What You Need to Know About Throbbing Knee Pain at Night

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

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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.

No one condition causes only nighttime knee pain, so your doctor may consider several potential causes. Some of the most common sources for nighttime knee pain include runner’s knee, osteoarthritis, bursitis, or injuries. When your doctor can pinpoint your pain's origin, they can help provide you with the treatment you need to rest easier.

Potential Causes of Nighttime Knee Pain

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Causes of Throbbing Knee Pain

Throbbing pains can come from a variety of musculoskeletal illnesses or injuries. Some of these conditions, like runner’s knee, may resolve after you rest your knee. Others, like osteoarthritis, are chronic in nature. 

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 report similar symptoms, such as dull or radiating pain near their knee or a grinding feeling near their kneecap.

However, runner’s knee is an umbrella term to refer to this knee pain; therefore, it can have various causes. You may have overexerted your knee by running or jumping. Some people are 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 doctors 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 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 wear-and-tear typical of aging. 

If you are experiencing knee pain that interrupts your daily life and that persists after several days of rest, consider consulting with a doctor. 

Why It’s 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 doctor.

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.

What You Can Do About It

Your exact treatment will depend on your specific injury or knee condition. Of your medical options, your doctor may recommend you take certain medications, make lifestyle changes to promote better sleep, or consider other therapy 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 pharmacy near you.

However, your doctor 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 doctor 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 doctor 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 a 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 doctor 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. 

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 doctor 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 like 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.

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