Knee Pain While Sleeping at Night
Knee pain can occur with any motion or movement. It most commonly happens whenever a person squats, kneels, or goes up and down stairs. Pain with motion and movement most commonly indicates damage to the soft tissues or internal structures around the knee.
Knee pain can also occur at night or whenever the knee is in a single position for a prolonged period of time. Some people complain of knee pain while sleeping that wakes them up throughout the night. This can be a sign of injury to the knee or something much more serious.
The most severe conditions that will wake a person up during the middle of the night involve tumors of bone or soft tissues. Overall these conditions are not very common, but they can occur. Some tumors are more common at different ages. Osteosarcoma, soft tissue growths, and multiple myeloma are severe growths and tumors that require immediate medical and surgical intervention.
Fortunately most cases of knee pain during the night are the result of soft tissue injuries to the muscles, tendons, ligaments, and cartilage around the knee.
During the night pain signals are being sent to the brain telling it that the muscles, tendons, and ligaments are damaged and trying to be repaired. Certain tendons and ligaments are stretched during the night when we are sleeping, and those pain signals continue to increase while you sleep in that position.
The body is waking itself up so that you can move and change positions to relieve the pain signals. This is very similar to when you are riding in a car or airplane for a long period of time. Eventually the stiffness begins to increase, which gets you to move and change positions. By stretching and rolling over you are changing the stress on the tendons and ligaments and relieving the pain.
As previously stated, most cases of knee pain are the result of muscle and tissue damage. During an evaluation, if the pain can be reproduced then it is most likely from these muscles and tendons. If the evaluation cannot reproduce the pain around the knee, then further testing and imaging should be utilized to rule out serious internal changes to the bone and soft tissues.
Several common conditions can cause pain during the night including chondromalacia patella, patella tendonitis, iliotibial band syndrome, patellofemoral syndrome, degenerative osteoarthritis, and other soft tissue injuries.
The large femur sits atop of 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 near as much as the tibia. 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.
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.
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 exercises and flexibility programs.
The lower extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and 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, 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.
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.