Knee pain at night: why it happens, what helps and when to get it checked

Many people notice knee pain most when they lie down. Part of the explanation is simple: during the day movement, work and distraction compete with the signal from the joint, and at night they do not. Lying still for long periods can also let a joint stiffen, and changing position in bed may load an injured or arthritic knee in an awkward way.

Night pain is a description of timing, not a diagnosis. The sources used for this guide, from the NHS, do not single out night pain as a separate condition, so this page uses the NHS knee pain and osteoarthritis guidance to explain the common causes and what to do. If the pain wakes you repeatedly, or is severe at rest, that is a reason to be assessed rather than to wait it out.

The NHS says knee pain can be a symptom of many different conditions and that you should not self-diagnose but see a GP if you are worried. It lists causes in two groups, depending on whether there has been an injury.

Osteoarthritis is a frequent reason for persistent knee pain in adults. The NHS says it causes joints to become painful and stiff, is the most common type of arthritis in the UK and most often affects the knees, hips and small joints of the hands. Symptoms can include swelling, tenderness and a grating or crackling sound on moving the joint, and they vary from person to person, being mild and coming and going for some and more continuous for others.

The NHS says a GP may suspect osteoarthritis if you are aged 45 or older, have joint pain that gets worse the more you use your joints, and have stiffness that is absent in the morning or lasts less than 30 minutes. Further tests such as X-rays or blood tests are not usually necessary but may be used to rule out other causes. It adds that osteoarthritis cannot be cured, that it does not necessarily get worse over time and that it can sometimes gradually improve.

Risk factors listed by the NHS include joint injury, other conditions such as rheumatoid arthritis or gout, older age, family history, obesity and being a woman.

For knee pain generally, the NHS suggests starting with the steps in the bullets below. For osteoarthritis it says mild symptoms can sometimes be managed with regular exercise, losing weight if you are overweight, suitable footwear and special devices that reduce strain on the joints during everyday activities, and that more severe symptoms may need painkillers and a structured exercise plan with a physiotherapist.

• Put as little weight as possible on the knee, for example by avoiding standing for a long time.

• Use an ice pack or bag of frozen peas wrapped in a tea towel for up to 20 minutes every 2 to 3 hours.

• Use painkillers such as paracetamol or ibuprofen gel or tablets.

• Check that the painkiller is suitable for you with a pharmacist if you have other conditions or take other medicines.

• Aim for the NHS exercise targets where you are able to: at least 150 minutes of moderate aerobic activity a week plus strength exercises on 2 or more days.

The NHS says to see a GP if knee pain does not improve within a few weeks. It says to get advice from 111 now if your knee is very painful, you cannot move it or put any weight on it, it is badly swollen or has changed shape, it locks, gives way or painfully clicks (painless clicking is normal), or you have a very high temperature or feel hot, cold or shivery with redness or heat around the knee, which can be a sign of infection.

Pain that is constant, severe at rest or associated with fever should not be left to settle. A hot, red and swollen knee needs same-day assessment, because a joint infection can damage the joint quickly.

The NHS says a doctor can suggest treatment based on the cause. They might prescribe medicine or physiotherapy, or refer you to hospital for a scan or specialist treatment such as surgery. In many areas you can refer yourself to NHS community musculoskeletal (MSK) services for help such as physiotherapy without a GP referral.

In a small number of cases of osteoarthritis, where other treatments have not helped or the damage to the joint is particularly severe, the NHS says surgery may be done to repair, strengthen or replace a damaged joint.

Most knee pain is managed in primary care and physiotherapy on the NHS. Private physiotherapy or an orthopaedic consultation is an option if you want faster access, and scans such as MRI can be arranged privately. Whichever route you use, bring the history of your symptoms and any scan reports to later NHS appointments so that your care stays joined up.