Why Does My Knee Hurt at Night When Lying Down?

If that's your night, you're far from alone. Knee pain at night is a common reason people in their sixties and seventies wake up. This page explains why the knee hurts more in bed, how to lie so it hurts less, and what to do when it wakes you. At the end are five pressure points I press before bed, all done sitting down. They are the outer knee eye (ST35), the outer knee (GB34) and the back of the knee (BL40). Then the front of the shin below the knee (ST36) and the inner leg above the ankle (SP6).

Why does my knee hurt at night when lying down?

During the day, every step pumps fluid in and out of the knee. That fluid feeds the cartilage and keeps the joint gliding. It works a little like oil in a hinge that keeps swinging.

At night the hinge stops swinging. For hours, the knee barely moves. The fluid settles, the tissues around the joint tighten, and the knee sets like honey in a cold jar. Then you turn over, the stiff joint is asked to move, and it complains.

There is also less to distract you. In the daytime your mind is busy with people, chores and noise. In a dark bedroom, the knee is the loudest thing left.

Six reasons your knee hurts more in bed

1. Stillness stiffens the joint

A knee that has been still for hours needs a few moments to loosen. That's why the first steps after getting out of bed often feel the worst. The same stiffness can build up while you sleep, until a turn of the body wakes you.

What helps: keep the knee moving a little through the evening. A slow walk after dinner, or a few gentle bends while you sit, both count.

2. Worn-joint arthritis

Osteoarthritis is the wear-and-tear kind. The smooth cartilage on the ends of the bones thins out over the years. Some people have been told their knee is "bone on bone". A worn knee commonly aches after rest and stiffens in cold, damp weather.

As arthritis grows, night pain tends to grow with it. Many people with sore knees say the nights are the hardest part.

Other kinds of arthritis behave differently. If both knees swell, feel warm, and stay stiff for a long time each morning, ask your doctor to check for an inflammatory type.

What helps: the routine on this page is written with worn knees in mind. Everything is done sitting, nothing asks you to kneel, and nothing presses on the joint itself.

3. How you lie

Some positions load a sore knee all night. Lying on your side with one knee stacked on the other presses bone against bone. Curling up tight bends the knee hard for hours. Lying on your stomach can lock the knee straight and twist it.

What helps: a pillow in the right place. More on this below.

4. The day catches up

A long walk, a day of shopping, gardening, or many trips up and down stairs. The knee often copes well at the time. The ache shows up hours later, when you finally lie down.

What helps: spread the heavy jobs across the week. Break long walks into shorter ones. Sit for part of the cooking and the ironing.

5. Thigh muscles that have quietly weakened

The big muscles at the front and back of your thigh hold the knee steady. Over the years, with less activity, they can thin out. Then the joint carries more load than it should, and it tends to ache more.

What helps: a little strength work in the daytime, done sitting. Two easy ones:

• Seated knee straightening. Sit tall on a firm chair. Slowly straighten one knee until the leg is out in front of you. Hold for five slow breaths, then lower it. Do this eight to ten times on each leg.
• Thigh squeeze. Sit with your leg resting straight on a footstool. Tighten the muscle on top of your thigh so the kneecap draws up a little. Hold for five breaths, then let go. Repeat ten times.

If either one causes sharp pain, stop. A physiotherapist can give you a plan that fits your knee.

6. A quiet, cool night

At night the body's natural calming hormones run lower, and the room grows cooler. Cold makes stiff joints feel stiffer. A knee left outside the covers often aches first.

What helps: keep the knee warm. Long pyjama trousers, a soft knee sleeve or an extra blanket over the legs all help.

Is knee pain at night a sign of arthritis?

Often it is. Aching after rest is one of the most typical signs of worn-joint arthritis in the knee.

But it is not the only cause. A torn cartilage pad, an inflamed fluid sac at the front of the knee, a sore tendon or gout can all ache at night. So can pain that starts in the hip or the lower back and travels down. If the pain is new, keeps getting worse, or you aren't sure what it is, let your doctor take a look.

How to sleep with knee pain

The aim is simple: keep the knee gently supported, slightly bent, and free of pressure from the other leg.

If you sleep on your side: put a firm pillow between your knees and ankles. It keeps the top knee from resting on the bottom one, and it keeps your hips level. A long body pillow stays in place better through the night. Bend your knees a little, not tightly.

If you sleep on your back: slide a pillow or a rolled towel under your knees so they bend slightly. Put it under the whole back of the knee and thigh, not as a hard lump in the hollow behind the knee. If the knee is puffy, a pillow under the lower leg can lift it a little higher.

Try not to: sleep on your stomach, curl up tightly, or sleep with your knee locked straight.

Your mattress: one that sags lets your hips sink and twists the knees. A medium-firm mattress usually keeps the legs better aligned.

Pillow between the knees or under them? It depends on how you lie. Between them for side sleepers, under them for back sleepers. Many people keep both pillows in bed and change during the night.

What to do when knee pain wakes you up

This is the moment that decides the rest of your night. Here is what I do.

1. Breathe out slowly. Longer out than in, as if you were cooling a cup of tea. A tense body makes a sore knee feel worse.
2. Change position. Roll onto your other side or onto your back. Put the pillow back between or under your knees.
3. Move the ankle, then the knee. Point your toes and pull them back, ten slow times. Then slide your heel a little toward you and away again, a few times. You're bringing the fluid back into the joint, gently.
4. Warm it. Pull the covers over the knee, or slip on a soft knee sleeve kept by the bed.
5. Sit before you stand. If you need the bathroom, sit on the edge of the bed for 30 seconds first. Circle your ankles, then stand slowly with one hand on the bed or a stick.

If you are still awake and sore after about 20 minutes, go and sit in a comfortable chair with a soft lamp. Rest the leg on a stool. Go back to bed when you feel sleepy.

One thing I don't do at night: press points. Searching for a tender spot and working it is wake-up work. At night, the job is the opposite. I keep all pressing for the daytime and for bedtime.

Should I use heat or ice on my knee before bed?

For a stiff, aching knee, many people find warmth more soothing. A warm pack or a warm bath in the evening can loosen the joint before bed.

For a knee that is puffy or feels warm after a busy day, a cold pack may feel better. Wrap it in a thin towel and keep it on for 15 to 20 minutes. Never sleep with a heating pad or an ice pack on your skin.

A knee that is hot, red and swollen on its own needs a doctor, not a hot pack.

Daytime habits that help your nights

• Move a little, often. Short walks through the day are kinder to the knee than one long one.
• Keep the thigh muscles working. The two seated exercises above, most days of the week.
• Pace the heavy jobs. Stairs, gardening and long shopping trips spread across the week.
• Make the last hour gentle. A warm bath, a few easy knee bends, then the pressing routine below.
• Take medicines as prescribed. If your doctor has given you something for knee pain, ask whether the timing could cover the night. Keep taking exactly what was prescribed. This is something you do in addition.

Before bed: five points I press on myself

I have studied Vietnamese acupressure for fifteen years. This is the short knee routine I do sitting on the edge of my bed. It takes about ten minutes. Sit with your feet flat and your knees bent to about a right angle.

Every point here sits around the knee, in soft hollows or on muscle. Nothing presses on the worn joint itself. If your knee is "bone on bone", you can still do this routine, gently, sitting down.

If the front of your knee aches: the outer knee eye — Dubi (ST35)

Find the lower edge of your kneecap and the thick tendon running straight down from it to the shin. On either side of that tendon is a small dimple. The outer one, toward your little toe, is your area.

Probe the hollow with the round end of the stick, or your thumb tip with the nail short. When one spot stings sharply, make small circles on it. One to three minutes on each knee.

If the outer side of your knee aches: the outer knee — Yanglingquan (GB34)

Run your fingers down the outside of your knee until you meet a small, round knob of bone. Slide down and forward from it into the soft dip. Search that dip for the spot that stings. One to three minutes on each leg.

If you feel a jolt or tingling run toward your foot, lift off. Move a little forward, toward the shin, and press more gently.

If the back of your knee feels tight: the back of the knee — Weizhong (BL40)

Wrap both hands around your knee so your fingertips meet in the hollow behind it. Feel the firm cord on each side. The area is on the skin crease, halfway between them.

Light pressure only here. If you feel a pulse under your finger, move off it. Skip this point if you have varicose veins behind the knee or have ever had a clot in the leg. One to three minutes on each leg.

For heavy, tired legs: four fingers below the kneecap — Zusanli (ST36)

Find the dip at the outer lower edge of your kneecap. Lay four fingers below it, going down the leg. Where your lowest finger sits, move one finger-width out from the sharp edge of the shin, onto the muscle. Search that patch until one spot stings. One to three minutes on each leg.

For everyone, to settle: above the inner ankle — Sanyinjiao (SP6)

Rest one foot across your other knee, or on a low stool. Find the bump of your inner ankle bone and lay four fingers above it. At the level of your top finger, roll off the back edge of the shin into the soft groove. It's often tender. Then the other leg.

Skip this point if you are pregnant, or if the skin there has a bulging vein, swelling, a rash or a wound.

When you finish: pillow in place, knee covered, lie down slowly.

How I press the points for knee pain at night

1. Find the area. You don't need to land on a pinhead. Get into the right neighbourhood.
2. Search for the tender spot. Move the tip slowly around the area. One spot will feel sharper than the rest. That's your spot.
3. Make small circles on that spot. Circle slowly without sliding away.

Start with about one minute per spot, and build up to two or three over the following evenings. It should feel tender while you press and ease once you lift off.

Stop and leave a spot alone if it still hurts after you lift off. The same goes if the pain spreads, or the skin looks swollen, hot or red. Don't press on a knee that is hot and swollen. After knee surgery or a knee replacement, ask your surgeon or physiotherapist first.

Sore hands? Pressing around the knee asks a lot of a stiff thumb. A smooth, round-ended stick does the work for you, and it finds the tender spot more easily than a tired thumb.

The honest timeline for knee pain at night

Some things work on the first night: the right pillow, a warm knee, sitting before you stand.

The rest is slower. Thigh muscles take weeks to grow stronger. For the pressing, think about ten minutes each evening for two to four weeks. Many people notice the knee feels a little easier to bend in the morning. Some people notice very little, and I'd rather you heard that from me now.

What This Won't Do

This won't rebuild worn cartilage or give you a new knee. Nobody honest can promise that. It won't replace your doctor, your physiotherapist or anything they have given you. Keep taking exactly what was prescribed. This is something you do in addition. A routine you can do sitting on the edge of your bed, with your own two hands, so the nights hurt a little less.

Short videos on knee pain at night

Two short clips from my channel on the same subject. Each one is under a minute.

Questions people ask about knee pain at night

Why does my knee hurt at night but not during the day? In the daytime, movement keeps fluid flowing through the joint and your mind is busy. At night the knee stays still, stiffens and cools down. With nothing else to notice, the ache feels louder.

Is knee pain at night a sign of arthritis? Often, yes. Worn-joint arthritis commonly aches after rest and at night. Tendon problems, a torn cartilage pad, gout or pain from the hip can do it too, so new or worsening pain is worth a check.

Should I put a pillow between my knees or under them? Between your knees if you sleep on your side. Under your knees if you sleep on your back. Both keep the knee slightly bent and free of pressure.

What is the best sleeping position for knee pain? On your back with a pillow under the knees, or on your side with a pillow between them. Try not to curl up tightly or sleep on your stomach.

What should I do when knee pain wakes me up? Breathe out slowly, change position and put your pillow back. Move your ankle and knee gently, and keep the knee warm. Sit on the edge of the bed for 30 seconds before you stand.

Are there pressure points for knee pain? In Vietnamese acupressure, several points around the knee are commonly used for a stiff, aching knee. I use the outer knee eye, the outer knee, the back of the knee and the point below the kneecap. I press them in the daytime or before bed, never in the middle of the night.

Can I press points if my knee is bone on bone? Yes, gently and sitting down. The points sit in soft hollows and on muscle around the knee, not on the joint itself. Skip any knee that is hot and swollen, and ask your surgeon first after a knee replacement.

When should I worry about knee pain at night? When the knee is hot, red and swollen, you have a fever, or you can't stand on the leg. A swollen, painful calf needs help the same day, because it can be a clot.

I have spent fifteen years studying traditional Vietnamese medicine, and I write about things you can do for yourself at home, sitting down.

This is general wellness education, not medical advice. It is not a substitute for care from your doctor. If you have a health condition, are pregnant, or take medication, check with your doctor first.

(Points shown: ST35 Dubi, GB34 Yanglingquan, BL40 Weizhong, ST36 Zusanli, SP6 Sanyinjiao.)