What You Need to Know About Throbbing Knee Pain at Night

A woman sits on her bed, cradling her knee as though in pain

LightFieldStudios / Getty Images

Knee pain is a common discomfort, and many people struggle with pain-induced insomnia. Knee pain at night is frustrating. A throbbing or aching knee can prevent you from getting restful sleep, which can leave you exhausted. Not knowing the cause is an additional frustration.

This article will help you understand the causes of knee pain, why it often worsens at night, and what you can do to feel better. 

Potential Causes of Nighttime Knee Pain

Theresa Chiechi / Verywell

Causes of Throbbing Knee Pain

No single condition causes nighttime knee pain—throbbing pains can come from a variety of musculoskeletal illnesses or injuries. As a result, your health care provider may consider several potential causes.

Some of the most common sources for nighttime knee pain include runner’s knee, osteoarthritis, bursitis, or injuries. Some of these conditions, like runner’s knee, may resolve after you rest your knee. Others, like osteoarthritis, are chronic in nature.

With a proper diagnosis, your health care provider can provide you with the treatment you need to rest easier.

Runner’s Knee

Runner’s knee 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. Many people with this condition report similar symptoms, such as dull or radiating pain near their knee or a grinding feeling near their kneecap.

Runner’s knee is an umbrella term to refer to this form of knee pain. It can have various causes. For example, you may have overexerted your knee by jumping rather than running. Some people are also more prone to developing runner’s knee because their kneecap may not be positioned to cover and protect the joint properly.

In most cases, runner’s knee symptoms go away after several weeks of resting from strenuous activity and taking over-the-counter pain relievers as needed.

Osteoarthritis

Unlike most mild cases of runner’s knee, osteoarthritis symptoms are not temporary. Osteoarthritis is a chronic illness, so patients should consult their health care providers to make a long-term treatment plan.

In a healthy knee, soft tissue, including cartilage, cushions the three bones. These tissues are shock absorbers that support your body weight when you walk or fall. The cartilage in your knee helps your knee bend without the bones scraping against one another.

In a knee with osteoarthritis, these soft tissues have degraded due to wear and tear. This can result in the knee bones rubbing against one another, resulting in irritation and inflammation. Your knee may feel stiff when you try to bend it or stand.

Unfortunately, there is no cure for osteoarthritis because there is no way to completely repair or replace the damaged or eroded joint tissue. However, osteoarthritis patients have several treatment options to reduce their pain and prevent further damage to their knees.

Osteoarthritis pain may feel like stiffness, aching, swelling, or throbbing. These symptoms may seem more pronounced at night since osteoarthritis pains can flare during periods of rest.

Bursitis 

Bursitis can cause painful swelling over your kneecap or at the side of your knee. In your knee, there are small sacs of fluid that help allow tendons to glide smoothly over your joints. These sacs are called bursae. In bursitis, these sacs of fluid swell, which can cause knee pain.

Bursitis, like runner’s knee, can be provoked in several different ways. The most common cause of bursitis is putting too much pressure on your knee, such as by kneeling or squatting without wearing knee pads or braces for support. Sometimes, a bursa can become inflamed after you hit your knee during an injury.

Bursitis is like runner’s knee in that it is often caused by overexertion. However, bursitis is less common than runner’s knee.

This condition also presents several symptoms, like swelling, that are distinct from runner’s knee. In moderate to severe cases, the inflamed bursa may become visible, appearing as a lump on your knee. Bursitis symptoms may feel like warm, aching pains.

Other Knee Injuries and Conditions

Because the knee is the largest joint in your body, it is prone to injury and strain. If you fall or bump your knee, you may experience pain from bruising. If you’ve fractured any of the three bones in your knee, you may experience weakness, sharp pain, or deep throbbing sensations.

Rheumatoid arthritis can present similar symptoms to osteoarthritis, but this autoimmune condition may require different treatments than joint damage caused by the typical wear and tear of aging.

Recap

Knee pain may be caused by overexertion. When it is, it's called runner's knee, even though it's not always caused by running. In these cases, it's usually resolved by resting. Knee pain may also be caused by chronic conditions like bursitis, osteoarthritis, or rheumatoid arthritis.

Why Knee Pain Is Worse at Night

Many knee conditions, like runner’s knee and bursitis, can improve after several weeks of rest. However, your knee pain may become worse at night. What are the medical reasons behind this?

You’re Trying to Relax

When your body is at rest, you may notice the mild to moderate pains that you could more easily ignore when your mind was preoccupied with busy thoughts during your waking hours.

Additionally, when you sleep, your body produces less cortisol. While high cortisol levels can lead to heart disease, healthier levels can help your body reduce inflammation.

Since most joint pains are caused by or worsened by inflammation, moderate amounts of cortisol can help your body manage this inflammation. But when your body is relaxed, such as when you’re trying to go to sleep, your body has less cortisol to mitigate the swelling and irritation in your knees.

Nighttime Inflammation

When you sleep, your body is at rest. The hours of laying still can cause your joints to feel stiff and less flexible when you wake. While overexertion can cause knee pain, some moderate amount of activity helps keep your joints healthy. Low-impact activities like walking, swimming, and yoga can keep your joints loose and flexible.

Such movement can actually help keep your tendons limber and can circulate fluid that helps lubricate and protect your knee joints. People with chronic conditions like arthritis tend to experience better health outcomes and less pain when they engage in a regular exercise program approved by their health care provider.

Lack of Sleep Makes Pain Worse

It can be easy to get stuck in a cycle where you can’t sleep because of knee pain. That lack of sleep can actually make your pain worse. Sleep is vital for healing and rejuvenation. Without sleep, you have less energy to expend on healing as you need to focus your bodily processes on staying alert and awake.

If nighttime knee pain causes you to toss and turn, you may end up accidentally further straining your knee by sleeping in an uncomfortable position.

Recap

Knee pain can seem like it gets worse at night simply because you're more likely to notice it when you're not involved in other activities. Inflammation and soreness may accompany waking when you have chronic conditions like arthritis or don't get enough physical activity. Lack of sleep can also worsen pain and your ability to withstand it. If you are experiencing knee pain that interrupts your daily life and persists after several days of rest, consult with a health care provider.

What You Can Do About It

Your exact treatment will depend on your specific injury or knee condition. For example, your health care provider may recommend you take certain medications, make lifestyle changes to promote better sleep, or consider other therapeutic options.

Treat the Pain

To help alleviate pain, many people use nonsteroidal anti-inflammatory drugs (NSAIDs). Some common NSAID pain relievers include Advil, Motrin, and Aleve. These basic NSAIDs can be purchased at a local pharmacy.

However, your health care provider may prescribe a more powerful narcotic pain reliever such as hydrocodone. These medications can help provide relief from severe pain but can be highly addictive. Please consult your health care provider before taking any new medications.

Practice Good Sleep Hygiene

While pain can disrupt your sleep, you can promote a more restful night when you include these sleep hygiene strategies into your daily routine:

  • Avoid taking long naps during the day.
  • Make your bedroom cool and dark.
  • Avoid eating heavy foods or exercising right before you sleep.
  • Talk to your health care provider about taking melatonin supplements or other sleep aids.
  • Don’t use phones or computers before bed since the blue light from the screen can disrupt sleep.
  • Use a pillow and supportive mattress to avoid straining your back or your knees.
An illustration of correct sleep posture, with a pillow cushioning the knees when laying on your back and with a pillow held between the knees when sleeping on your side

solar22 / Getty Images

Consider Additional Therapies

Acupuncture is a popular form of alternative medicine that many patients use to cope with mild to moderate arthritis symptoms. The American College of Rheumatology has listed acupuncture as a “conditional recommendation” for osteoarthritis. People may consider consulting their health care provider about including acupuncture in their normal treatment plan.

You may alternate between applying a hot or cold pack on your knee to reduce pain and swelling. A knee pillow can also help support and stabilize your sore knee when you are trying to sleep.

Summary

Knee pain may be caused by repetitive stress injuries (called "runner's knee"), osteoarthritis, bursitis, or other conditions. It may be more apparent at night because you're at rest, but it doesn't have to derail sleep. Heat and ice packs as well as NSAIDs, prescription pain relievers, and complementary therapies such as acupuncture can help manage discomfort. Keeping good sleep habits can also help you get to sleep and stay asleep.

A Word From Verywell

Nighttime knee pain can feel like a never-ending, exhausting cycle, especially if you are coping with a chronic condition like arthritis. Fortunately, you can work with your health care provider to make a treatment plan that’s right for you.

When you receive a diagnosis for your knee pain, you can begin exploring treatment options such as medication, rest, physical therapy, or icing your knee. When you couple these pain-management strategies with sleep hygiene, you can give yourself the best chance at a good night’s sleep.

Frequently Asked Questions

  • Which is best for easing knee pain, a cold or hot compress?

    Use both. Start with heat, which increases blood flow and offers some initial relief, but then apply ice to prevent the blood from pooling and swelling in the area around the joint (which would make the knee throb).

  • Why is arthritis pain in the knee worse in the morning?

    During the night, your leg isn’t moving, which causes muscles and tissues around an already swollen joint to tighten up. That increases stiffness and pain around the knee.

  • Is it common to have nighttime pain after a knee replacement?

    Yes. It’s estimated that more than half of those who have had a joint replacement wake up with pain during the night. The sleep disruptions and pain should ease two to three weeks after surgery.

Was this page helpful?
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: An update and a path forwardJ Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007

  2. Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitationPhys Ther. 2014;94(12):1816-1825. doi:10.2522/ptj.20130597

  3. Nejati P, Farzinmehr A, Moradi-Lakeh M. The effect of exercise therapy on knee osteoarthritis: a randomized clinical trialMed J Islam Repub Iran. 2015;29:186.

  4. Staffe AT, Bech MW, Clemmensen SLK, Nielsen HT, Larsen DB, Petersen KK. Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participantsPLOS ONE. 2019;14(12):e0225849. doi:10.1371/journal.pone.0225849

  5. Cordeiro B. 8 healthy sleep habits. MD Anderson Cancer Center. April 2014.

  6. 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 kneeArthritis Rheumatol. 2020;72(2):220-233. doi:10.1002/acr.24131

  7. Nurcan Ç, Karadağ M. Superficial heat and cold applications in the treatment of knee osteoarthritisOsteoarthritis - Progress in Basic Research and Treatment. 2015 doi:10.5772/60534

  8. Cleveland Clinic. Why do I have knee pain at night? Published February 12, 2021.

  9. Andersen Charlotte Hilton. 30 tips and tricks to prevent arthritis morning stiffness. CreakyJoints. Published December 10, 2018.

  10. Association of Hip and Knee Surgeons. Getting a good night's sleep after hip or knee replacement surgery. Updated 2017.