Knee Pain at Night: Causes and Solutions

Knee pain worse at night? Arthritis and a few other conditions related to inflammation or injury can cause knee pain to worsen at night. This nighttime pain can also be incredibly frustrating, especially if it’s keeping you up or hurts more when you’re resting.

Orthopaedic surgeon Kim Stearns, MD, explains what you can do if knee pain is keeping you awake at night and why you may want to bring this specific issue to your primary care provider.

Why do my knees hurt at night?

Activity during the day contributes to the pain you feel in your knees at night, but so does the fact that you’ve actually slowed down enough to notice.

“When you’re moving your joints, they’re also staying lubricated,” Dr. Stearns explains. “When you’re not moving, they don’t lubricate as much. The lack of movement, the lack of lubrication — it all catches up with you.”

Whether you feel pain in one knee or you have discomfort in both, there could be several causes, including:

• Osteoarthritis — The most common type of arthritis, this can get worse at night because of wear-and-tear over time.
• Rheumatoid arthritis — This autoimmune condition causes uncontrolled inflammation and can flare up at night.
• Prepatellar bursitis — This common condition causes the front of your knee to swell, which puts pressure on your knee and causes pain when bending or at rest.
• Tendonitis — You might experience pain at night from overusing or straining the tendons in your knee during the day.
• Runner’s knee — Also called patellofemoral pain syndrome (PFPS), this may cause a dull, constant pain behind your kneecap after excessive physical exercise or injury.
• Gout — This form of inflammatory arthritis can cause sudden, intense knee pain at night because of a buildup of uric acid.
• Osgood-Schlatter disease — Repeated everyday stress can cause inflammation to spike at night for kids and teens, especially during growth spurts.
• Injury — Any direct trauma, impact or injury, like meniscus tears, can cause knee pain that spikes at different times of day.

“People with healthy knees usually don’t get pain at night,” clarifies Dr. Stearns. “There’s typically a reason, and it can be caused by several conditions.”

Tips to relieve discomfort in knees at night

Treating knee pain is all about pain management and reducing stress on your joints. As the pain could come from a number of causes, Dr. Stearns says it’s important to bring these concerns to a healthcare provider if you’re experiencing any kind of pain that disrupts your day-to-day functioning or your ability to sleep.

Once a doctor diagnoses the issue, they can share the available treatment options with you. But if you’re looking for quick relief to hold you over until you can schedule an appointment, the following tips may help.

Exercise smartly

High-impact exercising, especially running on pavement, can cause a lot of lingering joint stress. But there are ways to exercise safely so you can reduce the pressure on your knee joints and the amount of pain you feel during the day and at night.

“Low-impact exercises, like swimming and bicycling, are good because they exercise the knee joints but don’t pound them,” says Dr. Stearns. “There are also special braces that work to keep pressure off of certain parts of the knee — unloader braces — that can sometimes help alleviate arthritis pain.”

Try anti-inflammatory medications

If you’re considering over-the-counter (OTC) painkillers, Dr. Stearns says it’s best to take NSAIDs like naproxen (Aleve®) or ibuprofen (Advil®). They have anti-inflammatory properties that can help ease the swelling that’s causing your knee pain at night.

“Acetaminophen medications, like Tylenol®, don’t work as well because they mask the pain but do nothing about the source of the pain,” he adds. Dr. Stearns also recommends taking the dose after dinner, as that allows you to have the maximum dose before you head to bed.

Just be careful: If you’re on any blood-thinners or anti-inflammatory medications, you’ll have to stick to Tylenol or other painkillers prescribed by your doctor because interaction with some arthritis medications might have dangerous side effects, like internal bleeding. Check with your healthcare provider to make sure you pick the one that’s best for you.

Use heat and cold for immediate and long-term relief

Cold treatment, like ice, can dull pain, while heat on injuries can also make a painful joint feel better. But the key is to use both:

• Use heat for initial relief or shortly after an injury.
• Switch to cold for long-term relief.

“Using heat on the sore joint will certainly make it feel better, but it will also increase blood flow to the area. That will eventually leave it more swollen and throbbing,” explains Dr. Stearns. “Follow warmth with cold so the blood doesn’t pool there.”

Topical gels like IcyHot® or Bengay® and even anti-inflammatory patches can also help bring relief when your knees are aching at night.

Adjust your sleeping position

Adjust your position in bed to cut down on knee discomfort so you can get better sleep.

“Sometimes, if you have arthritic knees, we suggest sleeping on your side with a small pillow between your knees,” Dr. Stearns shares. This position gives more support and keeps your knees from knocking together and causing more pain at night.

If you’re a back-sleeper, he recommends trying to sleep with a pillow under your knees instead. Besides offering support, this keeps your knees slightly bent, which can keep bones from pressing together at the worn-down, painful joint.

“It’s really about finding the position of comfort and using a pillow for cushioning that feels best for you,” Dr. Stearns says.

Bottom line? You don’t have to just endure nighttime knee pain. If knee pain is keeping you up at night, reach out to a healthcare provider so you can get some sweet-dreams relief.