Is Your Knee Pain Worse at Night? A Physical Therapist Explains Why That Might Be

Getty Images | Yuttana Jaowattana / EyeEm
Getty Images | Yuttana Jaowattana / EyeEm

It isn't until bedtime that I fully regret my morning run. My knee pain at night often leaves me tossing and turning — and wondering why on earth it's worsening hours after my exercise.

According to Zachary Rogers PT, DPT, CSCS, physical therapist at HSS, any knee pain at night should be addressed through a medical professional's guidance. "I would suggest seeing a physical therapist, a physiatrist, or your primary care physician if you are experiencing knee pain at night," Dr. Rogers said.

That's likely because there are many different conditions that can lead to knee pain at night — and only a trained expert can make that call.

"Osteoarthritis is the musculoskeletal condition I see most often in my clinical practice that can present with worsening pain at night," Dr. Rogers said. "However, any knee condition that is associated with increased inflammation can present with increased pain at night. Some examples could be patella femoral pain syndrome, patella tendinitis, quadriceps tendinitis, and medial or lateral meniscus tears."

Another reason that knee pain can feel more uncomfortable at night is due to increased activity levels during the day that are perhaps outside the person's exercise or functional capacity.

"This can be seen when someone is accustomed to running one mile per day for exercise but then one day that person decides to run three or four miles without proper training or gradually building up to this distance."

That sudden jump to four miles might be outside of the person's current capacity, therefore leading to a worsening of knee pain in the evening.

An increase of activity can also affect those with the aforementioned knee conditions, potentially increasing inflammation and worsening pain in the evening.

Outside of reaching out to a medical professional, there are some things you can do at home to help relieve your knee pain.

"When dealing with knee pain at night, I recommend applying an ice pack to the knee before bed for 15-20 minutes to help soothe the pain," Dr. Rogers said. "A lot of times ice before bed will be sufficient to help reduce the knee pain at night."

Alternating between a heating pad and an ice pack could also be helpful if ice alone isn't doing the trick.

"One can use a heating pad on the knee for 15-20 minutes about an hour before bed and then use an ice pack on the knee for 15-20 minutes right before bed. Sometimes the alternating combination of heat and ice before bed can be helpful to soothe knee pain at night."

However, it's crucial that you don't fall asleep with the heating pad or ice pack on your knees, as either could lead to skin burns. So, be sure to set an alarm or avoid these methods while in bed.

Gentle stretching of the quadriceps, hamstrings, and calves may also help in reducing knee pain at night, Dr. Rogers added.

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