Q: I am a 76-year-old female and have been treated for arthritis in my knee. I am fine in the daytime when my weight is on my legs (standing, walking) but within a few minutes of retiring, my hip OR knee OR both begin to ache, sometimes unbearably. When the pain does not subside after a few minutes, I get up and walk around; it is gone…like turning off a switch. I hesitate to take anything at night because of a bladder lift that could result in bed wetting if I ignore the urge to urinate.
I take an abundance of calcium, chondroitin/glucosamine with MSN and get lots of exercise and frankly, I am in excellent health. Help!
A: The possible causes of your pain are many, to include the arthritis you already know you have, sciatica, tendinitis and bursitis of the knee or hip, to name a few.
Arthritis refers to inflammation of one or more joints because of a breakdown of cartilage that generally protects a joint and allows it to move smoothly. Without cartilage, bones rub against each other, resulting in pain, stiffness and swelling.
Sciatica is an indication of an underlying medical condition that results from pressure or damage to the sciatic nerve that begins in the lower spine and travels down the back of each leg; however, it most commonly is unilateral. Causes for this condition include fracture, injury, a slipped disk, tumor, or narrowing of the muscle in the buttocks. The intensity may vary greatly but often begins slowly and progresses after standing or sitting, at night, when walking even a very short distance, or when spinal stenosis is present.
Tendinitis can occur because of injury, over-use, or degeneration with aging. It can also occur in individuals with rheumatoid arthritis, diabetes and other systemic diseases. While it can present in any tendon, it is most common in the shoulder, elbow, wrist or the Achilles tendon in the heel. Pain exacerbates at night and with movement.
Bursitis refers to inflammation of the bursa (a fluid-filled sac) found between a tendon and skin or a tendon and bone. This condition is common in the knee, elbow, shoulder and hip and generally presents with pain and warm skin. The knee and elbow can become inflamed simply by walking – either out of doors or on a treadmill – or from a muscle pull. It exacerbates at bedtime when the individual is in a flat position. Referred pain is difficult, since it presents in one location but may originate from another.
Trochanteric bursitis refers to inflammation of the bursa between the bony area of the hip and the iliotibial band. It is commonly the result of overuse with athletes but is also present when a person remains sedentary, such as at a desk or work bench for extended periods of time. This condition is more common in women than in men and often affects those of middle age and older. As such, it commonly exacerbates at night, especially when an individual rolls onto the affected hip.
Diagnosis for trochanteric bursitis might be made by a health care professional through palpation at the point of the greater trochanter of the hip, or through X-ray or perhaps an MRI, with the latter being the better choice in my opinion. While waiting to see your doctor, I recommend you change your footwear to that of good cushioned sneakers (worn even when you walk around the house), using an over-the-counter non-steroidal anti-inflammatory (NSAID) drug with your physician’s approval, placing a rolled pillow under your knees while in bed, and trying to avoid sleeping on your affected side. If stronger prescription medication is in order, you should discuss the matter with your physician.
Your quality of life has been affected. It’s time to see a therapist, orthopedic specialist or osteopath with a dedicated practice to musculoskeletal issues, receive appropriate testing, get a diagnosis, and make changes to move on toward recovery. The sooner you do it, the sooner you’ll get a good night’s rest.