People with bursitis knee pain at night usually say it’s worse than during the day. Why does that happen? And more importantly, what can you do about it?
One reason is that your senses aren’t as distracted before you sleep. Compared to how you usually are during the day, this can make you focus more on what you’re feeling in your body.
Of course, there are several other reasons why nighttime knee pain can be worse than daytime pain. But, rest easy knowing that your injury likely isn’t getting any worse.
Even better news is that there are several things you can do about it. Here are 6 tips to reducing bursitis knee pain at night:
6 ways to reduce knee pain at night caused by bursitis
1) Take a warm bath before going to sleep
If it’s hard for you to fall asleep, this can help.
Research suggests that taking a 10-minute shower may help you fall asleep 30+% faster. Do this 1-2 hours before bedtime. (5)
The study says that this happens because the heat makes our blood vessels wider. This, in turn, decreases our temperature. And, since our bodies need low temperatures to fall asleep, a nice bath can speed up the process!
2) Try the RICE method to reduce the painful swelling
This popular method can relieve pain and bursitis symptoms before going to sleep.
It stands for:
- Rest: Lie on your bed, try to relax.
- Ice: Place an ice-pack on top of the inflammation site.
- Compression: Wrap the ice-pack on your knee with a bandage. The compression will help reduce the swelling.
- Elevation. For best results, elevate the sore joint above your heart using some pillows.
If you have severe pain at night, this protocol can help you manage it so you can have restful sleep.
Do this for 10-15 minutes before going to sleep and you’ll be good to go!
Learn more: Quick guide on RICE for knee pain.
3) Try a new sleep position
The goal is to find a position that lets you have quality sleep.
People with knee pain may find that these positions help ease pain:
- Sleeping on your side, with a pillow between your knees.
- Sleeping on your back, with a pillow under your knees.
They help reduce joint stress which may provide pain relief.
That said, avoid positions that put pressure on the bursa. They can make your knee pain worse.
On the other hand, some people have tried these positions and haven’t felt much relief. For them, another option is buying a knee pillow. If that’s you, talk to your doctor about which design will be best for your needs.
4) Rest during the day to avoid further damage
Bursae are fluid-filled sacs located between tissues. They help reduce the friction between them so we can move our joints easier.
Bursitis happens when there’s inflammation on the bursa. The most common cause is constant pressure on the area, like kneeling often. The excessive friction from overuse can also cause swelling on the bursa. (1)
This means that excessive movement can make this type of knee pain worse. And, resting during the day may reduce knee pain at night.
But, we do understand that some people can’t afford to rest because of their jobs. If that’s your case, try taking a small break before you feel like you need to.
Wearing knee pads can also reduce the pressure on the bursa – and should help reduce nighttime knee pain.
5) Practice good sleep hygiene for better sleep
Sleep hygiene means having good sleeping habits. Done methodically, these habits can help you have a good night’s sleep. This, in turn, will help you manage knee pain better.
A common habit is going to sleep and waking up at the same time every day. Your body will get used to it, making you feel sleepy around the same time.
If you can, make sure your room is dark and quiet with a comfortable temperature. Also, it’s best to avoid watching TV or scrolling on your phone before bedtime.
6) Talk to your doctor about alternatives
Your doctor may suggest pain management medication before bedtime. This may help if you often have disrupted sleep.
But, you must still treat the underlying cause of knee pain. That’s the reason why you can’t sleep well in the first place.
If bursitis is causing your knee pain at night, treat it. The most common form of treatment is rehabilitation. But, your doctor may recommend other treatments depending on your symptoms.
Why does knee bursitis hurt more at night?
We all know sleep is important. During our slumber, our bodies heal and do many complex processes that keep us alive.
Also, people experiencing knee pain at night can feel it’s worse than during the day.
So, how does sleep – or lack thereof – affect pain? Scientists have found several factors that make knee pain at night worse, including (2):
Enhanced perception of your body and mind
As you lay still in bed, your senses aren’t as distracted. So, your brain focuses more on what you’re feeling, increasing your perception of pain.
This doesn’t mean your injury is getting worse, though. It only means you’re now giving it more attention.
Your worrying thoughts
Your thoughts before sleep play a huge role. In fact, thinking about the worst things can make you feel more pain. (2)
And, these thoughts can worsen your sleep quality as well. This can start a bad sleeping cycle which causes more pain. (2)
If you’re constantly thinking about your pain before going to sleep, it’s best to talk with a therapist. They can give you strategies to manage those thoughts so you can sleep well again.
Stiffness of knee joints during sleep
Movement lubricates our joints and keeps them flexible.
But, when we sleep, our body doesn’t move as often as when we’re awake. This lack of movement reduces the blood flow to the knee joint.
It can make the joint stiffer than usual and it can be painful to some people.
This usually gets better when the injury improves. If you have bursitis, try the 6 tips above to keep the stiffness at bay while you recover.
Sleep issues can worsen pain
Some people may feel throbbing knee pain the day after a bad night’s sleep. Again, this doesn’t always mean your injury got worse.
Research has shown that lack of sleep can increase your pain perception. Meaning, it can make you feel more pain compared to when you’re well rested. (2)
And, it doesn’t have to be something extreme, like pulling an all-nighter. A study found that 4 hours of sleep restriction for 2 consecutive nights can make you feel more pain. (2)
So, if you have sleep issues, treating them can also help reduce pain.
Treatment for bursitis
The inflammation of a bursa usually improves on its own after some rest.
But, you also have several treatment options if you want your recovery to go smoother and faster. These include:
Physical therapists can help you reduce your knee pain. For example, a PT treatment plan for bursitis would include:
- Low-impact exercises
- Passive strategies to provide relief.
We can also help you prevent future episodes of bursitis. This is very helpful for people whose occupations or hobbies make them prone to bursitis. This includes runners, housemaids, gardeners, and carpenters.
The bottom line is that working with a physical therapist will help you get back on track faster and safer.
Let our team help you connect with a qualified therapist in your area so you can finally get rid of that knee pain.
These will depend on the characteristics of your bursitis (1):
- People with an infected bursa need antibiotics. They may also need fluid aspiration to have less pain.
- Steroid injections are an option when anti-inflammatory medication isn’t working. However, there’s a high risk of accidentally infecting the bursa during this procedure. (1)
- Surgery isn’t common for bursitis. If required, the orthopedic surgeon will remove a part, or, the whole bursa.
This can help: Top 5 treatments for knee bursitis.
When should I see a doctor for bursitis pain at night?
Go to the doctor if:
- Your pain isn’t getting better after 48 hours.
- You experience pain at night after a fall or a direct hit in the affected area.
- There’s any sign of infection: fever, redness, and/or warmth in the injured area.
- The pain is unbearable.
- You can’t walk or move the affected joint.
Your doctor will perform a physical exam and may request a blood test and/or an MRI. This will help them check what’s going on and how to help.
How to prevent bursitis in the knee joints?
To keep your small fluid-filled sac healthy, avoid kneeling for long periods of time. Frequent pressure on the bursa is the most common cause of bursitis.
Here are a few other tips to help prevent bursitis:
- Avoid repetitive activities. Or, try to do them differently to reduce the friction on the bursa.
- Do some exercise. This will keep your joints healthy and may prevent a knee replacement.
- If your BMI is above >25, a 10% decrease in weight can reduce knee pain and improve overall health. (3)
Other causes of chronic knee pain at night
Some conditions can also cause knee pain at night:
An excessive physical effort can cause pain in your knees at night. The most common causes of this type of pain include:
- Moving to a new place.
- Changes in your workout.
- Walking more than usual.
This pain can become chronic if you don’t give your sore knee enough time to rest and recover.
Osteoarthritis is the wear and tear of the cartilage within our knees. It can cause pain and swelling, which may worsen at night.
Also, research suggests arthritis pain can be worse for people with renal insufficiency – a type of kidney trouble.
Advanced arthritis may need joint replacement surgery. Here, the orthopedic surgeon replaces the affected tissue with a prosthesis. Ask your doctor about knee replacement if you think it’s an option.
This is an autoimmune condition that causes inflammation. Here, the immune system attacks healthy cells in the joints.
Arthritis pain comes from the swelling of the affected joint. It can happen in the hands, knees, feet, and other complex joints.
Knee arthritis can be mistaken for bursitis, as both are inflammatory diseases. However, they’re treated differently. Also, people with rheumatoid arthritis are prone to have bursitis and stomach ulcers. (1, 4)
Gout happens when uric acid builds in the joints. It can cause joint pain and swelling. Research shows that people with other chronic diseases like heart disease or kidney problems are prone to have gout.
What does bursitis in the knee feel like?
Like a sharp pain on the inflamed bursa. You’ll probably have a swollen lump in the area. If the bursa is infected, it may be warm and tender to the touch as well.
The pain usually increases with movement, like walking or climbing stairs. The swelling may restrict the range of motion of the affected joint.
Why is bursitis so painful at night?
Because we’re paying more attention to our symptoms. Our senses aren’t distracted as usual.
The lack of movement also plays a role, as it reduces the blood flow in our joints. This can make them feel stiffer than usual.
Our worrying thoughts about our symptoms can also increase our perception of pain. (2)
How do I relieve knee pain at night?
By finding what’s causing the knee pain in the first place.
This will determine the treatment plan so you can relieve your knee pain at night.
Conclusion: Nighttime knee pain due to bursitis
Nighttime knee pain can be worrying and scary. But, you’re more in control than you think.
The pain worsening before bed usually has to do with:
- Your senses are less distracted.
- More focus on your body and your thoughts.
- Your sleep patterns.
Increase your chances of having restful sleep with the simple tips above. Try going to sleep and waking up at the same time. Make your room dark and comfortable for you. Apply some ice on your knee to reduce pain.
And, finally, don’t go through it alone. Your doctor and/or physical therapist can help you sleep better. Remember that you’ll get over your injury faster the better sleep you have.
- Lohr, Kristine. “Bursitis: Practice essentials.” [Updated 2020 Dec 11]. Medscape. Available from: https://emedicine.medscape.com/article/2145588-overview
- Finan, Patrick H et al. “The association of sleep and pain: an update and a path forward.” The journal of pain vol. 14,12 (2013): 1539-52. doi:10.1016/j.jpain.2013.08.007
- Messier, Stephen P et al. “Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better?.” Arthritis care & research vol. 70,11 (2018): 1569-1575. doi:10.1002/acr.23608
- Tsujimoto, Saki et al. “The prevalence of endoscopic gastric mucosal damage in patients with rheumatoid arthritis.” PloS one vol. 13,7 e0200023. 9 Jul. 2018, doi:10.1371/journal.pone.0200023
- Harding, Edward C et al. “Sleep and thermoregulation.” Current opinion in physiology vol. 15 (2020): 7-13. doi:10.1016/j.cophys.2019.11.008