Knee Pain at Night: Causes and Treatment

You wouldn’t think sleep could hurt your knees. So, if your knees hurt at night or keep you up at night, you may be wondering what’s up. About one in four adults suffer from knee pain at night, which makes things worse during the day.

Knee pain at night can set up a vicious cycle of waking up and not being able to sleep.

But don’t worry: There are lots of things you can do to relieve the pain and sleep well. Find out what causes knee pain while sleeping, and how to treat it, especially with exercises.

Causes of Knee Pain at Night

Knee pain can happen for a variety of reasons. There are times when it’s not even a medical issue. Instead, it can come from things like strenuous exercise, sitting too long, or kneeling too much.

Some of the most common causes of knee pain at night are runner’s knee, osteoarthritis, bursitis, and injuries. Some, like runner’s knee, go away with rest, while others, like osteoarthritis, last forever.

1. Runner’s Knee

Runner’s Knee, also known as Patellofemoral Pain Syndrome (PFPS), is a condition characterized by pain around the kneecap (patella). It is commonly associated with activities that put repeated stress on the knee, such as running, squatting, and climbing stairs. The pain is typically felt in the front of the knee, around or behind the kneecap.

The primary symptom of Runner’s Knee is a dull, aching pain around the kneecap. This pain may worsen with activities that increase stress on the knee, such as running or descending stairs. Other symptoms include

• A feeling of grinding
• Popping in the knee joint
• Swelling around the kneecap
• Increased pain after sitting for extended periods

2. Osteoarthritis

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that can affect more than just the joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart, and blood vessels. RA is an autoimmune disorder, which means the immune system mistakenly attacks the body’s tissues.

Rheumatoid arthritis symptoms include tender, warm, swollen joints, joint stiffness that is usually worse in the mornings and after inactivity, fatigue, fever, and loss of appetite.

Over time, RA can cause the joints to deform and shift out of place. The symptoms can vary in severity and may come and go.

3. Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that can affect more than just the joints. In some people, the condition can also damage a wide variety of body systems, including the skin, eyes, lungs, heart, and blood vessels.

Unlike osteoarthritis, RA affects the lining of the joints, causing painful swelling that can eventually result in bone erosion and joint deformity. When RA affects the cervical spine, it can lead to neck pain and stiffness, which might be more pronounced upon waking.

This is due to the inflammatory nature of RA, where inflammation can increase during the night when the body is at rest, leading to increased stiffness and pain in the morning. 

4. Post-Traumatic Arthritis

Post-Traumatic Arthritis (PTA) is a form of arthritis that develops after an injury to a joint. This condition is a type of osteoarthritis, which is the most common form of arthritis. PTA can occur at any age and in any joint, often resulting from physical trauma such as sports injuries, vehicle accidents, or falls.

The symptoms of Post-Traumatic Arthritis include joint pain, swelling, and stiffness. These symptoms can develop immediately after the injury or may appear years later, complicating diagnosis. The affected joint may also show signs of instability and decreased range of motion. In some cases, the pain and swelling may be intermittent, with periods of relief followed by flare-ups.

5. Bursitis

Bursitis is the inflammation of the bursae, which are small, fluid-filled sacs that cushion the bones, tendons, and muscles near joints. This condition is commonly caused by repetitive motion or excessive pressure on the bursae, particularly in joints such as the shoulder, elbow, hip, and knee. Bursitis can also result from infection or be associated with other conditions such as rheumatoid arthritis or gout.

The primary symptoms of bursitis include pain, swelling, and tenderness in the affected area. The skin over the bursa may be red and warm to the touch. Chronic cases may involve repeated attacks of pain and swelling, leading to limited mobility in the affected joint.

6. Gout

Gout is a form of inflammatory arthritis characterized by the accumulation of urate crystals in the joints, leading to intense pain and inflammation. This condition typically affects one joint at a time, often the big toe, and is caused by high levels of uric acid in the blood.

Gout can lead to sudden and severe pain episodes, known as gout attacks, which can be triggered by diet, alcohol consumption, and other factors. Symptoms include severe joint pain, swelling, redness, and tenderness, often starting suddenly at night.

The affected joint may feel hot and very sensitive to touch, to the extent that even a light pressure, such as from a bedsheet, can be agonizing.

7. Growing Pains

Growing pains are a common condition affecting children, typically between the ages of 3 to 12 years. Despite the name, these pains are not directly linked to periods of growth or growth spurts. Instead, they are believed to be the result of overuse and muscle fatigue from children’s high levels of activity during the day.

Growing pains are characterized by aching or throbbing sensations in the legs, particularly in the shins, calves, thighs, or behind the knees.

These pains usually occur late in the day or at night, and they can be severe enough to wake a child from sleep. However, they typically resolve by the next morning.

While the exact cause of growing pains is unknown, they are thought to be related to the muscular tiredness from the day’s activities.

8. Other Knee Injuries and Conditions

Knee injuries and conditions encompass a wide range of issues that can affect the knee joint, ligaments, cartilage, and surrounding muscles. These injuries can result from acute trauma, such as sports injuries, falls, or accidents, or from chronic conditions like arthritis.

Common knee injuries include ligament tears (such as ACL and MCL injuries), meniscus tears, fractures, and dislocations. Conditions like osteoarthritis, rheumatoid arthritis, and patellofemoral pain syndrome also commonly affect the knee, leading to pain, swelling, and mobility issues.

Why Knee Pain Gets Worse at Night

Knee pain can often feel worse at night, even if it was improving during the day. Here’re some reasons:

• Lack of Distractions: During the day, individuals are generally more active and distracted by daily activities such as work, errands, and social interactions. These distractions can help divert attention away from the pain. At night, the absence of these distractions can make people more aware of their knee pain. The quiet and stillness of the night can lead to heightened perception of pain as there are fewer external stimuli to divert attention from the discomfort.
• Decreased Movement: Movement during the day helps maintain joint lubrication and blood flow, which can alleviate pain to some extent. At night, the lack of physical activity can reduce the circulation of synovial fluid in the joints, which is essential for lubricating and nourishing the joints. This reduction can lead to stiffness and increased pain. 
• Changes in Hormone Levels: Cortisol, a natural anti-inflammatory hormone, has lower levels at night. Cortisol helps to regulate and reduce inflammation in the body during the day. At night, the decreased levels of cortisol can lead to increased inflammation and pain in the knee joints. 
• Fluid Buildup: When the body is at rest during the night, fluid can accumulate in and around the joints, leading to swelling and inflammation. This process can cause the muscles and tissues surrounding the joints to become tight and stiff, resulting in increased joint pain during the night and upon waking.
• Cytokines and Inflammatory Processes: At night, certain cells in the body release cytokines, which are small proteins that help activate the immune system. While some cytokines are involved in promoting sleep, they can also generate inflammation, which can exacerbate joint pain.

When to See a Doctor for Knee Pain at Night

Knee pain at night can be a significant issue that disrupts sleep and affects overall quality of life. You should consider seeing a healthcare provider for knee pain at night under the following circumstances:

• The knee pain lasts for a few days without improvement despite rest and home remedies like icing, elevation, and over-the-counter pain medications.
• Intense pain that prevents you from sleeping or performing daily activities
• Presence of other symptoms such as significant swelling, redness, warmth around the joint, or fever.
• The knee pain started immediately after an injury, especially if you heard a popping sound or cannot bear weight on the knee.
• Difficulty in bending or straightening the knee.

If you’re unsure about the severity of your knee pain or if the home remedies are appropriate, it’s always safer to consult a healthcare provider for a personalized assessment and treatment plan. This is especially important if the pain disrupts your sleep regularly, as ongoing sleep disruption can lead to other health issues. 

How to Relieve Knee Pain at Night

To relieve knee pain at night, you can employ a variety of strategies that focus on reducing inflammation, providing support, and ensuring comfort. Here are some effective ways:

• Use Pillows for Support: Place pillows strategically around your knee to reduce pressure and pain. If you’re a side sleeper, place a pillow between your knees. If you sleep on your back, place a pillow under your knees.
• Apply Heat Before Bed: Heat can increase blood flow and relax muscles. Use a heating pad on your knee for about 15-20 minutes before going to bed.
• Cold Therapy: Apply a cold pack or ice wrapped in a towel to your knee to reduce inflammation and numb the pain. Do this for about 20 minutes before sleeping.
• Elevate Your Knee: Keep your knee elevated on a pillow or several cushions to reduce swelling and pain.
• Over-the-Counter Medication: Consider taking pain relievers like ibuprofen, naproxen, or acetaminophen before bed to help manage pain.
• Use Topical Analgesics: Apply creams or ointments that contain pain-relieving ingredients directly to the knee.
• Gentle Stretching: Light stretches before bed can help reduce tension in the muscles around your knees.
• Stay Warm: Keeping your knee warm with blankets can prevent stiffness and pain, especially in cold weather.
• Avoid Long Periods of Inactivity: Try to move around during the day to keep your joints from stiffening up.
• Massage: Gently massaging the knee can help increase circulation and ease pain.
• Acupuncture: Consider trying acupuncture, which some find effective for pain relief.
• Wear a Knee Brace at Night: A knee brace can provide additional support and help maintain proper alignment of the joint.

How to Avoid Knee Pain at Night

To prevent knee pain while sleeping, try these tips:

• Maintain an Active Lifestyle: Engage in activities that don’t put excessive load on the joints but require your knees to go through a full range of motion, such as biking and swimming. These activities help lubricate the knees with the fluid inside, contributing to flexibility and preventing stiffness. 
• Manage Your Weight and Eat a Healthy Diet: Keeping your weight in a healthy range reduces the pressure on your knees. A balanced diet rich in fruits and vegetables provides nutrients essential for cartilage production. Over-the-counter glucosamine supplements may also support knee health.
• Stretch Often: Regular stretching prevents ligaments and tendons from becoming overly tight, which can lead to arthritis. You may dedicate a specific time each day for stretching. Many find early morning or before bedtime ideal, as it can help wake up the body or prepare it for rest.
• Proper Footwear: Wear sturdy, proper shoes to prevent shifting your walk and run patterns, which can lead to knee deterioration and injury. Shoes with a sturdy sole support proper leg alignment and balance, reducing pressure on the knee joint.
• Avoid Sitting With Your Knee Bent or Cross-Legged: This position over-stretches the ligaments and muscles surrounding your knee and increases pressure on your knee joints, which can cause pain and swelling.
• Use Ice and Heat Appropriately: Ice is beneficial in the evening when your knees are aching or painful, as it helps reduce inflammation and pain. Heat is best used for loosening up stiff muscles and joints, particularly useful in the morning.

Frequently Asked Questions

1. Why does my knee hurt at night with a burning sensation?

A burning sensation in the knee at night can be caused by several conditions, including nerve irritation, inflammation, or specific knee disorders. One common cause is gout, an inflammatory condition characterized by high levels of uric acid in the blood, leading to the formation of urate crystals in the joints, which can cause intense burning pain.

2. What’s the reason for throbbing knee pain at night?

Throbbing knee pain at night can often be attributed to conditions that cause inflammation and swelling within the knee joint. Arthritis, particularly osteoarthritis, is a common cause, where the degradation of cartilage leads to pain that can become more pronounced when the body is at rest and the joints are less active.

3. What causes sharp knee pain at night?

Sharp knee pain at night can be caused by several factors, including injuries to the knee structures such as ligament tears or meniscal injuries. These injuries can cause acute, sharp pain that is often worsened by the lack of movement during sleep, which can lead to stiffness and increased pain. Fractures or severe injuries to the knee can also manifest as sharp pain, particularly if they have not been adequately treated.

4. Why do I have knee pain only at night?

You should take knee pain seriously if it only occurs at night and is accompanied by a loss of weight and a general sense of unwellness. A combination of these symptoms may indicate a serious medical condition, such as cancer. In this case, don’t hesitate to get medical help immediately. 

Sophia Anderson, PT, DPT

Sophia Anderson, PT, DPT is a physical therapist who offers online pain management consultations. She helps people with various types of pain, especially neck, back, and knee pain.

She graduated from the University of St. Augustine with a Doctor of Physical Therapy (DPT) degree. She has experience in orthopedic physical therapy, sports medicine, neurological rehabilitation, advanced assessment and treatment of running injuries, and advanced treatment of the pelvic complex, spine, and extremities.

If you’re experiencing any pain, let Sophia Anderson, PT, DPT help you out.