Why does my knee hurt more at night?

Why night makes pain more noticeable

During the day, movement keeps the joint fluid circulating and your attention is elsewhere. At night the knee is still for hours, inflammation and fluid that built up during the day sit in the joint, and certain sleeping positions compress or stretch painful tissues. Many people also notice pain more when tired or worried.

A throbbing knee after an evening padel match or a long day on your feet is a common example: the load came hours earlier, but the ache peaks in bed.

Common causes of night knee pain

• Knee osteoarthritis: a deep ache in bed, stiffness on getting up, often worse after an active day
• Meniscus tear: pain on the inner or outer side when turning over or lying with the knees together
• Bursitis or pes anserine pain: tenderness on the inner side when one knee rests on the other
• Patellofemoral pain: an ache at the front after lying with the knee bent for a long time
• Gout or pseudogout: sudden, severe pain that often starts in the night
• Pain from the hip or lower back felt in the knee

What can help tonight

• A pillow between the knees if you sleep on your side, or under the knees if on your back
• Ice wrapped in a towel for 15 minutes after an active day, or gentle warmth for stiffness
• A short walk or gentle knee bends before bed
• Pain relief recommended by your pharmacist, taken at the right time for the night
• Spreading heavy activity through the day rather than all in the evening

When to see a knee specialist

Book an appointment if night pain is regular, wakes you most nights, or comes with swelling, locking or giving way. Seek prompt care if pain is constant, not eased by rest or position, or comes with fever, night sweats or unexplained weight loss.

At Aman Hospital in Doha, Dr. Gelber looks for the cause of night pain and arranges imaging when the pattern calls for it.