Knee Pain At Night | 9 Causes And Their Treatments

Written By on June 28, 2022 — Medically Reviewed By Kris Ceniza (PT)

Having knee pain at night can be scary and frustrating. But with a little guidance, you might know what’s causing it and how to manage it.

For example, a common cause of nighttime knee pain I’ve seen in my patients is excess physical activity during the day. This is easily manageable, but other causes like bursitis or osteoarthritis may need specific treatments to fully recover.

You’ll learn all about it below, so don’t worry. Here’s what we’ll cover, click on any of these topics to easily navigate through the article:

9 problems that may cause knee pain at night

In order to know how to treat nightly knee pain, you need to know what’s causing it first. The common reasons behind this include:

1) Too much physical activity

Here, apart from knee joint pain, you may also experience swelling and stiffness. It can affect other parts of your body too, usually the lower back and/or hips.

And although it can be annoying, it’s actually part of a natural response from our bodies. See, doing more physical activity than what we’re used to puts our joints under a lot of stress.

This in itself isn’t a bad thing, though – that’s how they get stronger.

But for people that don’t exercise often, it can elicit an inflammatory response that often gets worse after lying in bed. Yet, this should improve after a day or two.

Now, these are common scenarios that can cause this type of knee joint pain:

  • Spring cleaning the house.
  • Moving to a new place.
  • Playing with a toddler.
  • Trying new changes in your workout – e.g. more reps or lifting more weight.
  • Walking or standing more than you’re used to.

Related: 5 reasons why your knees hurt when exercising.

How to treat it?

The easiest way to treat this is by having a good night’s sleep. That will help you wake up refreshed and don’t carry over that pain the day after.

But if you’re experiencing severe pain or the symptoms prevent you from falling asleep, try:

  • Applying an ice pack to your painful knee to reduce pain and swelling.
  • Propping your leg up with a few pillows to help get rid of inflammation.
  • Taking some medication for knee pain, like NSAIDs.

2) Knee osteoarthritis

This is the wear and tear of the knee cartilage. There are many causes of knee osteoarthritis, but the main one is overuse. People at risk of developing it include (1):

  • Those over 50 years old.
  • Overweight/obese individuals.
  • Athletes.
  • Have a previous meniscus and/or ligament injury.

Here, the pain tends to worsen not only at night but in some moments during the day as well. Like while walking, climbing stairs, sitting, or resting.

The symptoms have a gradual onset – they’re unlikely to go from mild to extreme from one day to the next. But, one of the tell-tale symptoms of osteoarthritis is waking up with joint stiffness that lasts less than 30 minutes. (2)

Further reading: Knee osteoarthritis – the ultimate guide.

How to treat it?

There are several ways to treat knee OA properly, but this largely depends on your symptoms and the stage of the degeneration you’re in.

It’s key to get the right treatment right away to prevent chronic knee pain – a common complication that can happen if this condition isn’t managed adequately.

With that said, the most common treatments include:

Going to the doctor will be crucial here. Your physician will give you a proper diagnosis and suggest the best treatments for your case.

Learn more: How to treat knee OA – 10 proven strategies.

3) Knee bursitis

Bursae are fluid-filled sacs present in our joints. They reduce friction between the tendons, bones, muscles, and the skin.

Now, “bursitis” is the inflammation of said sac. This condition has several types, depending on which bursa is affected and how.

You’ll know it’s bursitis because one part of your knee joint will be very swollen and painful. It can even be reddened and hot, which is a sign of infection. (3)

Also, you’ll probably be unable to put pressure on that area due to the pain, making it very difficult to find a comfortable sleep position.

How to treat it?

If you think this is the cause of your throbbing knee pain at night, please go straight to the doctor. Infected and non-infected bursitis look remarkably similar but are treated differently (3):

  • Infected bursitis requires a course of antibiotics, otherwise, it won’t get better.
  • Non-infected bursitis can be treated at home, but stubborn ones may benefit from physical therapy.

This can help: 6 ways to reduce bursitis knee pain at night.

4) Growing pains

child and a parent, both wearing pajamas. The kid grabbing their knee and the parent touching the knee

This pain is common in children between 4 to 12 years old. It’s harmless and not a sign of anything serious, but it can be intense. It often affects both knees, but the symptoms are mostly present in the muscles around them, particularly (4):

  • The thigh.
  • The back of the knee.
  • The calf and/or shin.

Symptoms tend to worsen during the evening or at night but improve the next day.

The cause is still unknown, but it can run in families. Researchers believe it has something to do with muscle fatigue and overuse due to physical activity. (4)

How to treat it?

The recommended way to alleviate pain in this condition is with home treatments, such as:

  • Massaging the child’s legs before sleep.
  • A warm bath to increase blood flow and manage pain.
  • Applying a hot or cold compress to the area – choose what the child likes the most.

Some medication may help, but this should be discussed with the pediatrician first.

5) Runner’s knee

This is one of the most common repetitive stress injuries. Also known as patellofemoral pain syndrome (PFPS), it affects the front area of the knee. The pain tends to be unspecific and often gets worse with bending motions.

It may get worse at night, but will likely be present during the day while you sit for long periods or climb stairs as well.

The cause is often multifactorial, including (5):

  • Malalignment of the lower extremity and/or kneecap.
  • Muscle weaknesses in the foot, knee, and/or hips.
  • Excess physical activity.
  • Overuse.
  • A direct trauma, like falling on your knees.

PFPS may be the reason behind your knee pain if you’re an athlete or an active adolescent/young adult.

Check more: What is runner’s knee?

How to treat it?

The treatment is focused on managing pain and includes:

  • Doing home treatments like ice/cold therapy or stretches.
  • Improving the malalignment with exercises and/or knee braces.
  • Going to physical therapy to relieve knee pain.
  • Taking painkillers to reduce symptoms.

6) Jumper’s knee

This overuse injury affects the patellar tendon. That’s the thick, vertical band that connects the kneecap to the tip of the shinbone. It’s also known as patellar tendonitis and it’s fairly common in jumping sports.

See, the frequent jumping accumulates tension on the tendon. If it doesn’t have enough time to heal, it can ultimately cause tiny tears on the tissue. (6)

This in turn can cause pain with movement, rest, and of course – before sleep.

How to treat it?

The management focuses on reducing pain with rest and hot/cold therapy. It may not respond well to NSAIDs though, so you’ll likely have to do physical therapy (PT) to help the tendon heal.

Surgery can help in specific cases, where symptoms don’t get better with PT and there’s a partial tear of the patellar tendon. (6)

7) Knee sprain

basketball player grabbing their knee in pain

This happens when a knee ligament stretches more than it should, sometimes to the point of tearing. It can occur after a bad movement or a direct hit, making it more common in young soccer and basketball players. (7)

Apart from pain at night, sprains have other associated symptoms such as:

  • A feeling of instability.
  • Joint swelling.
  • Inability to bear weight in severe cases.

Some people may be able to walk with a knee sprain, but others won’t. This will depend on the severity of the injury.

Know more: All about knee sprains – types, treatments, and more.

How to treat it?

The management is determined by how severe the sprain was. Most of the time, it includes:

  • RICE protocol to reduce pain and swelling.
  • Wearing some kind of support device, like a brace or crutches.
  • Light exercises, preferably given to you by a physical therapist.
  • Medications.

If the ligament is completely torn or there are other injuries associated, you might need surgery. Doctors can recommend this right away to athletes to help them go back to the sport faster.

This can help: What to do with a sprained knee?

8) Rheumatoid arthritis

This is an autoimmune condition that affects the joints of the hands and sometimes the knees. It usually happens on both sides at the same time.

The cause is unknown, but several factors can increase the risk of having it, including (8):

  • Having a family member with it.
  • Cigarette smoking.
  • Being overweight/obese.
  • Following a Western diet.

It can cause knee pain at night, but symptoms will likely get worse in the morning. In fact, a common sign of rheumatoid arthritis is having morning stiffness that lasts several hours, instead of a few minutes. (8)

How to treat it?

If you suspect you have rheumatoid arthritis, please go to the doctor straight away. Preferably a rheumatologist.

Apart from a physical exam, your physician will request some blood and imaging tests to rule out other conditions. If the diagnosis is rheumatoid arthritis, you’ll have to take specific medications and do some lifestyle changes to keep it in check.

Related: What doctor for knee pain – ortho or rheumatologist?

9) Gout

In this inflammatory condition, uric acid crystals accumulate in certain joints – commonly the big toe, ankle, and/or knee.

It mostly affects older men, but having these conditions can increase the risk of having gout (9):

  • Hypertension.
  • Diabetes mellitus.
  • Hyperlipidemia.
  • Psoriasis.
  • Renal insufficiency.

Gout knee symptoms are most frequent at night and in the morning. They can be sudden and intense, to the point of waking you up while you sleep. (9)

During a flare-up, it can make the joint look swollen, warm, and red.

How to treat it?

This condition is often managed with a variety of oral and injected medications, paired with lifestyle changes. But, early diagnosis is crucial to prevent complications.

So, if you suspect you have gout, please visit a rheumatologist. As with RA, the doctor will also request several tests to rule out other conditions first.

When to see a doctor?

To be honest, having knee pain at night frequently can be a sign that something’s going on with your joint. That in itself is reason enough to get it checked by your doctor.

These are some signs that you should go to your physician as soon as possible:

  • The pain wakes you up at night or doesn’t let you sleep.
  • Symptoms are unbearable.
  • You’re limping or can’t walk during the day.
  • The symptoms are not getting better after 48-72 hours.
  • You’re experiencing knee pain at night after a fall or a direct hit on the joint.
  • The area is red, warm, painful, and/or very tender to the touch.
  • You also have a fever.
  • There’s any sign of infection: fever, redness, and/or warmth in the injured area.
  • No home remedies help with symptoms.

FAQs

Why does my knee hurt at night?

There are several reasons why your knee hurts at night, including excess physical activity, osteoarthritis, rheumatoid arthritis, or gout. If it doesn’t let you sleep or happens frequently, please consult a doctor.

What causes burning knee pain at night?

Burning knee pain at night may be a sign of infection, which could come from conditions like bursitis or gout. Please go to the doctor to check this out.

Why do my knee joints hurt at night but not during the day?

Your knee joints hurt at night but not during the day likely because you’re less distracted, thus paying more attention to how your knee feels. But it can also happen because of an underlying problem or injury.

If this doesn’t subside after a few days, get it checked by a doctor or physical therapist.

Conclusion: Severe knee pain at night

Knee pain in the evening or at bedtime can be due to several causes. From something as benign as doing too much, to an injury, to a severe condition like rheumatoid arthritis.

In this article, you learned the most common reasons behind this. But remember that having knee pain at night for most days is a red flag in itself.

If that happens, please go to the doctor to get an accurate diagnosis and start the right treatment. This will prevent you from developing chronic pain and other physical limitations.

Resources

  1. Hsu H, Siwiec RM. “Knee Osteoarthritis.” [Updated 2021 Jul 25]. Statpearls. Retrieved on June 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK507884/
  2. Heidari, Behzad. “Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I.” Caspian journal of internal medicine vol. 2, 2 (2011): 205-12.
  3. Lohr, Kristine. “Bursitis: Practice essentials.” [Updated 2020 Dec 11]. Medscape. Retrieved on June 2022 from: https://emedicine.medscape.com/article/2145588-overview
  4. Lehman, Patrick J, and Rebecca L Carl. “Growing Pains.” Sports health vol. 9, 2 (2017): 132-138. DOI: 10.1177/1941738117692533
  5. Bump J M, Lewis L. Patellofemoral Syndrome. [Updated 2022 Feb 18]. Statpearls. Retrieved on June 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK557657/
  6. Santana J A, Mabrouk A, Sherman Al. Jumpers Knee. [Updated 2022 Feb 7]. Statpearls. Retrieved on June 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK532969/
  7. Gray, Aaron M, and William L Buford. “Incidence of Patients With Knee Strain and Sprain Occurring at Sports or Recreation Venues and Presenting to United States Emergency Departments.” Journal of athletic training vol. 50, 11 (2015): 1190-8. DOI: 10.4085/1062-6050-50.11.06
  8. Chauhan K, Jandu J S, Goyal A, et al. Rheumatoid Arthritis. [Updated 2022 Apr 30]. Statpearls. Retrieved on June 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK441999/
  9. Fenando A, Rednam M, Gujarathi R, et al. Gout. [Updated 2022 Mar 23]. Statpearls. Retrieved on June 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK546606/

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Author
Mich Torres (PT)
Mitch is a physical therapist, personal trainer, and nutrition coach. Fascinated with the knee joint, Mitch poured that passion into writing about knee pain and how to overcome it with movement. His goal is to teach you how to apply this knowledge into your daily life, so you can keep knee pain away for good.

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