Why does my knee hurt at night?

December 7, 2009 1:09 PM

Yet another knee pain question. This time while sleeping.

I've had pain in my right knee for a couple of months now. Finally went to the orthopedist last month, who basically told me that I weigh too much (yes, I do, at 300 lbs) and it would continue to hurt until I lost some weight and to take Aleve and glucosamine. He did take xrays and I do have a small arthritic spur in that area. The pain seems to emanate from just below the kneecap on the inside of my knee and that area is quite tender when pressed upon. Needless to say, I wasn't thrilled at the prognosis of having to wait a few months for relief, while I lost some weight.

I am fully willing accept 85% of the pain is due to my excess weight and I am working on that, however the pain continues at night when I am sleeping, often waking me up. I do sleep with a big pillow between my knees to cushion the inner knee area.

Anyone had anything similar? Should I get a second opinion? Yes, I do know YANMD.

posted by sarajane to Health & Fitness (11 answers total)

Well, the best you're going to do is getting a second opinion, because nobody here is qualified to diagnose you or able to do so over the internet (and please don't take bad advice from random internet people as to what magical herbal remedies or homeopathic nonsense will be "safe" and "effective"). If it would give you peace of mind to get the second opinion, then do so: worst case it's the same result, best case it turns out to be something easier to manage.

With all that said, follow any advice the original doctor gave you to the letter (and don't hesitate to call the doctor's office with follow up questions): I've found that nagging, aggravated injuries tend to feel a lot better when I deliberately give them time for some of the inflamation to die down.
posted by Inspector.Gadget at 1:18 PM on December 7, 2009

Even before I was overweight, I often suffered from knee pain while sleeping. I frequently had dreams where I was trying to climb stairs but had to pull myself up using the railing because my knees wouldn't bear my weight. Then I'd wake up to find my knees bent and very achy. A few years after this started, I was diagnosed with Lupus. During my routine exams with my rhematologist, he'd press on an area just a bit diagonally below my knee (some sort of cartilage pad or plate?) and sometimes (not always) I'd retract/wince in pain. He'd then give me a shot of cortisone and all was well for a while. Apparently the problem was some sort of inflammation of that pad/plate, and I can't remember the medical term, but long story short you may want to get a second opinion.
posted by Oriole Adams at 1:24 PM on December 7, 2009

Best answer: A second opinion never hurts; I would have said absolutely get one if the first orthopedist hadn't taken x-rays, but even so, more eyes on a problem often helps.

That said, it's not abnormal for that kind of knee pain to manifest at any old time, even when you're not actively doing anything with the knee (e.g. when you're lying down or sleeping). When that tissue gets enflamed or swollen, it has the capacity to simply be sore in its own right, without needing to apply additional pressure to the area.

I've had that before with a troublesome knee, in about the same place you describe. The pain eventually went away for me, with time and care.

In the absence of getting a second opinion, I'd say try to take care to minimize the opportunities for your knee to get overly exerted, impacted, or anything else that triggers more inflammation. Stick with non-impacting aerobic exercise, i.e. no running. Icing can help if it gets swollen. Pain relievers and anti-inflammatory medicines are also good management tools, but be careful about using them before exercise; you want to be reasonably tuned in to what's going on with your knee when you're exercising, or you run the risk of inadvertently over-exerting it and getting into more severe complications.

IANAD, just someone who's spent time nursing these kinds of situations during my own physical fitness regimen. FWIW, I've had a number of physical therapists who have given me similar advice.

I wish you luck, and a speedy recovery. Knee pain sucks when you're trying to work out. :P
posted by Brak at 2:30 PM on December 7, 2009

Yes, get a second opinion. Not everyone who weighs 300 pounds has bad knees. My grandfather never weighed more than 160 pounds and he had terrible knees his entire life. Your weight might be a contributing factor to your symptoms, but that doesn't mean it is the only or even the main cause for your pain. Any doctor who writes off your pain because of your weight is doing you a disservice and might be causing you harm by failing to diagnose an underlying problem due to his own fat-bias.

Try to find a fat-friendly orthopedist and get a second opinion. And good luck!
posted by jennyb at 2:46 PM on December 7, 2009

I'm just now getting over the exact same thing. Somehow I injured my knee at night while sleeping, I could barely walk the next couple of days, and it has taken over a week to get back to near 100%. In *my* case, it was most likely some meniscus issue and my guess is either a loose object or a flap of meniscus folded over so that when I extended my knee the meniscus was compressed pretty severely. I suspect this because of conversations I've had with knee doctors over the last dozen years or so. I've had surgery once (torn acl, and meniscus tear), and had to go for other concerns off and on (none related to the surgery though, which has turned out great for me). However, the last dr I went to basically told me that knees in general don't get better and you have to suck it up. I probably won't go back to that dr again, but you might want to take it as another data point.

As for what to do. Losing weight will help I'm sure, but the immediate thing you need to do is to baby your knee as much as possible until it stops hurting. Keep sleeping with the pillow, as that helped speed my recovery as well. If it is cartilage or a meniscus issue, then it is important to not do anything that hurts. Don't force anything, you could end up damaging things more and causing more pain, for a longer period of time.

Best of luck. Oh, and fwiw, I'm not overweight, I just haven't treated my knees as nicely as they've deserved over the years.
posted by forforf at 2:52 PM on December 7, 2009

This book taught me correct posture while walking. I no longer have knee pain. I have never had weight problems.

http://www.walkyourselfwell.com/

On her website she has some of the pages of the book available to read.

Good luck!
posted by GregorWill at 3:00 PM on December 7, 2009 [1 favorite]

Definitely get a second opinion or see your primary doc for referral to a physical therapist. IANAD, however IAAPT- there are a lot of treatment options and exercises that will help.
Nthing ice as well- frozen peas are comfy and cheap. 5-15 minutes after you exercise or at the end of the day should help to settle things down.
I agree with katherineg above- if you are not getting proactive treatment whatever your circumstance you are working with the wrong practioner.
posted by bookrach at 4:59 PM on December 7, 2009

Do you see a pattern here? Everyone suggests a second opinion. That is good advice. I think Inspector Gadget pretty well summed it up. I would only add this: You took a long time to gain all of that weight and your knees have had to deal with that extra weight for a long time. Give your weight situation more than a few days to resolve. Diligently work to reduce the work your knees have to do and the pain will gradually decrease. Let the pain in your knees be the motivation you finally need to get onto a reasonable weight management routine and stick with it.

One last thought. You are busy and distracted a lot during the day. No matter how much your knees hurt during the day, the pain has to compete with other stimuli. After you've gone to bed and it is quiet and you are not paying attention to a lot of different things, the pain jumps out a little more. If the doctor has prescribed a pain medication, take it just before you go to bed and let it go to work just as the world around you is calming down. Don't over medicate as this does no more good and can affect you liver and kidneys.

Best wishes.
posted by Old Geezer at 7:27 PM on December 7, 2009

Are you (unknowingly) sleeping in a weird position? I'm not prone to knee problems, but I've had knee pain a few times in my life and was surprised to discover that I cross my legs in some really weird, prezel-y positions whenever I fall asleep on my back. Don't do that. :)

Irrespective of Inspector Gadget's amusing slagging off of herbs and homeopathic solutions, my husband (not overweight) has virtually eliminated his decades worth of painful knee problems by using these particular supplements:

Serrapeptase - Doctor's Best brand; 40,000 serratio units per veggie cap, 1x day.
Hyaluronic Acid with MSM - Now brand; HLA 100 mg, MSM 900 mg 1x day.
Glucosamine did absolutely nothing for him, and ibuprofen, Aleve, etc just temporarily masked the pain, but did nothing for the underlying issue.

He no longer winces in pain because of his knee, nor babies his knee in any way other than to keep it warm in cold weather. He also has been able to resume running and playing soccer, two activities he'd virtually given up on a few years ago. Make of that what you will.

I also think you should get a second opinion.
posted by LuckySeven~ at 7:46 PM on December 7, 2009

Oh! And to make my trifecta of wacko alternative remedies complete, I'll suggest Castor oil rubdowns to the affected area throughout the day, as needed, but especially before bedtime. Good luck!
posted by LuckySeven~ at 7:52 PM on December 7, 2009

Response by poster: Thanks everyone. Will definitely get a second opinion. Up to this knee thing, I've been quite healthy and had pretty good luck with medical care, until this doctor.
posted by sarajane at 11:41 AM on December 8, 2009