Patient question
Why does the inside of my knee hurt at night when I lie on my side?
Dr. Pablo GelberOrthopaedic Knee Surgeon
Quick answer
Inner knee pain at night when lying on your side is often pressure from the other knee on a tender pes anserine bursa or an arthritic inner joint. A deep, throbbing night ache that started suddenly, especially over 50, can signal a meniscal root tear or bone stress and should be examined, says Dr. Pablo Gelber in Doha.
Pressure pain or joint pain?
Notice whether the pain only appears when the knees touch or press into the mattress. That surface pressure pain usually comes from the pes anserine bursa or a sore MCL on the inner side, and it eases as soon as you move the leg.
A deep ache inside the joint that keeps you awake whatever position you choose is different. It suggests inflammation or a problem in the bone or cartilage of the inner compartment.
Possible causes
- Pes anserine bursitis: tender spot below the inner joint line, sore when the knees touch
- Inner-knee osteoarthritis: night ache after an active day, morning stiffness, swelling at times
- Medial meniscal root tear: a sudden pop or pain while squatting or stepping, followed by marked pain on walking and at night, typically in adults over 50
- Bone marrow oedema or subchondral insufficiency fracture: sudden, severe inner pain with no or minor injury, worse at night, in older adults
- Rarely, infection or inflammatory arthritis, with warmth, swelling and constant pain
Tonight and over the next few weeks
Place a firm pillow between the knees and ankles when lying on your side, or sleep on your back with a small pillow under the knees. A cold pack for 15 minutes before bed can calm a sore bursa.
During the day, gentle strengthening, a walking pattern broken into shorter bouts and weight management reduce the load that causes night flare-ups. If an older adult has developed sudden night pain after a pop, reduce weight-bearing with a walking aid and arrange an examination rather than waiting it out.
When to see a knee surgeon in Doha
Seek prompt care for a hot, red, swollen knee or fever. Book soon if night pain began suddenly, if it wakes you most nights for more than two weeks, or if you cannot put full weight on the leg.
At Aman Hospital in Doha, Dr. Gelber examines the joint line and bursa, reviews standing X-rays and often arranges an MRI when a root tear or bone problem is suspected, because these are not visible on X-ray early on. Early identification can change the treatment options.
Frequently asked questions
Why is the pain worse at night than during the day?
With fewer distractions and a still joint, inflammation and pressure are felt more. Bone problems in particular are known for aching at night.
Can a meniscus root tear really cause night pain?
Yes. A root tear lets the meniscus stop doing its job, which overloads the inner bone and cartilage. Night pain and painful walking are common early features.
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