How To Relieve Knee Pain At Night? | 7 Tips, Causes, Why They Happen, and When You Should be Worried

A lady lying on their side of the bed to relieve knee pain at night

If you’re having knee pain, you know some nights can be a hassle. Changing positions constantly, losing precious hours of sleep… It’s natural to wonder how to relieve knee pain at night for good.

The first step is identifying what caused the pain – Arthritis? Gout? Injuries?

This will help you get rid of the knee pain at night faster.

In the meantime, there are things you can do during the day and before bed. These should help you reduce that annoying knee pain at night.

Here are 7 recommendations and common causes. I’ll even add in when to check with your doctor and why knee pain worsens at night.

Let’s go!

7 ways to reduce knee pain at night

1. Change your sleep position

Try these sleeping positions if you have knee pain at night:

  • If you’re a back sleeper, place a pillow under your knees and/or feet.
  • For side-sleepers, place it between your knees and/or feet.
  • If you sleep on your stomach, bend the affected knee.

These variations help you keep your knees bent which, in turn, will reduce the strain within your knee joint.

Try different heights, adding more pillows or a rolled towel. Test until you find the right amount of knee flexion for you.

2. Apply heat and/or cold before bed

Different temperatures can also help you ease knee pain at night.

Use cold if you’re having pain after an injury, as it will help you reduce swelling. To apply it:

  • Lie on your back.
  • Place an ice pack above the kneecap, wrapping it around the knee to add some compression.
  • Remove the ice after 10 minutes.

Heat can help you relax the tissues. This is best for osteoarthritis patients.

To apply it, place the warm towel or heat pad on top of the kneecap. But, unlike using ice, don’t add any compression as it could worsen the inflammation.

3. Establish a bedtime routine

According to the Sleep Foundation, a bedtime routine is a group of activities done in the same order every night before going to bed.

This routine helps our brains recognize that those activities come before sleep. This makes it easy for us to fall asleep and rest.

The activities vary from person to person, but they’re usually relaxing. A warm bath, light stretching, reading, meditating, or journaling are a few good examples.

If you have joint pain, a good routine before bed would include activities that ease pain, such as(1):

  • A warm bath
  • 10 minutes of ice therapy on the painful joint to reduce inflammation. Or heat to increase the blood flow and relax the muscles.
  • 15-20 minutes of another relaxing activity you enjoy (e.g. reading, journaling, stretching, etc.)
  • Going to bed and waking up roughly at the same time

Try different activities and keep the ones you enjoy the most.

4. Treat the underlying condition

What is the fastest way to relieve knee pain at night, you ask? This is it.

There’s no “one-size-fits-all” solution here. Treatment options will depend on the root cause of the pain.

For instance, sports injuries, excess/lack of exercise, and osteoarthritis each have a different treatment plan.

Most knee pain at night goes on its own. But, if you’ve been suffering for 4-6 weeks, the fastest way to get rid of it is by going to a physical therapist.

We can help you by:

  • Reducing pain.
  • Decreasing your need for medication.
  • Helping you return to the activities you love.
  • Giving you specific recommendations for your daily life.

5. Try to be active throughout the day

The benefit of exercise in knee pain in the evening is twofold:

  • An increased level of daily physical activity is associated with better sleep and less insomnia.(1)
  • Doing physical activities can help you reduce knee pain and restore function.(2)

Just walking a little more through the day can make a huge difference at night.

You can also try tai-chi, yoga, and water-based disciplines. They’ve shown to help manage knee pain at night.(2)

If you prefer more demanding activities, start and progress gradually. This should help cut down your risk of injury.

Although, it’s still best to check with your physical therapist first.

6. Buy a knee pillow

These are pillows designed to fit between or below your knees, depending on your preferred sleeping position.

They may be helpful for people with knee pain that tends to worsen over time, like knee osteoarthritis.(3)

If you’re considering buying one, first try different sleeping positions with the pillows you already have.

That way, you can find out what helps you manage your pain before committing to a knee pillow.

7. Change your mattress

Experts suggest replacing your mattress every 6 to 8 years, or when it doesn’t help you get restful sleep.

The firmness and material of your mattress are 100% subjective. But, there are factors you might want to consider, including:

  • Your preferred sleeping position
  • Weight
  • Whether or not you sleep alone

That being said, joint pain sufferers have benefited from mattresses that are firm enough to support their weight but also soft enough that the foam conforms to the shape of their joints.

So, a memory foam mattress that feels medium-firm should be a good place to start. Other great mattress types for joints include latex and hybrids.

Consider changing your mattress if:

  • You’ve been using it for +8 years.
  • If changing your sleeping position doesn’t help anymore.
  • If you’re waking up with stiffness in your back and other joints.

Other treatment options for knee pain at night

Medications for pain

Over-the-counter medications can reduce pain in some people.

But it’s best to use them sparingly as some studies suggest they can impair the healing of the tissues.

Losing weight

For people with a BMI >25, losing weight is a great strategy for treating knee pain at night.

For this population, aiming for a 10% weight loss can provide less pain, better knee function, and improve overall health.(4)

Knee replacement

Joint replacement surgery is a procedure where the surgeon reconstructs the joint to decrease pain and improve function.

This is the last resort for people with advanced knee arthritis when conservative treatments such as weight loss, viscosupplementation, medications, and others become ineffective.

What causes knee pain at night?

Falling on your knees

You may have some swelling and pain before going to sleep 1-2 days after the fall. Try 10 minutes of cold therapy before going to sleep to manage that inflammation and reduce pain.

But if you have severe pain, bruising, or limping for +3 days after falling, please consult with your doctor.

Excess or lack of movement

Here are some common and harmless activities that could cause pain at night:

  • Changes in your workout.
  • Walking or standing more than you’re used to.
  • A sudden bout of intense physical activity – like moving to a new place.

In these scenarios, the pain at night usually lasts 2-3 days.

If the pain is severe or if you’re limping, check with your doctor to make sure everything’s okay.

Knee injury

Having runner’s knee or a ligament/meniscus tear can cause pain on the affected knee joint at night.

Depending on the severity of the injury, it could ease after a few days, or you might need physical therapy and medication to help you with the pain.

If you’ve had a sports injury, please talk to your doctor to make the best treatment plan for you.

Knee osteoarthritis (OA)

Knee OA is a degenerative disease where the knee joints lose their cartilage due to wear and tear.

Some studies have shown a link between the severity of osteoarthritis and the prevalence of knee pain at night.(3)

It’s also reported that as many as 81% of OA patients may have some trouble maintaining sleep.(6)

This is a huge problem because our bodies need to sleep to recover and help us manage pain.(7)

If you have knee OA, it would be wise to develop a routine before going to bed. This will help you reduce the pain signals and get some much-needed sleep.

Rheumatoid arthritis

This is an autoimmune disorder where fluid accumulates in the joints – typically of the hands, wrists, and knees. This causes pain and swelling in the affected joint.

It’s mostly treated with medication to prevent or manage flare-ups, as well as physical therapy to maintain the quality of life.

Gout

This happens when uric acid crystals build up in the tissues, usually the joints of the hands, toes, and knees. There’s also pain and inflammation in the joints.

In general, the prevalence of gout is 1 to 4%. Older age and male sex are two common risk factors noted globally. – Fenando, 2020

As with rheumatoid arthritis, gout is mostly treated with medications and lifestyle changes.

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

Consult with your doctor if:

  • The pain at night doesn’t let you rest.
  • Nothing gives you pain relief.
  • You’re having severe pain at night.
  • You have pain after a knee replacement.
  • You’ve had pain for 4-6 weeks.

Also, make an appointment with your doctor if you have any of the following health conditions:

  • Knee OA.
  • Rheumatoid arthritis.
  • Gout.
  • History of cardiovascular issues.

FAQs

Why is knee pain worse at night?

In most people, it’s usually a combination of two factors:

  • As you rest, you’re lying still for many hours at a time. This could make your knee joint stiff.
  • Your brain has an enhanced perception of your body because your senses aren’t distracted by the things of daily life.

This could make your brain more attentive to how you’re body’s feeling, increasing the perception of pain.

How should I sleep with knee pain at night?

It’s recommended to sleep on your back with a pillow under your knees, or on your side with a pillow between your knees.

In the end, it’s up to your personal preference.

How can I relieve knee pain overnight?

You could reduce the knee pain overnight just by having a good night’s sleep.7 Yet, total relief of knee pain won’t happen overnight in most people.

Use the recommendations above to help you reduce your knee pain. Keep in mind that physical therapists and doctors will still be the fastest, safest, and the surest way to get rid of pain.

How to prevent knee pain at night?

If you have some knee pain during the day, avoid the activities that increase the pain temporarily.

These can also help you prevent knee pain at night(4):

  • Exercise regularly.
  • Keep your BMI below 25.
  • Eat nutritious foods most of the time.
  • Take care of your mental health.

Conclusion: How to ease knee pain at night?

There are many ways you can try to ease the pain at night, like:

  • Applying ice/cold to your joint
  • Changing your position.
  • Moving more throughout the day.
  • Having a routine before bed.

But the bottom line is that you need to treat the root cause to get rid of your pain for good.

Finally, remember to check with your doctor if you have any previous medical conditions or if the pain began after an injury.

Resources

  1. Markwald, Rachel R et al. “Behavioral Strategies, Including Exercise, for Addressing Insomnia.” ACSM’s health & fitness journal vol. 22,2 (2018): 23-29. doi:10.1249/FIT.0000000000000375
  2. Goh, Siew-Li et al. “Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis.” Sports medicine (Auckland, N.Z.) vol. 49,5 (2019): 743-761. doi:10.1007/s40279-019-01082-0
  3. Sasaki, Eiji et al. “Nocturnal knee pain increases with the severity of knee osteoarthritis, disturbing patient sleep quality.” Arthritis care & research vol. 66,7 (2014): 1027-32. doi:10.1002/acr.22258
  4. 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
  5. Hsu H, Siwiec RM. “Knee Arthroplasty.” [Updated 2020 Jul 31]. StatPearls. Retrieved on May 31, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK507914/
  6. Smith, Michael T et al. “Cognitive-behavioral therapy for insomnia in knee osteoarthritis: a randomized, double-blind, active placebo-controlled clinical trial.” Arthritis & rheumatology (Hoboken, N.J.) vol. 67,5 (2015): 1221-33. doi:10.1002/art.39048
  7. 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