Written By: Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by: KPE Medical Review Board
Knee pain at night is a very common problem.
Whether your nocturnal knee pain makes it hard to drop off, wakes you up or leaves you feeling restless, it can have a big impact on your quality of sleep and in turn, your general health and quality of life.
The stresses and strains on our knees build up over the course of the day and when we finally get to chance to relax and unwind, knee pain can strike with a vengeance. But what's going on and what can we do to relieve knee pain at night?
The most common problems that cause knee pain at night are:
Gout is a common cause of knee pain at night while sleeping. A build-up of uric acid causes crystals to form in joints which result in inflammation, excruciating pain and swelling.
Gout knee symptoms frequently flare-up very suddenly at night as the crystals form in the joints at lower body temperature. The result is often debilitating nocturnal knee pain, redness, heat and swelling in the knee.
Gout is usually treated with a combination of rest, medications and ice and usually settles in a week or two. However, there is a high risk of recurrence unless proper preventative strategies are put in place.
You can find out lots more about the causes, symptoms, treatment and prevention options in the Gout Knee section.
Knee arthritis is a common cause of knee pain at night, particularly in the over-60's age group. Arthritis causes thinning of the knee cartilage and also bone spur formation, both of which cause narrowing of the joint space.
The knee joint is surrounded by a capsule filled with fluid which nourishes, lubricates and cushions the joint, just like the oil in your car.
But overnight this fluid dries up, and the knee bones start to rub against each other. The result is knee pain at night and stiffness in the joint when you wake up – both classic features of knee arthritis. Symptoms usually ease of once you get going for the day, but often return in the evening.
You can find out all about the causes, diagnosis and treatment options in the Knee Arthritis section.
Anything that causes swelling or inflammation in the knee joint can lead to knee pain at night e.g. tendonitis, knee sprains and strains, trauma, bursitis and rheumatoid arthritis.
There is only so much space in and around the knee joint, so any injury that causes swelling or excess fluid in the joint, such as a cartilage tear, increases the pressure which can result in a dull, achy pain in the knee.
Physical activity increases blood flow to joints which can lead to swelling. Inflammation in the knee typically builds up the more we use the body, so tends to peak in the evening. Physical exertion can also cause a build-up of lactic acid in muscles leading to delayed onset muscle soreness. You might have no idea that you are overdoing during exercises, but later that evening your knee pain at night really kicks in.
You can find out loads more about the causes, symptoms and best treatment options in the knee swelling section.
Many children suffer from knee pain at night during and following growth spurts.
Essentially what can happen during a growth spurt is that the leg bones grow faster than the leg muscles can lengthen.
This places a great deal of tension through the muscles and tendons which can then start to pull on the bone, causing knee pain which is typically worse at night.
Growth spurts occur most frequently between the ages of 3-5 and 8-12 years. One of the best remedies is stretches, both for treating and preventing growing pains.
Many people find they have more knee pain at night than they do during the day. There’s nothing more frustrating than climbing into bed at the end of a busy day, feeling exhausted and then suddenly “boom”, your knee pain kicks off with a vengeance. You’ve soldiered on through the day, done all the things you needed to do, finally have the chance to give your knees a break, and that’s when they really start to hurt. But why?
There are a number of theories out there as to why knee pain gets worse at night time:
During the day, there’s lots going on, our minds are distracted by other things and we often don’t have time to notice or think about pain.
But when we climb into bed, with less stimulation and diversions to distract us, the pain that has been grumbling away in the background suddenly gets very loud as there is nothing masking it. There’s less to take our minds off our pain and the more we think about it, the more conscious we are and the more knee pain at night we feel.
Night time knee pain can quickly become a vicious cycle. Sleep deprivation has been found to increase sensitivity to pain, decrease pain thresholds, impair healing, reduce tolerance levels and increase fatigue.
As these feed into each other, pain levels increase and the cycle continues and knee pain at night gets progressively worse and worse.
When we breathe, we draw in oxygen from the air, and then expel carbon dioxide. When we sleep our respiratory rate, the number of times we breathe in and out per minute, drops and we breathe more slowly.
As a result, the level of carbon dioxide in our blood increases which causes blood vessels to dilate - widen in diameter. This can put pressure on surrounding nerves, making them more sensitive which can lead to knee pain at night.
There are a number of things you can do to help relieve knee pain at night such as gentle exercises or over the counter medication and home remedies such as ice or heat packs, relaxation and deep breathing.
The best treatments for knee pain at night are:
The best way to deal with knee pain at night is to stop it from developing in the first place – prevention is better than cure! There are a number of things you can do during the day to reduce your risk of developing knee pain at night:
What Causes Burning Knee Pain At Night? The most likely cause of burning nocturnal knee pain is gout knee. Other possible causes of knee burning at night include knee bursitis, nerve pain, ligament tear and knee cartilage injury
Why Do I Get Throbbing Knee Pain At Night? A throbbing pain in the knee is usually caused by a problem in the blood vessels such as venous hypertension, popliteal aneurysm or a DVT. If you get a throbbing pain in your leg, seek medical attention.
What Causes Stabbing Knee Pain At Night? A stabbing pain in the knee at night is usually caused by something getting stuck or squashed in the knee joint, such as a cartilage tear or arthritis, or tendonitis.
Why Do I Get Knee Pain Only At Night? Knee pain that only comes on at night, not during the day, should always be taken seriously, particularly if it is coupled with weight-loss and generally feeling unwell as it could indicate a serious underlying medical condition such as cancer.
Knee pain at night can be caused by various factors, including arthritis, bursitis, gout, and tendonitis. Treatment depends on the cause of the knee pain but typically includes rest, physical therapy, icing the knee, exercises, medications to reduce inflammation and pain, and, in some cases, injections or surgery.
Don't feel you have to just put up with knee pain at night, go and get it checked out by your doctor and you will soon be on your way to a good night's sleep.
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Page Last Updated: 21/03/23
Next Review Due: 21/03/25
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1. Arthritis Care & Research, American College of Rheumatology. Sleep Disturbance in Osteoarthritis: Linkages with Pain, Disability and Depressive Symptoms. P. Parmelee, C. Tighe and N. Dautovich. March 2015
2. Arthritis Foundation: Sleep and Pain