Table of ContentsView AllTable of ContentsRunner’s KneeOsteoarthritisRheumatoid ArthritisMeniscus TearKnee BursitisGoutGrowing PainsWhy Is Knee Pain Worse at Night?What You Can Do About It
Table of ContentsView All
View All
Table of Contents
Runner’s Knee
Osteoarthritis
Rheumatoid Arthritis
Meniscus Tear
Knee Bursitis
Gout
Growing Pains
Why Is Knee Pain Worse at Night?
What You Can Do About It
A wide variety ofmusculoskeletalconditions can cause knee pain. Someacuteconditions likerunner’s kneemay resolve after you rest your knee. Otherchronicconditions likeosteoarthritismay require ongoing care and management.
Runner’s Knee
Runner’s knee, also calledpatellar tendonitis, is one of the most common causes of knee pain in athletes. If you have runner’s knee, you may feel an ache behind your kneecap, a dull or radiating pain near your knee, or a grinding around your kneecap.
The pain from runner’s knee begins when the kneecap does not move properly and rubs against the lower part of the thigh bone.
This may occur due to:
In most cases, runner’s knee symptoms go away after several weeks of rest.Ice packsand over-the-counter (OTC)nonsteroidal anti-inflammatory drugs (NSAIDs)like Advil or Aleve can help ease inflammation and pain.
Knee Osteoarthritis
Unlike runner’s knee,symptomsof osteoarthritis (OA) are not temporary. OA is a chronic aging-related condition in whichcartilagegradually wears away in joints. This can cause knee bones to rub against each other, leading to jointinflammation, stiffness, and pain.OA pain can flare up and cause pain and aching when you bend a knee or stand. Swelling and throbbing are also common symptoms that may seem more pronounced at night.
Another form of OA called post-traumatic arthritis develops years after an injury to a joint (such as a fractured knee orruptured ligament).
There is no cure for OA, but different treatments can slow the progression of the disease and help ease symptoms. These include knee exercises, ice packs,heat therapy, NSAIDs,cortisone injections, and, in severe cases, joint replacement (arthroplasty).
With RA, thesynovial membranecovering the knee joint is the target of the inflammatory attack. This causes the membrane to swell, leading to knee pain and stiffness.Studies suggest that up to 80% with RA have sleep difficulties during acute episodes.
There isn’t a cure for RA but there are several treatment options including NSAIDs, cortisone injections,immunosuppressant drugs, physical and occupational therapy, and surgery.
Not all knee injuries are apparent at first and may only be recognized when there is pain at night. This is especially true withmeniscal tearsin which two wedge-shaped pieces of cartilage between the thigh and calf bone (calledmenisci) become torn.
A meniscus tear is most often due to acute injury, such as a sudden twist of the knee during sports like soccer, football, basketball, baseball, skiing, or wrestling.Meniscus tears can also be a complication of knee osteoarthritis.
Mild meniscus tears can often heal after a period of rest with a knee brace, ice application, and NSAIDs. Severe cases may requirearthroscopic surgery.
Bursitisis the inflammation of the cushioning sacs between joints, calledbursae. When the knee is affected, these sacs will begin to swell and place pressure on the adjacent parts of the knee. Symptoms include a swollen kneecap, pain when bending the knee, and nighttime knee pain.
Bursitis is common in professions that require constant kneeling or squatting, particularly when protective knee pads or support braces aren’t used. Sometimes, a bursa can become inflamed after an impact injury to the knee.
Bursitis is commonly treated with rest, ice application, and NSAIDs. In severe cases, the inflamed bursa may need to be surgically removed.
Goutis a painful form of inflammatory arthritis that usually affects the big toe but can develop in any joint, including the knee. When the body has high levels of uric acid (often due to foodshigh in purine), sharp crystals form in the joint causing sudden bouts of pain, swelling, and tenderness.
Nighttime attacks (“flares”) are 2.4 times more common than attacks during the day.
Osgood-Schlatter Disease
A common cause of knee pain in growing adolescents is called Osgood-Schlatter disease. It’s not really a disease, but instead inflammation of the area just below the knee where the tendon from the kneecap attaches to the shinbone.
This type of knee pain most often occurs during growth spurts when bones, muscles, tendons, and other structures are changing rapidly. Osgood-Slatter disease symptoms tend to be worse at night and first thing in the morning.
Rest, ice, and NSAIDs, along with stretching and strengthening exercises will usually relieve knee pain until bones and connective tissues start to align more normally.
These include:
A Word From VerywellEarly morning joint stiffness is a characteristic feature of an inflammatory process causing knee symptoms that are worse on awakening after a night of not moving the knee joint.—STELLA BARD, MD, MEDICAL EXPERT BOARD
A Word From Verywell
Early morning joint stiffness is a characteristic feature of an inflammatory process causing knee symptoms that are worse on awakening after a night of not moving the knee joint.—STELLA BARD, MD, MEDICAL EXPERT BOARD
Early morning joint stiffness is a characteristic feature of an inflammatory process causing knee symptoms that are worse on awakening after a night of not moving the knee joint.
—STELLA BARD, MD, MEDICAL EXPERT BOARD
Treatment
With a proper diagnosis, your healthcare provider can help you get the treatment you need to rest easier. For example, they may recommend you take certain medications, make lifestyle changes to promote better sleep, or consider other therapeutic options.
Pain Medications
To help alleviate pain, many people with knee pain use OTC NSAIDs like aspirin,Advil (ibuprofen), andAleve (naproxen)or prescription NSAIDs likeVoltaren (diclofenac)andCelebrex (celecoxib). These are used for a prescribed period as their overuse can lead to stomach ulcers and bleeding.
Hot and Cold Therapy
Heat from a hot water bottle or heating pad can help to improve joint pain and reduce stiffness. On the other hand, cold from an ice pack can reduce pain, inflammation, and swelling. Some people benefit from applying both, alternating between heat and cold therapies.
Practice Good Sleep Hygiene
While pain can disrupt your sleep, you can promote a more restful night when you include thesesleep hygienestrategies into your daily routine:
Alter Your Sleep Position
Whether you are a back sleeper or side sleeper, there are things you can do to reduce nighttime knee pains while you sleep:
solar22 / Getty Images
Routine Exercise
While overexertion can cause knee pain, some moderate amount of activity helps keep your joints healthy.Low-impact activitieslike walking, swimming, and yoga can keep your joints loose and flexible.
Physical and Alternative Therapies
Physical therapy may be recommended for certain conditions, such as rheumatoid arthritis, osteoarthritis, and some knee injuries.
Acupunctureis a popular form of alternative medicine that many patients use to cope with mild to moderate arthritis symptoms. The American College of Rheumatology has listedacupunctureas a “conditional recommendation” for osteoarthritis.
When to See a Healthcare Provider
Summary
Treatment options include rest, heat/ice therapy, OTC and prescription pain relievers, physical therapy, appropriate exercise, improved sleep hygiene, and complementary therapies such as acupuncture.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Medline Plus.Anterior knee pain.Johns Hopkins Medicine.Patellofemoral pain syndrome (runner’s knee).American Academy of Orthopaedic Surgeons.Arthritis of the knee.Tuncay Duruöz M, Öz N, Gürsoy DE, Hande Gezer H.Clinical aspects and outcomes in osteoarthritis.Best Pract Res Clin Rheumatol. 2023 Jul 29:101855. doi:10.1016/j.berh.2023.101855.National Institutes of Arthritis and Musculoskeletal and Skin Diseases.Rheumatoid arthritis: diagnosis, treatment, and steps to take.Arthritis Foundation.Rheumatoid arthritis and sleep.American Academy of Orthopaedic Surgeons.Meniscus tears.Howell R, Kumar NS, Patel N, Tom J.Degenerative meniscus: pathogenesis, diagnosis, and treatment options.World J Orthop. 2014;5(5):597-602. doi:10.5312/wjo.v5.i5.597American Academy of Orthopaedic Surgeons.Prepatellar (knee cap) bursitis.Penn Medicine.Bursitis.Centers for Disease Control and Prevention.Gout.Choi HK, Niu J, Neogi T, et al.Nocturnal risk of gout attacks.Arthritis Rheumatol. 2015 Feb;67(2):555–562. doi:10.1002/art.38917Hainer BL, Matheson E, Wilkes RT.Diagnosis, treatment, and prevention of gout.Am Fam Physician.2014;90(12):831-6Academy of Orthopaedic Surgeons.Osgood-Schlatter disease (knee pain).Duo L, Yu X, Hu R, Duan X, Zhou J, Wang K.Sleep disorders in chronic pain and its neurochemical mechanisms: a narrative review.Front Psychiatry.2023;14:1157790. doi:10.3389/fpsyt.2023.1157790Van Berkel AC, Rignelenberg R, Bindels PJE, Bierma-Zeinstra SMA, Schiphof D.Nocturnal pain, is the pain different compared with pain during the day? An exploratory cross-sectional study in patients with hip and knee osteoarthritis.Fam Pract. 2023 Feb 9;40(1):75-82. doi:10.1093/fampra/cmac074National Health Service (UK).NSAIDs.Food and Drug Administration.Hysingla (hydrocodone bitartrate) label.Nurcan Ç, Karadağ M.Superficial heat and cold applications in the treatment of knee osteoarthritis.Osteoarthritis Progress Basic Res Treat. 2015. doi:10.5772/60534American Academy of Sleep Medicine.Healthy sleep habits.Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Rheumatol. 2020;72(2):220-233. doi:10.1002/acr.24131Patel DR, Villalobos A.Evaluation and management of knee pain in young athletes: overuse injuries of the knee.Transl Pediatr. 2017;6(3):190-198. doi:10.21037/tp.2017.04.05
Medline Plus.Anterior knee pain.
Johns Hopkins Medicine.Patellofemoral pain syndrome (runner’s knee).
American Academy of Orthopaedic Surgeons.Arthritis of the knee.
Tuncay Duruöz M, Öz N, Gürsoy DE, Hande Gezer H.Clinical aspects and outcomes in osteoarthritis.Best Pract Res Clin Rheumatol. 2023 Jul 29:101855. doi:10.1016/j.berh.2023.101855.
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Arthritis Foundation.Rheumatoid arthritis and sleep.
American Academy of Orthopaedic Surgeons.Meniscus tears.
Howell R, Kumar NS, Patel N, Tom J.Degenerative meniscus: pathogenesis, diagnosis, and treatment options.World J Orthop. 2014;5(5):597-602. doi:10.5312/wjo.v5.i5.597
American Academy of Orthopaedic Surgeons.Prepatellar (knee cap) bursitis.
Penn Medicine.Bursitis.
Centers for Disease Control and Prevention.Gout.
Choi HK, Niu J, Neogi T, et al.Nocturnal risk of gout attacks.Arthritis Rheumatol. 2015 Feb;67(2):555–562. doi:10.1002/art.38917
Hainer BL, Matheson E, Wilkes RT.Diagnosis, treatment, and prevention of gout.Am Fam Physician.2014;90(12):831-6
Academy of Orthopaedic Surgeons.Osgood-Schlatter disease (knee pain).
Duo L, Yu X, Hu R, Duan X, Zhou J, Wang K.Sleep disorders in chronic pain and its neurochemical mechanisms: a narrative review.Front Psychiatry.2023;14:1157790. doi:10.3389/fpsyt.2023.1157790
Van Berkel AC, Rignelenberg R, Bindels PJE, Bierma-Zeinstra SMA, Schiphof D.Nocturnal pain, is the pain different compared with pain during the day? An exploratory cross-sectional study in patients with hip and knee osteoarthritis.Fam Pract. 2023 Feb 9;40(1):75-82. doi:10.1093/fampra/cmac074
National Health Service (UK).NSAIDs.
Food and Drug Administration.Hysingla (hydrocodone bitartrate) label.
Nurcan Ç, Karadağ M.Superficial heat and cold applications in the treatment of knee osteoarthritis.Osteoarthritis Progress Basic Res Treat. 2015. doi:10.5772/60534
American Academy of Sleep Medicine.Healthy sleep habits.
Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Rheumatol. 2020;72(2):220-233. doi:10.1002/acr.24131
Patel DR, Villalobos A.Evaluation and management of knee pain in young athletes: overuse injuries of the knee.Transl Pediatr. 2017;6(3):190-198. doi:10.21037/tp.2017.04.05
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