I hope this helps you understand how serious this disease is..

Google actually covered that well enough for me already. It is easy to find out, for instance, that rheumatoid arthritis is generally recognized to be incurable at present, and that it happens to a lot of people, and that it can kill. Add to that an image search on the name (producing a gallery of monstrous, gnarled hands) and yeah the seriousness is pretty clear, no reference to pain or stiffness needed. It's a disease with an overabundance of facets to be serious about.

> and if you wonder if you have stiffness, it is highly unlikely that you have rheumatoid arthritis.

And this is the point that I'm finding somewhat jarring. This information is so BASIC. Yet I couldn't find it out without asking here. Oh well, I guess that's how it goes sometimes.
posted by Koray at 11:47 AM on October 14, 2014

So, um... I'm not sure I understand your reply Koray. I did not mean to upset you. RA is a very misunderstood disease, but also a very treatable disease. The pictures that you see on Google are often from long-term disease that was not treated with the drugs that have been become available in the last 10 to 20 years.

You seem irritated that you had to ask on this forum about the meaning of stiffness in the context of rheumatoid arthritis. Do you have your answer? Morning stiffness for a rheumatoid patient is not just a transient feeling, it is very debilitating. It is also one of the hallmark symptoms of this disease, that is why rheumatologists are asking you if you have this very important symptom. It sounds like you don't have it, so you may not have rheumatoid arthritis

It is frustrating when you cannot get to the bottom of what is wrong, but at least you may be able to rule out rheumatoid arthritis.

I wish you well.
posted by lglavish at 12:56 PM on October 14, 2014 [1 favorite]

A few years ago I experienced this to the degree that getting out of bed was difficult and I would dread those first few steps of the day. I'd have to shuffle to the shower because my feet hurt badly and functioned about as well as wooden blocks. Opening jars and such was painful or impossible and buttoning clothes (and other fine motor movements) would be impossible. My hands/feet appeared swollen and puffy - my knuckles would practically disappear and sometimes the skin looked red and taut. When my hands and feet were like that they were pretty useless. These symptoms would disappear or lessen in a few hours. Eventually I became concerned enough to go to the doctor and was diagnosed with RA. My doctor said the morning stiffness was a key indicator of RA (more pain/stiffness in the morning that lessens as the day goes on as opposed to consistent pain).
posted by koselig at 1:40 PM on October 14, 2014 [1 favorite]

Response by poster: > I did not mean to upset you.

Ah no, I was intending to be neutrally commenting. This thread seems to have answered my question better than, say, a doctor would probably have done (because doctors are generally in a huge hurry), and I appreciate that help from the people here.
posted by Koray at 2:13 PM on October 14, 2014