Knee pain can be a nagging nuisance and knee pain at night can be particularly troublesome. Individuals who experience knee pain at night should know several possible causes.
Fortunately, there is also a range of treatment plans available, allowing people to get some sleep in the short term and resolve the issue. Health Report Live provides a comprehensive look at knee pain at night and what to know about it.
Knee Pain Overview
There are several common causes of knee pain. Some of those include ligament tears, meniscus injuries, arthritis, and gout. It can be a challenging ailment for those who suffer knee pain during the day.
The pain and discomfort can be distracting, whether it involves moving around the house, working at a job, or bending it in a car while shifting between home and work.
However, knee pain can also be at its absolute worst at night. Some might think being in bed and being off your feet would allow you some relief from the pain.
Knee pain at night can disrupt sleep. It can increase the duration it takes to recover. The pain can even become worse due to not getting enough rest.
Several issues can cause knee pain at night. Many of the conditions can be treated. However, they require time, work, and rest to bring much-needed relief.
What Causes Knee Pain at Night?
The ailment known as the runner’s knee affects the patella – better known as the kneecap, the bone at the front of the knee, and its associated tendons.
According to Cleveland Clinic, the condition known as patellofemoral pain syndrome is localized pain in the front of the knee.
Causes can include knee joint overuse, kneecap alignment issues, or weak muscles around the knee.
More than 100 types of arthritis can affect people and manifest in knee pain. Osteoarthritis is among the most common.
The Mayo Clinic defines it as a condition where the cartilage in the knee begins to degrade and deteriorate. That is due to two factors we cannot help: use and age.
However, osteoarthritis is a common form of arthritis affecting people and their knees.
Mayo Clinic calls rheumatoid arthritis the most debilitating form of arthritis. They describe it as an autoimmune condition characterized by arthritis pain.
Rheumatoid arthritis can affect almost any joint in your body, including your knees. While the condition varies in joint pain severity and can even disappear from time to time, it is a chronic disease that can cause chronic knee pain.
Overuse or Fatigue
While the runner’s knee is the most common overuse knee injury, others fit what might seem a very general category, like the normal wear and tear.
These injuries are attributed to “microtrauma associated with physical activity and exercise that exceeds the tissue tolerance of the affected structure.”
Iliotibial band syndrome is one overuse ailment that results in knee pain. Another is “jumper’s knee,” otherwise known as patellar tendonitis. If that goes unchecked, it can graduate to a more severe condition known as patellar tendinopathy.
Bursitis is a reasonably common knee ailment impacting the bursa, tiny sacs filled with fluid cushioning the knee joint bones.
When they become infected or otherwise irritated, that is known as bursitis. This irritation can be extremely painful and might even be accompanied by a fever. Typical telltale symptoms of bursitis include redness or tenderness in the knee joint.
As the Johns Hopkins site notes, bursitis in the knee goes by other names. These include goosefoot bursitis or Pes Anserine bursitis.
Bursitis has many causes, including tight hamstring muscles, being overweight, arthritis, or lack of stretching before exercise.
Gout is an arthritic condition occurring when uric acid crystals build up in the knee joint. Though it is commonly associated with the big toe (and overindulging in food or drink), it is a common source of knee pain that can surprise people diagnosed with it.
As the CDC site observes, symptoms can get worse from time to time, experienced as flare-ups. They can also disappear entirely, considered to be remission. If bouts of gout repeat, this condition might progress to gouty arthritis.
While there is no known cure for gout, it can be effectively treated and managed with medication and other forms of care.
Other Knee Injuries and Conditions
Ligament tears are some of the most serious knee injuries, requiring surgery and lengthy recovery time with significant physical therapy required to get back on track.
Meniscus tears, often caused by a combination of putting weight on the knee and then twisting or rotating it, are among the most common knee injuries.
The Mayo Clinic site advises that you might feel pain, stiffness, swelling, or difficulty extending it fully. However, at-home measures might be enough to address this issue. (In some cases, surgery will be required.)
A Baker’s cyst is another ailment that affects the knee. According to the Orthopaedic & Spine Center of the Rockies, a Baker’s cyst is also known as a popliteal cyst. It is a fluid-filled swelling at the back of the knee.
The swelling can restrict movement in the knee. Sometimes it does accompany an undiagnosed knee injury. However, it can also go away of its own accord in a number of cases.
Why Does Knee Pain Happen at Night?
You Are Trying to Relax
Simply put, you think about a lot of other things during the day. It is true that work, commuting, and the challenges of home life can be more difficult with knee pain.
However, at night, when you are lying in bed night, all you want to do is sleep. Nothing interferes with the ability to go to get a good night’s sleep like knee pain at night.
A Time article from 2019 explained that when you have an immune system response, cells that fight infection release chemicals.
Some of those create inflammation in infected tissues. Rather than occurring in a steady, constant output, these chemicals coincide with circadian rhythms.
Additionally, the symptoms will feel most severe when your immune system is working hardest. As you might have guessed, that is at night when you are sleeping — or trying to sleep.
Lack of Sleep Makes Pain Worse
When you do not get enough sleep, it physically impacts how you feel. An article from TheSleepDoctor.com observes that a lack of sleep will also raise inflammation levels in the body.
The article notes, “Laboratory studies have tested acute, prolonged sleep deprivation — conditions under which sleep is restricted for 24 hours or more — and found this severe degree of sleep loss increases inflammation activity in the body.”
Some of that activity is actually unhealthy inflammation attributable to C-reactive protein.
Preventive Measures During the Day
A lot of what you do during the day can affect a lot of what happens at night. The main piece of advice regarding daytime activity is to be careful. If your knee is acutely painful, be careful about how you move and try to rest and elevate your leg throughout the day.
Avoid foods that encourage inflammation. A Harvard University article said foods like tomatoes, olive oil, green leafy vegetables (including spinach, kale, and collards), nuts, fruits, and fatty fish fight inflammation.
However, foods like refined carbohydrates, fried foods, red meat, margarine, and soda all contribute to inflammation.
Preventive Measures During The Night
There is a lot you can do as you are getting ready to go to bed, and once you are in bed, that will allow you better sleep at night.
You want to be active if you can as regular exercise generally gives you more energy and helps your sleep cycles and improves your quality of life.
However, if you push yourself too much, you might make a current injury much worse than it is. If that happens, that pain can carry over to nighttime, leading to poor sleep quality.
Try to start with low-impact exercises. When done right, exercise can also help you maintain a healthy weight or achieve weight loss goals.
You want to make sure you are taking medication, especially anything to get pain relief, timed to kick in as you are getting ready to go to sleep.
Also, if you take any medications with diuretic qualities, it is best to take those during the day rather than at night.
It is not fun to wake up to go to the bathroom in the middle of the night. That is especially true if you have to do so on a knee that gives you pain.
Check Your Mattress
There is such thing as a mattress that is too firm. And if you are experiencing back pain, the quality of your mattress can be specifically tied to the quality of your sleep.
An article from The Spinery notes that there is a connection between a bad mattress and joint pain.
When you are placing your body weight onto a mattress that fails to provide pressure relief for hours a night, this can lead to pain in your knee joints.
Also, if your mattress is too firm, it can lead to undue pressure on the shoulders, hips, and knees. And that, in turn, can cause more pain.
Pillows, when strategically placed, can help you get in a comfortable sleeping position. You can buy knee pillows specifically designed for how you sleep. If you are a side sleeper, for instance, there are a number of knee pillows designed for you.
Establish a Nightly Routine
Bedtime routines are not just for kids anymore. Getting into a rhythm before you get into bed will help you establish an expectation that when you get to bed, you will be going to sleep.
It should also be a given that you try to reserve your bed exclusively for sleep. If you do a lot of TV watching, computer work, or phone time from bed, it might be harder for you to associate your bed with just sleep.
Stretch Before Bed
In some cases, knee pain can be attributable to overly taut muscles. It makes sense, as many knee injuries cause people to hold the muscles in their legs tauter to protect their knees.
Stretching before bed can help people with knee pain alleviate that tension.
Being Active and Managing Stress
Similarly, people can be tighter if they are not moving around as much or if they are holding in a lot of stress. Staying active can help people deal with stress — as exercise is a great stress reliever. That can also help you mitigate knee pain.
Taking a Warm Bath
If you are having trouble getting to sleep — or even just feeling calmer and more centered — a warm bath is a time-tested way to relax. While this might be a one-time thing you can do to help with tight muscles, you also possibly want to make it part of a bedtime routine.
Use Hot or Cold Packs (or Both)
Ice is extremely helpful in constricting blood vessels and decreasing blood flow to the area, managing pain and swelling. However, an ice pack can be less helpful if applied for more than 20 minutes.
Meanwhile, according to the Arthritis Health website, heat is good for relaxing muscles and keeping your joints in good shape.
Health providers advise using justice (and not heat) for the first 48 to 72 hours after a knee injury, but after that, alternating between heat and cold may help some people with pain.
Consider Knee Joint Injections
If your knee pain is keeping you up over time, a corticosteroid injection might be helpful. Obviously, it will be something to ask your doctor, and that kind of procedure is most likely the domain of an orthopedic specialist. Not all knee issues will resolve with an injection, but some may.
A TENS unit may be helpful in dealing with knee pain, especially if it is a persistent pain from an older injury.
TENS stands for transcutaneous electrical nerve stimulation, and as the Cleveland Clinic explains, TENS therapy uses low-voltage electric currents to treat pain. This happens via a small device that delivers an electrical current at or near the affected nerves. It can either block or change how you perceive pain.
Look Into Nerve Blocks
If pain from a chronic condition such as knee osteoarthritis cannot be resolved by other means, nerve blocks might be your answer.
As the Cleveland Clinic reports, either an injection or radiofrequency ablation can be used to give someone suffering from knee pain some degree of relief.
Practice Good Sleep Hygiene
The term sleep hygiene refers to the environment you place yourself in at night when you go to sleep to help ensure you are getting the best sleep possible.
The Sleep Foundation advises, “Keeping a stable sleep schedule, making your bedroom comfortable and free of disruptions, following a relaxing pre-bed routine, and building healthy habits during the day can all contribute to ideal sleep hygiene.”
Make Accommodations for Your Knee at Bedtime
While some find a knee pillow to be essential, others might just use extra pillows they have around the house to sufficiently support a painful knee at night.
Think about what you need to put your knee in the best possible sleeping position to allow you to sleep, and then get that ready before you sleep.
Consider Additional Therapies
Your doctor might have ideas about additional therapies that may help you with your knee pain. Google research can help you be aware of what is out there, but a conversation with your doctor will help you understand what will best work for you.
Do Not Rely on Sleep Aids
If you are having trouble getting to sleep, sleep aids can assist you. However, it might not give you the ideal quality sleep you need to get better.
Make sure that you are following all the advice above regarding sleep hygiene and setting yourself up for as pain-free a night as possible.
Do Not ‘Medicate’ With Alcohol
While Alcohol might be tempting as a way to get you to sleep and feel differently about your knee pain, you will not get the same quality of sleep with it. If your knee pain is caused by gout, Alcohol is likely to make your condition worse.
Best Exercises for Knee Pain
You may be able to take matters into your own hands (or, really, your own legs) with a few exercises that address knee pain.
The Arthritis Health website notes that the squat “is a multi-purpose knee strengthening exercise that targets the quadriceps, hamstrings, and buttocks.”
To do it correctly, stand with your feet shoulder-width apart and squat down as if sitting in a chair, keeping your back straight and raising your arms for balance if needed.
Heel Lift With Bent Knees
This exercise is great for the soleus, a muscle in the calf complex that flexes the foot and stabilizes the tibia.
Sit on the edge of a sturdy chair, bend your knees to 90 degrees, and then lift your heels.
As the Arthritis Health site shows, there are a number of ways to do a good hamstring stretch, which is one of four target muscle groups that affect knee pain. One easy way to do that is a supine leg raise.
Lie on your back, bend one knee, and lift the other leg straight up, holding that position for about 20 seconds once you get there. Alternate legs to make sure both sets of hamstrings are getting a workout.
If the Pain Becomes Worse While or After Exercise, Consider:
Lowering The Intensity
If what you are doing is too intense, dial it back a bit and then work up from there.
Shortening The Duration
It might be that what you are doing exercise-wise works, but you might be doing too much of it. Try cutting the amount of time you are doing it for, and then work up from there.
Seeking Experts’ Help Adjusting Your Methods
If you consult with a physical therapist, you have an expert in your corner who can help you choose an exercise regimen that works for you. A personal trainer may also be able to guide you through exercise.
Talking To Your Doctor
Your doctor can help you better understand why some exercises might seem too much for you.
When Should You See a Doctor?
There is not a specific rule about when to see a doctor for knee pain, though there are some definite symptoms — like knee pain and redness accompanied by fever or an inability to move or support your weight on the affected leg — that indicate the need for medical intervention.
If you are unable to address an issue on your own with ice and rest, or you have a knee issue lingering for longer than is typical for you, that may be the time to see your primary physician or healthcare provider.
A doctor can assess what is happening and give medical advice on whether you need a referral to an orthopedic doctor.
Possible Medical Treatments
There are different medications for pain management that might offer relief for your knee pain, depending on what is causing it.
In some cases, an over-the-counter non-steroidal anti-inflammatory drug might be all you need to relieve your issue.
If you have gout, however, a drug like allopurinol that addresses uric acid levels in the blood might be a necessary next step.
Not all knee pain issues need knee replacement surgery. However, if a torn meniscus causes your knee pain, you might require surgery. In addition, if the issue is a torn ligament, you will most definitely need surgery.
You will not be able to know the extent of what you need without getting an MRI so your doctor can make a proper assessment.