Why do so many people in their 40s, 50s and older wake up feeling stiff and sore?

There are probably a lot of reasons. A common contributor to stiffness is that few people get enough sleep. Sleep studies show that most people need, on average, eight to nine hours of sleep a night. Some need more. A few need less. Because of the nature of my specialty, most people I see in my practice are aching. When I ask them how long they sleep, they typically tell me five to six hours. That's a two- to three-hour sleep debt a night.

What other factors contribute to the development of aches and pains?

If you're not scheduling enough time for sleep, you're usually scheduling too many other things instead. You're constantly in fight-or-flight mode. People tend to ache from too much stress because they're constantly tensing their muscles.

More and more people are spending their days sitting in front of computers. They're tensing their muscles and leaning into the screen to see if that will make the computer work faster. Doing that every day can make the muscles in your neck and back ache.

It's basic poor muscle hygiene. You need to get enough rest, exercise regularly, use good posture and take time to relax.

What role does exercise play?

Americans tend to have two exercise settings: too much or none. When I tell people to start exercising, those who have never exercised in their life go at it for two hours. Then they hurt, and they use that as an excuse to stop exercising.

When I'm showing people who've been injured how to do an exercise, no matter what I do to make the exercise painless, they often wind up hurting because they believe exercise doesn't work unless they feel discomfort. People have difficulty finding a middle road — they have trouble moderating the amount of exercise they do. They aren't paying attention to their bodies, which tell them, through pain, that they're overdoing it.

Another problem is that people who exercise regularly tend to do one, two or three exercises without variation. Our ancestors did different activities all the time. People generally don't choose exercises that simulate the kind of movements involved in everyday activities. Lifting weights isn't much like lifting groceries, the normal kind of lifting you do in everyday life. It's not a natural use of your muscle.

Are you saying that weightlifting is bad for people?

I'm not saying it hurts you, but you're repetitively doing an unnatural thing. Take leg extensions to build the thigh muscles.  Leg extension exercises can actually damage a surgical repair, especially in people who have hurt their knee's anterior cruciate ligament. Do people normally go around lifting things that way? No.

I recommend exercises that activate the thigh muscles and the hamstrings, while keeping the knee aligned — lunges and squats, for example. Yoga and tai chi are other good activities that even older people can tolerate well.

Are there activities or exercises people should avoid?

Playing any kind of sport too aggressively can be harmful. Most sports injuries occur when you fall or hit something, or when you're playing with all your might, really trying to beat someone.

Soreness that follows 24 hours after exercise is normal and means that muscles are growing stronger. The response to this should be rest followed by continued moderate exercise. On the other hand, pain during exercise is a warning sign of impending injury and should prompt you to correct your form, reduce the workload, or adopt a different form of exercise.

Do your mattress and pillow make a difference in how you feel?

It used to be thought that people with back problems required a firm mattress, but a recent study indicates that they may sleep even better on a medium-firm mattress. This may be because very firm mattresses are hard on bony areas, like your knees and hips, and that makes it more difficult to sleep on your side.

Conversely, you don't want too soft a mattress because they can sag. Although no one has proved it, it makes sense that a sagging mattress won't hold the spine in alignment.

Regarding neck support, research is lacking. No single pillow is better than others, because you move around when you sleep, and you need the pillow to be in a different position when you're on your back than when you're on your side or stomach. Cervical pillows are available for neck pain, and some people swear by them. Try them out. If any pillow makes you feel worse, though, it's not working.

What do you recommend for self-care for everyday aches and pains?

At least for a little while, go to bed early. Also, use ice for the first few hours after an injury. Not only does it keep down swelling, but it also affects your nerves, slowing the transmission of the pain signal. It takes about 10 to 30 minutes to work and lasts a couple of hours. Then you have to use it again. The same is true of heat. Heat tends to result in muscle relaxation. Although it can relieve pain, it can increase swelling, so it's not recommended soon after an injury.

Massage is as effective or more effective than heat or ice. Corn oil or sesame oil from your cupboard can be as effective as a special oil or cream designated for massage. When you rub on a mentholated cream, it's probably the massage more than the cream that gives most of the relief. Over-the-counter pain pills and anti-inflammatory medications are safe for most people, if taken as directed.

When should you go to the doctor?

If your pain persists for longer than two weeks, or gets worse, it may be time to seek medical advice — especially if the pain doesn't respond to heat, ice or over-the-counter pain medicine. You also may want to see a doctor if you find a lump, or if your sore spot gets more red and swollen over time. Pain that keeps you up at night or impairs your ability to work also may be a warning sign of something more serious.

By Mayo Clinic staff