Pain at night can be one of the most frustrating problems to have in life – if we don’t sleep we get tired, when we are tired we are in a bad mood and this leads to all sorts of negatives like poor daily interactions, reduced productivity and general dissatisfaction.
The most important thing about our sleep, though, is that it is key to helping us repair, regenerate and heal. If we suffer from pain at night and do not sleep then this can add to our problem by not helping us return to normal.
Knee pain at night is a common complaint throughout many different sections of the population and there is a variety of reasons in which we get knee pain at night. This article looks to introduce you to some of the reasons we get knee pain at night and what can be done to help you achieve a better sleep and also to reduce your pain levels.
We are going to talk reasons for onset, look at the anatomy of the knee and what can be the issue and also methods of managing your symptoms.
This article should give you a comprehensive understanding and plan for action so that you can manage your own knee pain or hep a friend or relative who may be experiencing knee pain at night.
Anatomy
The knee’s anatomy when broken down is quite simple and gaining further understanding of this can help you to self-analyse the reasons why your knee is painful at night and what solutions are needed.
The knee joint is formed of three bones:
- The femur – thigh bone
- The Tibia – shin bone
- The Patella – knee cap
All three of the bones fit together to make two joints, which are:
- The Patello Femoral Joint – this is the smaller of the two joints in the knee and it is created when the knee cap sits on top of the end of the femur. There is a small groove in the end of the femur which the patella sits in and glides up and down when the knee bends and straightens The kneecap is held in place by small ligaments and the thigh muscles which sit around it.
- The Tibio Femoral Joint – this is the largest joint in the knee and it is a hinge joint which moves for the most part in flexion and extension. There is a small amount of movement in rotation each by 15 degrees but its main role is to allow bending of the knee which is its main functional property. This is the largest joint in the body and as well as facilitating movement helps to absorb shock.
Cartilage
The end of the femur which forms the knee joint has two large areas called femoral condyles. These are coated in a smooth cartilage and the top of the tibias. This has two discs of cartilage called meniscus, which contact each other to provide the shock absorption which is so important for the knee.
Smooth surfaces of this firm, yet spongy material help with regulating knee pain and maintaining full movement of the knee through its full range.
Ligaments
The bones of the knee are held together by connective tissue called ligaments. Bone to bone connection from ligaments helps the knee to become secure along with muscles and tendons. Their primary function is to provide stability. These can be injured with trauma when the knee is taken to its extremes but ensuring you have strong lower limb muscles will help keep your ligaments from harm.
The main ligaments of the knee are the medial and lateral collateral ligaments which sit on the inner side and outer side of your knee, respectively. The cruciate ligaments connect the femur and tibia to each other and run through the middle of the knee. There are also some smaller ligaments which help to keep the patella in securely in place.
Tendons
Tendons act as the attachment tissue from muscles to the bone – a muscle merges in to tendon and then attaches to the bone. The function of the tendon is to generate force in to a muscle and help to move a joint. The main tendons that help to operate the knee are the quadriceps tendon sitting just above the knee cap, coming from the thigh muscles and the patella tendon which leads from the kneecap in to the shin.
Muscles
The muscles of the knee help to move the knee when it bends and straightens. The quadriceps help to straighten the knee, secure it and make it secure when it is straight. The hamstrings help to bend the knee, extend the hip but also they help to secure the shin by pulling it back and preventing injury and they have a huge role in preventing pain at the front of the knee. The muscles around the glute area also have an effect on the knee as they help to rotate the femur and this controls knee rotation.
Causes / Symptoms
Now you understand the knee anatomy in more detail, lets take a deep dive in to the different reasons for the knee pain in the night that you might be experiencing.
Childhood knee pain in night
Also referred to as growing pains. When we are younger we are growing at a rapid rate and growth typically occurs at night when we rest. Children and young teenagers can typically complain of pain at night or an evening when they are at rest.
One of the common locations for pain when growing is the knee and this is due to the growth plates that sit around the knee area. Growth plates are sections of bone which lengthen out and the space they leave fills in with bone to allow us to grow. When this is happening at a speedy rate then this can give off pain which is more prominent at rest on a night.
The process is natural and it shouldn’t be anything to worry about, if the pain continues for long periods or is present consistently in mornings and combined with ill health or hot swelling then a visit to your GP would be helpful to get this checked for anything more serious.
Red Flags
This is a term in the medical world used to describe serious indicators of a harmful pathology, like cancer, for instance. Red flags in relation to pain at night would be if the pain levels far exceed anything you experience during the day – they consistently worsen at night and if the pain prevents you from sleeping at all.
These symptoms are signs that your body is attempting to fight something off which is out of the ordinary and requires more of your body’s energy. Don’t be alarmed however – these symptoms are rare and are typically accompanied by ill health, recurrent infection and or a sudden drop in weight within a short period of time such as 2 weeks. Again – it is a case of seeing your GP if you have concerns.
Osteoarthritis
This is when the smooth cartilage surfaces in the knee have worn down and the knee can become painful and sometimes swollen. This pain can flare at night due to the positions that we find ourselves in. If you have an acutely painful arthritic knee, then this may be difficult to get comfortable as the surfaces in the knee are inflamed.
When they rest still for prolonged periods at night, they get sore and want to be moved so that they can lubricate themselves in order to reduce pain. People with arthritis will tend to move around a lot in their sleep to find a position they can achieve a good night’s sleep.
Under/Over training
In order to have a healthy pain free knees, we must exercise and keep the muscles around the knee strong. The cartilage also likes to be exercised by absorbing shock and pressure which helps to keep it healthy. There is a balance that needs achieved with exercise however to keep your knees happy.
Firstly, if we do not exercise our knees enough and they are weak – instead of having strong muscles to support the knees and help to manage its load – the joint instead takes all of the load and extra pressure our muscles should be assisting with.
This leads to the joint and cartilage of the knee becoming sore – again typically at night this will become apparent and give us discomfort to try and move the knee. On the flip side of this, doing too much exercise can also irritate the knees – but again this would have to be excessive or out of the normal from your usual regime to aggravate the knees.
If the surfaces inside of the knee have been placed under excess stress – long lying positons at night will cause them to get painful due to their increased sensitivity.
Post-Operative Pain and Trauma
If you have ever had surgery on your knee you will realise how difficult it is to get to sleep during the night. There has been some trauma caused to the knee inside and there will be a wound site which is healing along with swelling.
There are lots of factors to why the knee is painful including on the surface and deep inside. Discomfort from the sheets touching, movement around the bed and also turning while asleep can be extremely uncomfortable.
Prevention / Treatment
Trying to manage knee pain at night can be a tricky task as we sometimes cannot control what our movement does while we sleep therefore it is a difficult task.
Childhood knee pain typically does not have many options other than gentle stretching of the quadriceps, hamstrings and calves, use of pain relief and ice/heat packs to sooth the pain levels and aid a good night’s sleep.
Osteoarthritis of the knee, however, can be controlled by many other preventative measures, such as pain relief, strengthening exercises and ice packs. In bed, a good way to support the knee may be the use of pillows and or knee supports which provide comfort to a sore joint.
Maintenance of the body with regular, varied exercise is the best way to keep your body happy and healthy and making sure you are not going to get too much in the way of regular knee pain. Plan your exercise effectively to ensure you do not under or overload yourself.
Post-operative pain or injury in bed may be the worst to deal with as your movement may be compromised. Appropriate pain relief which may need prescribed can help sleep a lot – this helps to reduce the sensitivity of what you feel and it gives you a more restful sleep.
Intelligent positioning of pillows helps to keep the knee elevated if it is swollen and this helps to aid healing. If your knee hurts when you turn over (and this is one of your nocturnal habits), then think of positioning the pillows around your body or leg to prevent you rolling on to the knee. Alternatively you may feel the knee needs support and placing pillows under the back of the knee to support it in a flexed position would be a great option to aid your comfort.
Conclusion
The take home message for knee pain at night is that it can be caused by many different reasons. Understanding why your knee is painful is key to remaining calm and being able to put a logical plan in place.
Always ensure you protect and treat the injury with respect and exercise it appropriately. The use of cold, heat and pain relief are great ways to reduce the sensitivity of different tissues such as cartilage, bone and tendons which may be sore in order for you to get a more restful sleep. If you are unsure at all about why your knee is painful or your symptoms are severe – contact a health professional for further advice.