Patella tendonitis: Patellar tendonitis is a common cause of pain in the front of the knee. It is a common overuse injury in sports requiring jumping and quick sprints. Patella tendonitis is common in jumping sports participants and is often referred to as a Jumper’s Knee. 13th March 2018 Knee Pain – Burning and Stabbing Pain on Inside of Knee By Mr. Sam Rajaratnam FRCS (Tr.& Ortho) Knee pain can be amongst the most troublesome of conditions and cause considerable inconvenience to leading a normal life even though the patient is otherwise in good health.If there is not an obvious cause of injury the pain inside the knee can have a number of causes depending on.

1. Occasional Sharp Knee Pain
2. Occasional Joint Pain
3. Occasional Knee Pain When Running

Knee pain at night can affect people with various forms of arthritis or it can be caused by issues with nerves in the leg. The pain in your knees can be mild, dull aches that keep you awake at night. Or, you could have severe throbbing knee pain that causes you to wake up in the middle of the night.

Nighttime chronic knee pain can mean that you don’t sleep well and it can make you tired and irritable the next day. Not getting enough sleep because of sharp pains in your knee can also have a knock-on effect on your knee pain. When you are well rested, your body deals with pain better.

There are some effective knee pain remedies that can help deal with pain in the legs at night. A warm compress or hot water bottle can help to relieve sharp knee pain by increasing circulation. Also, some remedies that include turmeric have pain-relieving properties and can help manage arthritis pain in your knees and joints.

So, what can you do if knee pain at night is keeping you awake and you can’t get to sleep? In this article, you can find out what it means if one or both your knees hurt during the night. I will also discuss some ways that can help to get relief from knee pain discomfort.

Occasional Sharp Knee Pain

Why Knees Can Ache at Night

It’s not unusual for joint pain to get worse at night, and that includes your knees. According to Dr. Michael Schaefer, a specialist in musculoskeletal medicine and rehabilitation at the Cleveland Clinic, walking and moving helps to lubricate joints during the daytime. Knees can then start to ache at night because joints tend to swell when you stop moving.¹

Dr. Schaefer points to another reason why you can get knee pain at night. Your sleeping position and body alignment can often cause pain in your knees, hips, and shoulders during the night. This is one reason why knee pain can get worse while you are sleeping.

Common Causes of Knee Pain at Night

Let’s look in more detail at some of the common causes of knee pain while sleeping.

Osteoarthritis

Osteoarthritis can cause sharp stabbing knee pains at night when you are resting in bed. The frequency and intensity of the night knee pain depend greatly on the extent of the osteoarthritis.

Researchers in the HSS Journal reported that there are a number of mechanisms that can contribute to nighttime knee pain. For example, minor injuries in the knee joint, damage to nerve fibers, or inflammation due to tissue damage could all be to blame for throbbing knee pain at night. Osteoarthritis sufferers describe nighttime knee pain as anything from mild, dull aching to intense jabbing knee pain.²

The journal Arthritis Care & Research published a study on the frequency of night pain in hip and knee osteoarthritis. It was found that just over 81% of osteoarthritis patients experience some type of night pain. The joint pain in the knees and hips was described as intermittent and variable. Most suffered night knee and hip pain regardless of the disease progression. However, the knee pain became more severe as the disease progressed.³

The Mayo Clinic says that other symptoms of osteoarthritis include:⁹

• Tenderness in affected joints that are sore to touch
• Stiff joints and lack of free movement
• Joint inflammation
• Loss of flexibility and difficulty moving joints without pain

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune condition that can cause pain in the knees and other joints at night.

A report published in the journal Annals of Rheumatic Disease found that many people with rheumatoid arthritis also suffer from nighttime joint pain. From the survey, nearly 30% of patients reported sleep disturbances due to pain in their joints. It was also found that joints tended to swell more during the night and become tender.⁴

If you suffer from arthritis, it’s also important to pay attention to your nutrition, and you can find more information about it in my article “Arthritis – Foods to Eat and Foods to Avoid“.

Gout

Gout is another arthritic and inflammatory condition that can cause severe throbbing knee pain at night. Although gout commonly affects the big toe, it can affect any joint in the body.

According to Dr. Nayana Ambardekar on WebMD, gout can attack the knees, ankles, elbows, and hands. The pain caused by gout can be excruciating and come on suddenly. In time, joints can become stiff and suffer from restricted movement.⁵

Research carried out by Dr. Hyon Choi from Harvard Medical School discovered that gout causes worse pain during the night. Around half of painful gout attacks happened between midnight and 8 a.m. Researchers concluded that knowing that gout causes nighttime pain in knees and other joints can help to take preventative measures against the pain.⁶

Other symptoms of gout include:¹⁰

• Swelling and redness in the affected joint
• Extreme tenderness in the joint making it very painful to touch
• Chills and fever in extreme cases

If gout flare-ups are making your knees sore during the night, you can try some natural remedies to relieve gout pain. There you can find out how tart cherry juice can help reduce inflammation in joints affected by gout.

Wear and tear

Just simple wear and tear of the knee joints can cause them to become sore and painful while you are sleeping.

The journal Archives of Gerontology and Geriatrics reported that knee pain during the night increases with age.⁷ However, rather than just put up with chronic aches and pains in your knees, Dr. Charlotte Grayson on WebMD recommends speaking to your doctor to find if the joint pain is due to wear and tear or a treatable condition.⁸

Fibromyalgia

Fibromyalgia causes widespread pain that can cause pain in muscles, joints, and tissue in your body. Fibromyalgia is characterized by dull aches in the body along with fatigue and difficulty concentrating.

Can fibromyalgia cause knee pain that wakes you up during the night? Dr. Joseph Biundo from the Tulane Medical Center says that fibromyalgia can cause painful symptoms similar to rheumatoid arthritis. This can cause pain in joints and/or muscles.¹²

Research into how fibromyalgia affects sleep has found that symptoms of pain associated with fibromyalgia increase at night. The Saudi Medical Journal reports that fibromyalgia sufferers often experience disturbed sleep patterns due to pain. This also leads to a decrease in pain tolerance and depression due to lack of sleep.¹¹

Doctors from the National Health Service say that other symptoms of fibromyalgia include:¹²

• Widespread pain that can feel like aching, a burning sensation, or sharp stabbing pains
• Stiffness in joints
• Extreme fatigue and general lack of energy
• Frequent headaches
• Poor sleep patterns
• Irritable bowel syndrome

If you suffer from fibromyalgia, you may find that some supplements like D-Ribose can help manage fibromyalgia energy levels. It’s also important to know which foods to avoid if you live with chronic pain and inflammation.

Tendonitis

Inflammation of the tendons in your knee can cause tendonitis which results in pain above or below the knee. Tendonitis often affects people who are overweight, occasionally engage in high-intensity sports, or are aging.

Researchers from Harvard Medical School report that tendonitis can cause pain above the knee. The pain may be worse when exercising and get better with rest. In some cases, tendonitis causes knee pain that disrupts sleep.¹³

Dr. Anthony Beutler, Professor of Family Medicine, says that knee pain at night caused by tendonitis can be a symptom of a tear of the tendon in the knee.¹⁴

Nighttime knee pain in adolescents

Many teenagers and adolescents suffer from a condition that’s called anterior knee pain. This causes pain in the front or center of the knee and can often be worse at night.

Doctors from the American Academy of Orthopedic Surgeons describe this type of knee pain as dull and achy. The pain may come on gradually, and physical activity can make the knee pain worse. The other symptoms of adolescent anterior knee pain include:¹⁵

• Popping noises in the knee when climbing stairs
• Nighttime knee pain
• Pain when bending the knee
• knee pain during intense physical activity

Home Remedies for Knee Pain at Night

If you suffer from knee pain at night while sleeping, what can you do to get rid of the pain without painkillers?

Regular exercise

Dr. David Zelman on WebMD says that knee pain caused by arthritic conditions can be helped by exercising and losing weight. Regular physical exercise can help to strengthen the muscles around the knee which makes the knee joint stronger. Also, stretching exercises will help to increase flexibility in the knee and help prevent chronic knee pain.¹⁶

To know the best type of exercise for relieving knee pain, you should visit a professional physical therapist. They can recommend a course of exercises specifically tailored to your condition and level of knee pain at night.

Warm compress

A very effective and cheap way to quickly relieve throbbing knee pain during the night is to apply a warm compress. Placing a hot water bottle on the sore knee can help to reduce the pain naturally and help you sleep better.

According to an article entitled “Fighting Arthritis Pain Without Pills,” researchers from the Arthritis Foundation recommend a warm compress for joint pain. They say that heat increases blood circulation to the area and relaxes the knee muscles.¹⁷

How to use a warm compress for knee pain at night:

1. Fill a hot water bottle with hot (but not boiling) water.
2. Wrap it in a thin towel and place on your knee for 15 minutes before going to bed to relieve the pain.
3. If you have chronic severe pain in your knee, you could leave the hot water bottle on for longer.
4. If a knee pain wakes you up in the middle of the night, you can use the hot water bottle again.

Turmeric extract (curcumin)

Turmeric has pain-relieving properties that can be used as a knee pain remedy to help reduce painful symptoms of knee pain caused by arthritis, tendonitis, or gout.

According to the Journal of Medical Food, extracts of turmeric (curcumin) can help to alleviate the symptoms of joint arthritis. Many studies have shown that turmeric helps to reduce joint inflammation and relieve painful symptoms. It was concluded that turmeric is justified to be used as a natural alternative treatment for joint arthritis.¹⁸

Also, the journal Clinical Interventions in Aging reported that turmeric supplements can help treat patients with knee osteoarthritis. In fact, in the study, it was found that turmeric was as effective as ibuprofen in relieving knee pain and with fewer side effects.¹⁹

In the trial, 2 g of turmeric extract per day was effective in reducing the symptoms of knee pain caused by arthritic conditions.

You can also make your own pain-relieving turmeric ginger tea and drink regularly to help get rid of knee pain. You should also know how to increase turmeric absorption for best results.

Other Natural Remedies for Osteoarthritis Knee Pain

Gelatin

In my article about how gelatin can reduce osteoarthritis knee pain I’ve mentioned a study suggesting that adding a special gelatin supplement to the diet could provide some relief to people with mild osteoarthritis of the knee.

In the study, 175 patients with osteoarthritis of the knee were randomly assigned to receive either a daily gelatin supplement or a placebo. Those who received a supplement containing 10 grams of gelatin plus calcium and vitamin C had significant improvements across the board in pain, stiffness, and mobility measures.²²

You can find more information on how to take gelatin for osteoarthritis, including vegetarian alternative to gelatin in my aforementioned article about this subject.

Sesame Seeds

In my article about how to use sesame seeds for knee osteoarthritis I’ve mentioned a research group from Tabriz University in Iran that studied sesame’s (Sesamum indicum L.) effect on the symptoms of knee osteoarthritis on 50 patience for 2 months. The results were published in The International Journal of Rheumatic Diseases, in October 2013.

Although this was a small study, the authors suggested that sesame seeds might be a viable adjunctive therapy for knee osteoarthritis. It was found that 40 grams of sesame seeds daily along with standard drug therapy caused the patients to have significantly less pain compared to their counterparts in the control group who received a standard therapy, which involved 500 milligrams of Tylenol twice daily along with 500 milligrams of glucosamine once a day. ²³

Ginger

The Journal Arthritis and Rheumatism published a 6 week study in 2001 which found that patients who received ginger extract twice daily had moderate reduction in knee pain on standing and after walking in comparison to the control group who took placebo. ²⁴

How to Prevent Throbbing Knee Pain at Night

If chronic knee pain is keeping you awake at night, there are many steps you can take to help prevent the painful symptoms. With a few preventative measures, you can help avoid waking up with sharp pains in your knee.

According to Dr. April Chang-Miller, who is a specialist in rheumatology, this is what you can do to prevent knee pain at night:²⁰

• Make sure that your bed, pillows, and blanket are comfortable and don’t add to your discomfort.
• Make sure that your bed allows you to have a comfortable sleeping position.
• Take a warm bath or shower before going to bed to help relax your joints and muscles.
• Avoid drinking stimulants like alcohol or coffee before going to bed to help you sleep better.
• Prop your legs up with a pillow to help reduce knee pain while sleeping.
• Don’t exercise within 3 hours before going to bed. However, remember that exercise helps to reduce knee pain over time.

When to See a Doctor for Knee Pain at Night

It’s good to remember that knee pain that keeps you awake at night can impact your daily activities. Not getting enough sleep can cause irritability, depression, increase your risk of various diseases, and aggravate chronic pain.

You should visit your doctor if you keep waking up with severe, throbbing knee pain. Doctors from the Mayo Clinic recommend visiting a doctor for knee pain in the following circumstances:

• You notice swelling and redness around the kneecap
• You have significant knee pain at night and during the day
• You can’t put any weight on the knee joint
• You can’t get a good night’s sleep because of the knee pain

Read my other related articles:

Medical Sources

1. ClevelandClinic. How to keep sore hips, knees, shoulders from ruining your sleep.
2. HSS J. 2012 Feb; 8(1): 26–28.
3. Arth Care Res. 2010 July;62(7):944-949.
4. Ann Rheum Dis. 1998 Jul; 57(7): 434–436.
5. WebMD. Understanding gout – basics.
6. WebMD. Gout attacks more common at night.
7. Arch Gerontol Geriatr.2010 Jan-Feb;50(1):34-5.
8. WebMD. Join pain, aging, and arthritis.
9. MayoClinic. Osteoarthritis.
10. WebMD. Gout.
11. Saudi Med J. 2017 May; 38(5): 465–475.
12. MSDManuals. Fibromyalgia.
13. HealthHarvard. Taming tendinitis in the knee.
14. UpToDate. Approach to adult knee pain.
15. OrthoInfo. Adolescent anterior knee pain.
16. WebMD. Osteoarthritis of the knee.
17. ArthritisOrg. Fight arthritis pain without pills.
18. J Med Food. 2016 Aug 1; 19(8): 717–729.
19. Clin Interv Aging.2014 Mar 20;9:451-8.
20. MayoClinic. How can I ease rheumatoid arthritis symptoms at night?
21. MayoClinic. Knee pain.
22. WebMD. Stiff Knees? Take Some Gelatin, Study Suggests.
23. Inter. Journal of Rheumatic Diseases. 20 June 2013.
24. Arthritis Rheum. 2001 Nov;44(11):2531-8.

Knee Pain Injuries Without Swelling or Trauma

Most times people do not have a single incident such as a slip or fall which causes knee pain. Their pain began slowly over weeks or months. Many times there is no swelling or any single painful spot. Damage to the muscles, tendons, and ligaments that surround and stabilize the knee is the most common source of pain with trauma.

Many of us like to point to a single incident that produces or started our injuries, such as falling off a swing or a bike 10 years ago. Acute trauma can predispose people to future injuries. However, most of our soft tissue damage is the result of chronic repetitive stress injuries which are an accumulation of small amounts of trauma and stress over months and years.

Muscles and tendons not only allow movement but they also absorb pounding forces when we walk, stand, or squat. Over time, the repetitive activities cause micro damage in the soft tissues, which increases over time.

The small micro tears, or micro trauma, eventually lead to larger knee injuries. This leads to multiple spots of tenderness and tissue remodeling in the muscles, tendons, and ligaments around the knee.

The large femur sits atop the tibia, much like two pillars stacked on top of each other. The smaller fibula bone is on the outside of the tibia in the lower leg. The fibula provides some weight bearing, but not nearly as much as the tibia does. At the end of the femur are two large condyles with rounded edges that allow for the rocking or hinging motion associated with knee movement.

In between the femur and the tibia are fibrocartilage shock absorbers, or meniscus. Several large stabilizing ligaments on the inside and outside of the knee prevent excessive forward and backwards movements. These stabilizing ligaments include the Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL).

The patella bone sits in front of the femur and slides in a groove. The backside of the patella is covered with hyaline cartilage along with the front side of the groove on the femur, which minimizes the friction as the patella slides. The patella is a large sesamoid bone, which means it is surrounded in muscle or tendon. Sesamoid bones act as a pulley system to change the direction of forces, in this case from the quadriceps muscle to the tibia.

The knee is a complex joint that is surrounded by a ligament joint capsule and lined with a synovial membrane that produces synovial fluid, which helps lubricate the knee. The lubrication reduces friction and damage to the internal components of the knee. Bursa are fluid-filled sacs that help reduce friction as muscles and tendons glide across the bursa.

With every step, the pounding forces of our body weight against the ground are rippled throughout the lower legs. Depending on the ankle and knee positions, those forces can travel through the knee and into the quadriceps or hamstrings. All of the muscles, tendons, and ligaments around the knee end up absorbing these forces.

Everybody has their own unique walking gait, which is why not everyone develops the same knee pain. The way you walk causes increased stress and strain to be delivered to certain points along your knee. If this happens to send more forces to the patella tendon or patella ligament, then you are more likely to develop patellar tendonitis.

If your walk causes excessive strain to be placed on the upper gastrocnemius, or calf muscles, you may develop pain along these muscles and tendons behind the knee. Likewise, pain behind the knee can be the result of popliteus muscle sprains.

Chondromalacia patella is caused when excessive forces damage the hyaline cartilage between the patella and femur. Patella femoral syndrome is when the hyaline cartilage damage is mostly to the patella surface instead of the patella.

Sprains and strains to the supportive ligaments, muscles, and tendons can cause an incredible amount of knee pain. Small tears throughout these tissues result in chronic dull and sharp pain across the knee with increased activity, bending, or squatting. The small sprains and strains are aggravated every time the tissue is overworked. With rest, the pain decreases but will increase whenever the tissue is overwhelmed.

At home the first step is always PRICE: protect, rest, ice, compress, and elevate. Reduce the stress and strain to the knee. Over the counter nonsteroidal anti inflammatory drugs (NSAIDs) as recommended by your doctor can help reduce pain and inflammation. Ice helps block the knee pain and reduce inflammation.

NSAIDs are often prescribed for the initial acute injury stages. In severe cases that involve multiple joint regions, muscle relaxers or oral steroids can be given. Trigger point injections, botox, or steroid injections can be treatment options, as well. Pain management is not usually required unless stronger medications or joint injections are involved in treatment.

MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. Nerve conduction velocity (NCV) testing may be utilized in cases that also involve muscle, sensory or reflex loss.

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

Iliotibial band Syndrome is common in runners who develop the injury because of weakness and poor stabilization of the leg and hip muscles. Specific knee exercises are given to increase strength and endurance. Proprioception exercises help teach the muscles how to work together again to stabilize the knee during walking or running.

Occasional Joint Pain

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.

The lower extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and during recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.

Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for the hip, knee, and ankle: flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, an exercise ball, and BOSU balls can be performed on the floor. The more unstable of the surface, the more effort and stabilization is required of all the lower extremity muscles.

Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments for knee pain and foot pain.

Occasional Knee Pain When Running

Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.