Why Do I Have Knee Pain at Night?

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

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Primary care sports medicine specialist Wesley Baker, DO, explains what you can do if knee pain is keeping you awake at night, and why you may want to bring it up with your primary care provider.

Why do my knees hurt at night?

Potential reasons for knee pain at night

Activity during the day can contribute to the pain you feel in your knees at night. And when you get into bed, you actually slow down enough to notice.

“When you’re moving your joints, they’re also staying lubricated,” Dr. Baker 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 both, there could be several causes, including:

Osteoarthritis: The most common type of arthritis, it can worsen at night due to wear and tear over time.
Rheumatoid arthritis: This autoimmune condition causes 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. Baker. “There’s typically a reason, and several conditions can cause it.”

Tips to relieve discomfort in knees at night

Treating knee pain is all about pain management and reducing stress on your joints. Because the pain could come from a number of causes, it’s important to bring your concerns to a healthcare provider if you’re experiencing any kind of pain that disrupts your day-to-day activities 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 exercise, especially running on pavement, can cause a lot of lingering joint stress. But there are ways to exercise safely to reduce pressure on your knee joints and lessen the 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. Baker. “There are also special braces, called unloader braces, which help keep pressure off certain parts of the knee. That can sometimes help alleviate arthritis pain.”

Try anti-inflammatory medications

If you’re considering over-the-counter (OTC) painkillers for nighttime knee pain, Dr. Baker says it’s best to take NSAIDs like naproxen (Aleve®) or ibuprofen (Advil®), which have anti-inflammatory properties that can help ease swelling. He recommends taking medications after dinner so they kick in just as you head to bed.

Just be careful: If you’re on any blood-thinners or anti-inflammatory medications, you’ll have to stick to acetaminophen, like Tylenol®, or other painkillers prescribed by your doctor. Interaction with some arthritis medications might have dangerous side effects, like internal bleeding. So, check with your healthcare provider to 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. Using 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.

“I usually tell people to do whatever feels best,” says Dr. Baker. “I’ve found chronic pain caused by arthritis usually does better with heat, and acute overuse injuries usually do better with ice. Things that swell typically need ice to constrict blood flow and help dampen pain receptors.”

Topicals like Voltaren Gel®, IcyHot® or Bengay® and even anti-inflammatory patches can help bring relief when your knees are aching at night.

Adjust your sleeping position

You can cut down on knee discomfort — and get a better night’s sleep — by repositioning in bed.

“Sometimes, if you have arthritic knees, we suggest sleeping on your side with a small pillow between your knees,” Dr. Baker says. 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, especially if you have a 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. Baker encourages.

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