Pain guide · Knee pain

Knee pain at night: arthritis, bursitis, gout, sleeping positions and pillows, and the warning signs

Knee pain at night, or knee pain that wakes you, is common. From mid-life the usual reason is arthritis: most people with knee arthritis have some night pain, and it's more common when the joint has changed more on X-rays, though it happens at every stage and comes and goes. Bursitis, gout, kneecap pain after a long sit, calf cramps and restless legs can disturb nights too, and children often have harmless growing pains.

A hot, red or swollen knee with a high temperature needs help from National Health Service (NHS) 111 now, leg swelling with breathlessness or chest pain needs a 999 call or accident and emergency (A&E), and bone pain that's worse at night, or a child's leg pain that isn't the pattern of growing pains, needs a general practitioner (GP). This guide covers those warning signs, how to sleep (including where a pillow helps and where it doesn't), how sleep and pain affect each other, what medicines and exercise offer, and a three-stage plan with a 3D demo of every move that ends with a full night's sleep.

3-stage exercise plan When to get help 41 sourcesUpdated 23 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Get advice from NHS 111 now: a hot, red or swollen knee with sudden severe pain, a very high temperature, or feeling hot, cold or shivery. This can be a joint infection.
Call 999 or go to A&E if redness spreads through the skin around the knee (cellulitis) and you have a very high temperature or feel hot, cold or shivery, a fast heartbeat or fast breathing, purple patches on the skin, feel dizzy or faint, are confused, or have cold, clammy or pale skin. These can be signs of a serious infection. Don't drive yourself.
Same day: the swelling over or below the kneecap becomes hot, red or more painful, the skin over it is broken, or you have a high temperature or feel shivery, sick or unwell. Ask for an urgent GP appointment or call NHS 111: it may be infected and need antibiotics.
Throbbing pain and swelling in one calf or thigh with red, blue or darkened skin or swollen veins, or sudden worse pain and swelling around a lump at the back of the knee (a possible clot or a burst Baker's cyst).
Leg pain or swelling with breathlessness or chest pain: call 999 or go to A&E, and do not drive yourself. It can be a blood clot that has reached the lungs.
After a recent knee replacement, ask for an urgent GP appointment or call NHS 111 for redness, tenderness, swelling or pain in your knee that isn't getting better or is getting worse, a high temperature or feeling hot, cold or shivery, throbbing or cramping pain in your leg, or oozing or pus from the wound. Call 999 or go to A&E for leg pain and swelling with difficulty breathing or chest pain.
You cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape.
You hurt your knee and cannot take 4 steps, or you are 55 or over and hurt it in a fall: get it checked the same day for a broken bone.
The knee locks, gives way or clicks painfully. Painless clicking is normal.
Same day: a pop or tearing feeling at the front of the knee after a fall, stumble, jump or landing, then you can't straighten the knee or lift the straight leg off the bed, there's a dent above or below the kneecap, or the kneecap sits higher or lower than on the other side. Go to A&E or an urgent treatment centre, or get help from NHS 111. A torn quadriceps or patellar tendon does best when it's repaired soon.
Your knee swelled up straight away after a twisting injury: get advice from NHS 111.
Back or leg symptoms with numbness around the genitals or bottom, new trouble controlling your bladder or bowels, or severe or worsening weakness or numbness in both legs.

See a doctor or physiotherapist if

Knee pain that has not improved within a few weeks of looking after it at home. Many areas offer NHS physiotherapy without a GP referral.
Bone pain that is constant or worse at night, especially with a lump, unexplained weight loss, fever or tiredness, or a past history of cancer.
Knee pain at night with feeling generally unwell, very tired or feverish, or losing weight without trying: see a GP. These can go with an inflammatory arthritis or, rarely, a problem in the bone.
A child or young person with knee or leg pain in only 1 leg or 1 joint, pain in the morning or when walking, a limp, swelling, a rash or unusual bruising, a high temperature, unusual tiredness, or not eating or losing weight: see a GP. These aren't the pattern of growing pains, and unexplained bone pain in a child or young person may need a very urgent X-ray.
Knee pain at night with swelling in several joints, or morning stiffness that lasts more than 30 minutes: see a GP. It can be an inflammatory arthritis such as rheumatoid arthritis rather than wear and tear.
Sudden, severe and persistent knee pain, often on the inner side, that came on with little or no injury, especially if you're over 60: see a GP rather than assuming it's arthritis. Early X-rays are usually normal, and a magnetic resonance imaging (MRI) scan may be needed.
A child or teenager with pain at a bump just below the kneecap or at its lower tip, worse with squats, jumps and kneeling: see our Osgood-Schlatter and Sinding-Larsen-Johansson guides, and get it checked if it is getting worse.
Bursitis that hasn't improved, or is getting worse, after 1 to 2 weeks of looking after it yourself, a knee you can't move, or very severe, sharp or shooting pains: see a GP.
Cramps that disturb your sleep, last longer than 10 minutes or come with numbness or swelling, or restless legs that stop you sleeping: see a GP.
Knee pain keeps you awake most nights for weeks despite these changes, or poor sleep is affecting your days: see a GP or physiotherapist. Treatment for the knee and for sleep, including talking therapy for insomnia, can both help.
Numbness, tingling or weakness that travels down the leg from the back. That points to a nerve (sciatica) rather than the knee.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

An ache in bed or when you turn over, from mid-life, with stiffness when you get up

Often knee arthritis, which can ache at night at any stage.

Read: Knee arthritis →A warm, tender swelling over or just below the kneecap

Bursitis. Hot and red with a high temperature needs help the same day.

Read: Knee bursitis →Tender on the inner shin just below the knee, sore when your knees press together in bed

Possibly pes anserine pain; our guide suggests a pillow between your knees.

Read: Pes anserine pain →A soft lump behind the knee

Often a Baker's cyst. If your calf becomes painful, red or swollen, get help the same day.

Read: Baker's cyst →An ache around the kneecap in the evening after a long sit, worse on stairs

Kneecap pain, which builds after long spells sitting.

Read: Runner's knee →A sudden tightening in the calf or behind the knee that wakes you

Usually a leg cramp, which mostly comes at night.

Read: Leg cramps →In the weeks after a knee replacement

Night pain is common early on and mostly settles. Your surgical team's advice comes first.

Read: Knee replacement →Both knees or legs in a child of 3 to 12, in the evening or at night, gone by the morning

Growing pains, in a child who is otherwise well.

Read: Growing pains →A tender bump below the kneecap in an active child or teenager

Often Osgood-Schlatter disease, which usually settles as growth finishes.

Read: Osgood-Schlatter →A child or teenager with knee or thigh pain and a limp, the knee itself looking normal

It can come from the hip: get it checked the same day.

Read: SUFE (slipped hip growth plate) →Pain, tingling or numbness that travels down the leg from the back

That points to a nerve (sciatica) rather than the knee.

Read: Sciatica →

Sudden, very painful, hot, red, swollen knee, often starting overnight

Possibly gout, or an infection if you feel unwell or have a temperature: get help from NHS 111 now, as the warning signs say.

An urge to move your legs when you lie still in the evening

Possibly restless legs syndrome; our exercise guide for restless legs covers what helps.

Sudden, severe, persistent pain on the inner knee in someone over 60

Possibly a small fracture under the joint surface, which early X-rays miss: see a GP.

Constant bone pain that is worse at night

Especially with a lump, weight loss, a fever or tiredness: see a GP, as the warning signs say.

Understand it

Night pain is common in knee arthritisStrong evidence

Night pain is part of knee arthritis for many people. In focus groups in 4 countries, 81% of 123 people with hip or knee arthritis had night pain, and it came and went from night to night. In an online survey of 101 people with hip or knee arthritis, 75% had it, and they rated it higher, and more often constant, than their pain during the day. In clinic samples, 64.7% of 150 people with knee arthritis had night pain, and so did 72% of 148 people about to have a knee replacement.

In the wider population it's less common: 7.6% of 942 community volunteers in Japan had night knee pain. The NHS says that in more severe cases, arthritis symptoms "can be continuous".

Sources 1, 2, 3, 4, 5, 6

Does night pain mean the arthritis is bad?Mixed evidence

The studies point both ways. In 1,214 local volunteers in Japan, night knee pain rose steeply with how much the joint had changed on X-rays, from 3.6% with no changes to 75.0% with the most severe, and sleep got worse with it. But in the focus groups, night pain came at every stage of arthritis, and the authors concluded it "may not be a distinct marker of disease severity". In 150 clinic patients, overall symptoms were linked with night pain and X-ray grade wasn't, once both were taken into account.

A more sensitive pain system plays a part too: in a Japanese community study, night pain in people with knee arthritis was 13.3% without signs of central sensitisation and 25.5% with them. So night pain tells you the knee is sore and your sleep is suffering, but on its own it's an uncertain guide to how worn the joint is. Whether to consider an operation depends on how much your symptoms affect your life, not on night pain alone, the National Institute for Health and Care Excellence (NICE) says.

Sources 7, 1, 3, 5, 8

Other causes at nightStrong evidence

Bursitis, a swollen, fluid-filled sac over or below the kneecap or on the inner shin, is tender and sore to press or lie on; the NHS suggests extra cushions around the joint while you sleep. Gout causes sudden, severe pain with hot, swollen, red skin. It's usually in the big toe but can be in the knee, and NICE describes its onset as rapid, often overnight.

Kneecap pain is typically worse on stairs, kneeling and squatting, and after sitting for a while, such as at the cinema or driving, so it can ache in the evening. Leg cramps mostly come at night or when resting, usually in the calf, and restless legs bring an urge to move your legs that is worse at night. Rheumatoid arthritis gives pain that's often worse in the mornings and after inactivity, with morning stiffness that lasts longer than the 30 minutes or so usual in osteoarthritis. A Baker's cyst is a soft lump behind the knee that aches and feels tight, worse after walking; it matters mainly because a sudden worse swelling or a swollen calf needs checking.

Sources 9, 10, 11, 12, 13, 14, 15, 16

After a knee replacementEmerging evidence

Night pain is common in the first weeks after a knee replacement and usually fades. In 111 people followed after surgery, night knee pain fell from 38.7% before the operation to 2.9% a year later, with the turning point at around 6 weeks. Poor sleep was slower to change: 54% slept poorly before surgery and 53% a year later.

Of 148 people about to have a knee replacement, 72% had night pain; they scored worse before surgery, but no differently a year after. The NHS says "do not sleep with a pillow under your knee" after a knee replacement, and that you don't need to sleep in a special position.

Sources 17, 4, 18

Children: growing pains, and when it's something elseStrong evidence

Growing pains are common between 3 and 12 and harmless: an aching or throbbing in the muscles or joints of both legs in the evening or at night, gone by the morning, in a child who is otherwise well. The NHS says they aren't caused by growing; they're more common in active children and in children with very flexible joints.

The NHS lists the signs that aren't growing pains: pain in 1 leg, pain in the morning or when walking, a limp, pain in 1 joint such as the knee, swelling, a rash or unusual bruising, a high temperature, unusual tiredness, and not eating or losing weight. NICE asks GPs to consider a very urgent X-ray for a child or young person with unexplained bone pain or swelling.

Sources 19, 20

When night pain needs checkingStrong evidence

What matters is the company night pain keeps. The NHS says see a GP for "pain or tenderness in a bone, particularly if it's worse at night", or for a lump, swelling or weight loss, and that bone cancer pain "may be constant or come and go". NICE asks GPs to offer blood tests for myeloma to people aged 60 and over with persistent bone pain. Most night knee pain has a common cause, such as arthritis.

A very high temperature, or feeling hot, cold or shivery, with redness or heat around the knee can be an infection, and the NHS says get advice from NHS 111 now. NHS inform says contact a GP for a knee that's hot, swollen or tender, especially if you can't recall an injury. A sudden, severe and persistent pain on the inner knee in someone over 60, often after little or no injury, can be a small fracture under the joint surface (a subchondral insufficiency fracture); women are affected more often, and early X-rays are usually normal.

Sources 21, 20, 22, 23, 24, 25

When a scan helpsStrong evidence

Usually not at first. NICE diagnoses osteoarthritis without imaging in people aged 45 or over with joint pain on activity and no morning stiffness, or stiffness that lasts 30 minutes or less, and keeps imaging for unusual features that suggest something else, such as an inflammatory arthritis or cancer. With bursitis, a GP may draw off fluid with a needle to test for infection or gout.

A sudden, severe inner-knee pain in an older adult is one time a scan matters: early X-rays are usually normal, and magnetic resonance imaging (MRI) shows the fracture. These fractures used to be mistaken for arthritis, a 2025 review says.

Sources 8, 26, 9, 24, 27

What helps, and how strong the evidence is

Sleep and pain affect each otherMixed evidence

Poor sleep and pain go together, but which leads is mixed. A review of long-term population studies found sleep problems predicted new and worsening chronic pain more strongly than pain predicted sleep problems. But in 229 adults with knee pain followed every 3 months for 3 years, worse pain predicted worse sleep the next quarter, and not the other way round.

In end-stage arthritis, poor sleep was reported by 48% of 870 people with knee arthritis, against 21% of people without arthritis, and the gap was fully explained by pain disturbing sleep. Either way, it makes sense to look after both the knee and the sleep.

Sources 28, 29, 30

Talking therapy for insomniaEmerging evidence

Cognitive behavioural therapy for insomnia (CBT-I) is a talking therapy for sleep. In 327 adults aged 60 and over with arthritis pain and insomnia, six telephone sessions of 20 to 30 minutes improved insomnia scores by 3.5 points more than education at 2 months, and helped tiredness and, to a lesser degree, pain.

In 100 people with knee arthritis and insomnia, CBT-I cut the time spent awake at night more than a comparison treatment; pain fell about equally in both groups, and less time awake predicted later pain improvement. The NHS offers CBT for insomnia and uses sleeping pills only rarely.

Sources 31, 32, 33

Exercise in the dayStrong evidence

Exercise is the core treatment for knee arthritis. Across 139 trials (12,468 people), exercise improved function by about 11 points out of 100 against a placebo or attention (moderate certainty) and may have eased pain by about 9 points (low certainty). NICE says offer exercise tailored to you, and explain that joint pain may rise when you start but regular exercise helps. None of these trials measured night pain on its own, so the honest claim is that exercise helps arthritis pain overall.

Sources 34, 8

Sleeping positions and pillows: health-service advice, no trialsEmerging evidence

No trial has tested a sleeping position or pillow for knee pain. The health-service advice is consistent, though: after a knee replacement, the NHS says "do not sleep with a pillow under your knee", and an NHS trust's knee pain advice for arthritis is to "straighten your knees fully when standing and avoid lying down with your knees up". With bursitis, the NHS suggests extra cushions around the joint while you sleep, and with gout, keeping the bedclothes off the joint at night.

A pillow between the knees when you lie on your side, so the top leg stays level, is our suggestion for the knee; it matches the advice our hip pain at night guide gives for the hip.

Sources 18, 35, 9, 10

Medicines and injectionsStrong evidence

For knee osteoarthritis, NICE recommends an anti-inflammatory gel or cream first, and tablets if that isn't enough; it doesn't routinely recommend paracetamol or weak opioids, and says there's no strong evidence that paracetamol helps. A steroid injection gives short-term relief of 2 to 10 weeks. Losing weight helps if you're overweight: any loss is worth having, and 10% helps more than 5%. Asking a pharmacist how best to time your usual painkiller around bedtime is our suggestion.

Source 8

How much pain is OK while you exercise?

0 to 2 is safe, up to 5 is acceptable, and the morning is the testEmerging evidence

For the exercises, this guide uses the knee hub's rule. Rate your knee pain from 0 to 10 during and after exercise. In the pain-monitoring model used in knee trials, 0 to 2 counts as safe, up to 5 as acceptable and above 5 as too much. Aim for 0 to 3 most of the time.

By the next morning your knee should be back to its usual level. If it is not, drop back one step next time (fewer sets, a shallower range, a lower step), not to nothing. Over the weeks pain should hold steady or ease; that last check is our suggestion rather than a tested rule.

Some knee programmes say you should feel no pain at all. The trials allowed some, and a meta-analysis found exercising into some pain did no worse than pain-free exercise. NICE says joint pain may rise when you start exercising with arthritis, and that regular exercise still helps in the long run. Sharp, catching or giving-way pain, or new swelling, is a reason to stop and get it checked.

At night (our suggestion): judge the plan by the week, not one night, because night pain in arthritis comes and goes. If a new exercise is followed by a worse night two or three times running, drop back a step or move that session earlier in the day. If you sleep badly, the NHS says don't exercise in the 4 hours before bed; gentle heel slides and thigh tightening in bed are fine.

Sources 36, 37, 38, 8, 33, 1

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Settle the nights, and keep the knee straightening and bending

About the first 2 weeks, little and often: tonight's changes (the written steps below), and moves in bed and through the day that keep the knee straightening and the thigh working, with a short walk or easy bike ride most days. With a hot knee, gout, bursitis that is still swollen or a recent knee replacement, use the warning signs and that guide first. Doses are a named guide's, NHS inform's or the move page's; the rest are editorial.

Quad set (static quads) demonstrated on the 3D figure

3D demoQuad set (static quads)Beginner · No equipment

Hold 10 s: 2 to 3 at a time, building to 8, 2 to 3 times a day; the first set in bed in the morning · As in our knee pain on stairs guide, which uses NHS inform's knee exercise and pacing. It keeps the knee straightening, which a night spent bent can stiffen (our reasoning)

Harder: Straight-leg raise

Supine heel slide demonstrated on the 3D figure

3D demoSupine heel slideBeginner · No equipment

10 slow reps each side, once or twice a day · The move page's dose, an editorial starting point. In bed before you get up, for morning stiffness, as in our hip pain at night guide

Harder: Hip windshield wipers

Straight-leg raise demonstrated on the 3D figure

3D demoStraight-leg raiseBeginner · No equipment

Hold 5 s at the top: 2 to 3 at a time, building to sets of 8, up to 2 sets of 15 · As in our knee pain on stairs guide (NHS inform's pacing)

Easier: Quad set (static quads) · Harder: Leg extension

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

2 sets of 10 · As in our knee pain guide

Easier: Pelvic tilt into bridge · Harder: Single-leg glute bridge

Recumbent exercise bike demonstrated on the 3D figure

3D demoRecumbent exercise bikeBeginner · Cardio machine

10 to 20 minutes at a moderate effort (you can talk but not sing), building towards 30 · The move page's dose, an editorial starting point. Or a short walk. If you sleep badly, finish at least 4 hours before bed, as the NHS advises

Harder: Stationary cycling

Move on when: These stay within the pain rule, nights are no worse, and your knee straightens fully each morning (our suggestion).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build: strength in the day

About weeks 2 to 8, 2 to 3 days a week: the strengthening that eases arthritis pain, done in the day rather than late in the evening. NICE says pain may rise a little at the start, and exercise still helps.

Sit to stand from a chair demonstrated on the 3D figure

3D demoSit to stand from a chairBeginner · A bench or box

3 sets of 8 to 12, higher seat to start · As in our knee pain guide

Easier: Sit to stand, pushing on the thighs · Harder: Bodyweight squat

Seated knee extension (chair) demonstrated on the 3D figure

3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight

3 sets of 10 to 15 each leg, 2 to 3 days a week · The move page's dose, an editorial starting point. Work from 90 to about 45 degrees if the full range hurts the kneecap, as the move page says

Easier: Quad set (static quads) · Harder: Leg extension

3D demoStep-upBeginner · A step

3 sets of 8 to 10 each leg, low step first · As in our knee pain guide

Easier: Low step-up · Harder: Dumbbell step-up

3D demoWall sitBeginner · A wall

4 holds of 20 to 45 s at a comfortable depth · As in our knee pain guide. Breathe normally through the hold

Easier: Straight-leg raise · Harder: Spanish squat (band squat hold)

Slow calf raise demonstrated on the 3D figure

3D demoSlow calf raiseBeginner · A wall

3 sets of 12 · As in our knee pain guide

Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise

Single-leg stand demonstrated on the 3D figure

3D demoSingle-leg standBeginner · A wall

A few seconds, building to 20 to 30 s, a hand near a support · As in our knee pain on stairs guide

Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix

Move on when: 3 sets of each stay within the pain rule, your knee is back to usual by the next morning, and nights have been steady or better for 2 weeks (our suggestion).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Keep it strong, and keep the nights

From about week 8, 2 days a week and ongoing: heavier strength and longer walks, as the knee hub's later stages. A full night's sleep comes back by the written steps below.

Dumbbell goblet squat demonstrated on the 3D figure

3D demoDumbbell goblet squatIntermediate · A dumbbell

3 sets of 8 to 12, deeper as tolerated · As in our knee pain guide

Easier: Bodyweight squat · Harder: Barbell front squat

Split squat demonstrated on the 3D figure

3D demoSplit squatIntermediate · No equipment

3 sets of 8 each leg, holding a support at first · As in our knee pain and knee arthritis guides

Easier: Bodyweight squat · Harder: Reverse lunge

Single-leg calf raise from a step demonstrated on the 3D figure

3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall

3 sets of 10 each leg · As in our knee pain guide

Easier: Slow calf raise · Harder: Single-leg pogo hops

Lateral band walk demonstrated on the 3D figure

3D demoLateral band walkBeginner · A band

3 sets of 12 steps each way · As in our runner's knee guide: hip strength helps kneecap pain

Easier: Hip abduction machine · Harder: Lateral band walk, band at the feet

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

Build to 20 to 30 min · As in our knee pain guide; walking outdoors counts the same

Harder: Treadmill jogging

Move on when: Our suggestion: you're sleeping through most nights, or waking less, and busy days don't bring worse nights. Keep two strength days a week for the long term, and if nights flare after a busy day, drop back a step for a few days.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

How to sleep tonight (written steps)

Our 3D figure can't show these changes. They come from the NHS, NHS inform and an NHS trust's knee pain page; no trial has tested a sleeping position or pillow for knee pain, and where a step is our suggestion, it says so.

1. On your side: a pillow between your knees, so the top leg stays level and your knees don't press together (our suggestion, as our hip pain at night guide advises for the hip).
2. On your back: let your knee rest straight. After a knee replacement, the NHS says "do not sleep with a pillow under your knee", and an NHS trust advises people with knee arthritis to avoid lying down with their knees up. If a thin pillow under the knee is the only way to settle on a bad night, use it, and do the morning quad sets (our suggestion).
3. With bursitis, put extra cushions around the knee while you sleep (the NHS), and lie on the other side (our suggestion).
4. With gout, keep the bedclothes off the joint at night, rest it and raise it (the NHS); a pillow either side of the knee can hold the duvet up (our suggestion).
5. Before bed, heat or ice for no longer than 20 minutes, whichever helps, but not if you have problems with circulation or feeling (NHS inform). For cramps, the NHS's calf stretch, last thing; for restless legs, a warm bath or heat pads before bed (the NHS).
6. Wind down for at least an hour before bed, get up at the same time every day, and keep the room dark and quiet (the NHS).
7. If you wake in pain, change position and do a few heel slides or quad sets. If you can't get back to sleep after a while, get up and do something calm until you feel sleepy (our suggestion).

Sources 18, 35, 9, 10, 23, 13, 14, 33

By day (written steps)

These come from NHS inform, an NHS trust, the NHS and NICE.

1. Keep active. In the first day or two of a flare, do a little less but move as much as you comfortably can, moving the knee gently for 10 to 20 seconds every hour while you're awake (NHS inform).
2. Break up long sitting: bend and stretch your legs a few times every half hour and before you get up (an NHS trust). Kneecap pain builds after long sitting (NHS inform).
3. Exercise during the day. With insomnia, the NHS says don't exercise in the 4 hours before bed; with restless legs, avoid strenuous exercise late at night.
4. Use a walking aid if you need one (NICE), and comfortable, soft-soled shoes with low heels (an NHS trust).
5. If you're overweight, any weight loss helps arthritis, and 10% helps more than 5% (NICE).

Sources 23, 35, 12, 33, 14, 8

A full night's sleep comes back (written steps)

No trial has tested how to bring back a full night's sleep with knee pain. These steps are our suggestion, built on the NHS's sleep advice and the insomnia trials.

1. Stages 1 and 2: the positions and bedtime steps above, every night, and exercise in the day.
2. Judge by the week, not one night: night pain in arthritis comes and goes. A simple note of each night and what you did that day helps you spot what makes a difference.
3. When nights have been steady for 2 weeks, change one thing at a time, such as a later evening walk or a different pillow set-up, and keep it if the next few nights are no worse.
4. If busy days bring worse nights, spread the load: shorter walks more often, and heavier jobs earlier in the day.
5. If poor sleep goes on for weeks despite these steps, see a GP: talking therapy for insomnia helped sleep in older adults with arthritis, and pain to a lesser degree.

Sources 1, 33, 31

Positions to swap, and why

Habit or position	Why it matters	Instead
A pillow propping your knee bent all night, especially after a knee replacement	The NHS says don't sleep with a pillow under your knee after a knee replacement, and an NHS trust advises people with knee arthritis to avoid lying with their knees up.	On your back, the knee resting straight; on your side, a pillow between your knees; quad sets in the morning.Try: Quad set (static quads)
Lying on your side with your knees pressed together	It presses the inner knees together; our pes anserine guide suggests a pillow between them.	A pillow between your knees.
Lying or kneeling on a swollen, tender knee	With bursitis, the NHS suggests extra cushions around the joint at night and rest from pressure.	Cushions around the knee, and lie on the other side.
Bedclothes pressing on a hot, swollen knee during gout	The NHS says try to keep bedclothes off the affected joint at night.	Keep the covers off it; a pillow either side can hold the duvet up (our suggestion).
Hard or long exercise late in the evening	With insomnia, the NHS says don't exercise in the 4 hours before bed, and with restless legs, avoid strenuous exercise late at night.	Exercise earlier in the day; gentle heel slides in bed are fine.Try: Supine heel slide
Sitting with your knees bent all evening	Kneecap pain builds after long sitting, and an NHS trust says bend and stretch your legs every half hour.	Straighten each knee a few times every half hour, and get up.Try: Seated knee extension (chair)
Resting your knee for days after a bad night	Exercise eases arthritis pain and improves function, and NICE says pain may rise at the start but exercise still helps.	The plan's first stage, in the day.Try: Sit to stand from a chair
The standing quad stretch at bedtime, with kneecap pain or arthritis	It takes the knee into a full bend, and kneecap pain is worse with deep bending such as squatting (our reasoning, from NHS inform).	Heel slides within comfort.Try: Supine heel slide
Sleeping tablets as the answer	The NHS uses them only rarely for insomnia, and talking therapy for insomnia has the evidence.	The NHS's sleep habits, and ask your GP about talking therapy for insomnia.

Routines to follow

Knee strengthening workout: from first steps to full range

A 25-minute session for knees that don't currently hurt: thigh and hamstring strength, single-leg control, then an optional full-range block with knees over toes.

25 minBeginner13 movesA bench or box, A wall

Low-impact leg workout (no jumping)

A gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.

20 minBeginner7 movesA bench or box, A step

Arthritis exercise routine: a joint-friendly circuit

A 30-minute joint-friendly circuit built like the GLA:D and ESCAPE-pain programmes: a gentle warm-up, chair, step and band strength moves, balance, then stretches.

30 minBeginner14 movesA bench or box, A step

Strength and balance exercises for seniors

A 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.

40 minBeginner18 movesA bench or box, Something with weight

Bedtime stretch routine

A slow, 10-minute floor routine to unwind before sleep: child's pose, twists, happy baby and slow breathing.

10 minBeginner7 movesFirm cushion, A wall

More moves for this area

Questions people ask

Why does my knee hurt at night?

From mid-life, the commonest reason is arthritis: most people with knee arthritis have some night pain. Bursitis, gout, kneecap pain after a long sit, calf cramps and restless legs can disturb nights too. Night pain with a fever, a hot, swollen knee or weight loss needs checking.

Why does my knee hurt at night but not during the day?

Many people with knee arthritis find it's worse in bed: in one survey, night pain was rated higher, and was more often constant, than pain during the day. It comes and goes from night to night. Pain that never eases whatever position you lie in, or comes with a fever, weight loss or a hot knee, needs checking.

Does night pain mean my arthritis is getting worse?

Not necessarily, and the studies point both ways. In 1,214 people in Japan, night pain was far more common with more joint changes on X-rays, but focus groups found it at every stage, and in one clinic study overall symptoms predicted it better than X-ray changes. It's a sign your knee is sore and your sleep is suffering, which is worth treating either way.

Does knee pain at night mean I have arthritis?

Not always. It's common with arthritis, but bursitis, gout, kneecap pain, cramps, restless legs and, in children, growing pains can also hurt at night. A GP can usually tell from your story and an examination, and NICE diagnoses arthritis from 45 without an X-ray when the symptoms fit.

What is the best sleeping position for knee pain?

No study has tested one, so go with what's comfortable. On your side, a pillow between your knees keeps the top leg level (our suggestion); on your back, let the knee rest straight, as an NHS trust advises for arthritis. After a knee replacement, the NHS says don't sleep with a pillow under your knee.

Should I put a pillow under my knee?

Not for long, if it keeps your knee bent all night. The NHS says not to after a knee replacement, and an NHS trust advises people with knee arthritis to avoid lying down with their knees up. A pillow between your knees on your side is a better choice (our suggestion).

Can knee pain at night be a sign of cancer?

Rarely. The NHS says see a GP for pain or tenderness in a bone, particularly if it's worse at night, or for a lump, swelling or weight loss you can't explain. In children and young people, unexplained bone pain or swelling may need a very urgent X-ray.

My child has knee pain at night: is it growing pains?

Growing pains are common between 3 and 12: an ache in both legs in the evening or at night that's gone by the morning, in a child who is otherwise well. See a GP if the pain is in 1 leg or 1 joint, there in the morning, causes a limp, or comes with swelling, a rash, a high temperature, tiredness or weight loss. Massage, a covered heat pack and children's paracetamol or ibuprofen can help growing pains.

Why does my knee hurt at night after a knee replacement?

Night pain is common in the first weeks: in one study it fell from 38.7% of people before surgery to 2.9% a year after, with the turning point around 6 weeks. The NHS says don't sleep with a pillow under the knee. Get urgent help for redness, swelling or pain that is getting worse, a high temperature or a throbbing calf, and call 999 for breathlessness or chest pain.

What helps arthritis knee pain at night?

Regular exercise during the day eases arthritis pain and improves function, and NICE suggests an anti-inflammatory gel as the first medicine for the knee. Sleeping with the knee straight on your back, or a pillow between your knees on your side, and winding down for an hour before bed can help too. Ask a pharmacist how to time your painkiller around bedtime (our suggestion).

Does poor sleep make knee pain worse?

They feed each other. Long-term studies suggest poor sleep can lead to new and worse pain, while in knee pain, pain seems to disturb sleep at least as much. Talking therapy for insomnia improved sleep in older adults with arthritis, and pain to a lesser degree.

When should I see a doctor about knee pain at night?

Get advice from NHS 111 now for a hot, red or swollen knee with a very high temperature or feeling shivery, and get help the same day for a swollen, throbbing calf. See a GP for bone pain that is worse at night, weight loss or feeling unwell, morning stiffness that lasts more than 30 minutes, or pain that hasn't improved within a few weeks.

Related exercise guides

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.