When you finally lay yourself down to sleep after a busy day, the last thing you want to experience is pain that keeps you awake. When knee pain at night sends you tossing and turning, though, there are ways to care for yourself during the day (and right before bedtime) to make it better. Here’s your guide to managing and preventing knee pain at night.

What causes knee pain at night?

Our knees are complex joints responsible for bearing the weight of our bodies as it travels to our feet. They literally help us move through the world smoothly, connecting four bones—the femur, the tibia, the fibula, and the patella—and two major muscles groups (the quadriceps in front and the hamstrings in the back).

Connecting and stabilizing these bones and muscles are ligaments and tendons, including:

  • The anterior cruciate ligament (ACL): Located on the front of the knee, the ACL prevents the femur from moving backwards onto the tibia
  • The posterior cruciate ligament (PCL): The PCL keeps the femur nestled back where it belongs
  • Medial ligaments: Stabilize the inside of the knee
  • Lateral ligaments: Stabilizs the outside of the knee

In addition to this, articular cartilage lines the patella to smooth movement, as does the meniscus (lateral and medial) tissue that allows the femur and tibia to glide together. Bursa are fluid-filled sacs inside the joint. They further cushion movement, preventing painful bone against bone rubbing.

Any part of this structure can develop painful conditions or suffer from issues that could cause knee pain at night. In general, the five main causes of knee pain at night are:

  1. Knee replacement pain at night
  2. Arthritis
  3. Gout
  4. Injury
  5. Overuse

Knee replacement pain at night

Knee replacement surgery is often the treatment of last resort when other conservative measures have failed to address painful damage to the knee. A total knee replacement removes the kneecap and removes or repairs damaged bone and other surfaces before inserting an artificial replacement. Partial knee replacement surgery is less invasive and preserves the parts of the joint that are healthy.

The level of your knee replacement pain at night depends on which type of knee replacement surgery you get. The recovery time for total knee replacement can be from one to three months. Partial knee replacement offers a faster recovery time of a week or two. Regardless, during recovery, knee replacement pain at night can be extreme and make daytime activities even more challenging.

Arthritis

The most common form of arthritis, osteoarthritis, is also the most common cause of knee pain at night.

Osteoarthritis is a wear-and-tear condition that affects the joints of the body. As we age, cartilage begins to thin and bursa provides less cushion in the joint. If we exercise less and lose supportive muscles in the quadriceps, hamstrings, and calves, the knee joint begins to press more firmly together, rubbing bone on bone as we move.

This rubbing causes inflammation in the joint. It can also cause pain two ways: when we move and when we are still.

Gout

When uric acid builds up in the blood, it is deposited as uric acid crystals in the joints. This can cause painful swelling. Gout most often occurs in the toes but can affect the knees, too. Swelling and uncomfortable warmth from gout can cause knee pain at night.

There is another condition called pseudogout that is less common but found in the knee more often than any other joint. A different type of crystal (calcium pyrophosphate) lodges in the joint, causes similar symptoms to gout (i.e., redness, swelling, warmth, and pain).

Injury

Injury to any part of the knee, even what you might consider minor, can cause knee pain at night.

This may not be chronic pain but can cause disrupted sleep, nonetheless.

Overuse

Whether you are a seasoned athlete or a weekend warrior, overuse of the knees can lead to knee pain at night. This includes going for a long bike ride after some time off, playing pick-up basketball games on Saturday mornings, a leisurely hike through the woods, or anything that taxes your knees.

Even if your knees feel good after the activity, you may experience pain when you lay down to rest. You are not as distracted by the demands of your day, which gives pain a chance to present itself.

What does knee pain feel like?

Knee pain can take many different forms. You might experience burning knee pain at night as an uncomfortable, steady warmth in the joint. You may also have throbbing knee pain at night, no matter what position you lie in.

Some people have pain that is sharp when they switch positions after being still. Other forms are not pain at all but can consist of tenderness or swelling inside the joint.

When should I see a doctor for knee pain at night?

In the days after knee replacement surgery or another type of injury, it is normal to expect a little pain at night. A few nights of lost sleep are not anything to worry about.

However, there are times when you should see a doctor for knee pain at night. Schedule a regular appointment if you experience the following symptoms:

  • Unusual or significant swelling
  • Excessive redness (redness that does not go away after the injury)
  • Fever
  • Increased or excessive pain
  • Warmth in the joint
  • Tenderness to the touch

There are also symptoms that warrant emergency treatment for knee pain. These include:

  • Deformed appearance of the joint
  • Pain that makes weight-bearing impossible
  • Injury that causes your knee to make a popping sound
  • Swelling that occurs suddenly

If your knee pain at night consistently interferes with sleep it could make pain during the day worse, too. When it comes to knee replacement surgery, poor sleep can also slow healing times. If pain is steady for three or four days, or intermittent for a week or two, best to schedule a follow-up with your doctor.

How to relieve knee pain at night

Relieving knee pain at night may be simply a matter of practicing a few comfort measures before you settle in for some shut-eye. Other nights, you might need something else.

Here are ten options for knee pain treatments that can help you get some rest.

1. Check your mattress

Is your mattress firm enough to provide the support you (and your knees) need? Sometimes a sagging or too-soft mattress is not a great choice.

As a general rule, replace your mattress every eight to ten years. For knee pain at night, foam mattresses can provide great support, as can a mattress that has independently wrapped coils. Ask your doctor for recommendations, then go give them a try.

Look for mattress companies that offer a money-back guarantee or free exchange, too.

2. Use pillows

Place pillows between your knees for extra support. This relieves pressure on the IT band and also prevents bones from pressing into each other during the night.

3. Establish a nightly routine

Sometimes dreading a poor night of sleep is a self-fulfilling prophecy.

Establish a nightly routine that includes gentle stretches and relaxing routines (e.g., a good book and a hot cup of tea) to set yourself up for sleepy success.

4. Stretch before bed

Knee pain stretches may be as simple as working out tight muscles in your quadriceps, forward folds to release hamstrings, or calf stretches to lengthen and strengthen those muscles, too. Keep your exercises low-key and relaxed. Consider the following:

  • Restorative yoga before bed: A quick 20-minute routine can prepare you for bed and keep all of your joints healthy (see the video below)
  • Stretches for knee pain: These knee pain stretches work the muscles in the lower leg to relieve tightness that applies pressure to the knee joint
  • Strengthening for knee pain: Again, these exercises target the muscles surrounding the knee to provide better support in the joint

As always, check with your doctor before starting any exercise program. If you experience an increase in pain, stop and check in with your doctor again.

5. Time medications

If you are regularly taking medications for chronic knee pain or are on prescribed medicine after surgery, time your medications so that they relieve pain overnight.

6. Use hot or cold packs (or both!)

Hot and cold packs can help alleviate pain and swelling. It may be challenging to sleep with a chilly cold pack on your knee, though.

Alternate this treatment so that you can go to bed with warmth.

7. Treat the underlying condition

If your knee pain is caused by an underlying condition like gout, it’s crucial to get a proper diagnosis and begin treatment. If the condition is unresolved, then further damage can occur.

8. Try TENS

TENS, or transcutaneous electrical nerve stimulation, replaces pain signals with a mild electrical buzzing. Patches are placed on the skin and connected to a patient-controlled device that is about the size of a cellphone. When deployed, a mild electrical current confuses pain signals being sent to the brain.

Some people may find the buzzing sensation distracting, but others are able to get used to it quickly and drift off to sleep. This non-invasive solution is a good conservative treatment option.

9. Consider knee joint injections

There are several types of knee joint injections that can provide long-term relief from knee pain when more conservative measures have failed. Corticosteroid injections can provide relief from pain and swelling. Hyaluronic injections rejuvenate the cushioning and lubrication in the knee.

Knee joint injections are generally recognized as safe, but there are risks and side effects. It’s important to talk to your doctor about all of your options.

10. Look into nerve blocks

A nerve block is a specific type of knee joint injection that prevents nerves from delivering pain signals to the brain.

After a knee replacement, the most common kind of nerve block for knee pain is a saphenous nerve block. For patients who cannot have knee replacement surgery or who are experiencing chronic knee pain at night from other causes, genicular nerve blocks are another option.

Get help

At Arizona Pain, we know how challenging it is to be up all night in pain. If you’re in Arizona and knee pain at night is disrupting your sleep and impacting your life, get in touch today. We can help you get back to your life and reduce your nighttime aches.

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