Why the hip hurts at night
- Greater trochanteric pain syndrome: irritation of the gluteal tendons and the bursa over the bony point on the outside of the hip; the most common cause of pain when lying on the side; see hip bursitis.
- Hip osteoarthritis: pain in the groin or front of the thigh, stiffness in the morning, difficulty putting on socks.
- Lower back and sciatica: pain in the buttock and down the leg, often with back pain.
- Hip flexor or muscle strain after activity; see hip flexor strain.
- Mattress and position: a very firm mattress concentrates pressure on the side of the hip; a very soft one lets the pelvis sink and the spine twist.
- Pregnancy: pelvic girdle pain and pressure on the hips when side sleeping.
Why it is worse in bed
At night, the tendons on the outside of the hip are compressed by body weight when you lie on the painful side. When you lie on the other side, the top leg drops across the body and stretches the same tendons over the bone. Both positions provoke pain. Inactivity also increases stiffness in arthritis, and there are fewer distractions at night, so pain feels stronger.
Best sleeping positions for hip pain
- On your back: a pillow under the knees reduces strain on the hips and lower back.
- On the non-painful side: place one or two firm pillows between the knees and ankles so the top leg stays level with the hip, not dropped forward.
- Avoid lying directly on the painful hip until it settles.
- Avoid the «figure four» position with the top knee crossed over.
- A body pillow can help maintain the position through the night.
See also shoulder pain from sleeping on your side if both are a problem.
Mattress and topper
A medium-firm mattress suits most people. If yours is hard, a 5 to 8 cm memory foam or latex topper spreads pressure on the side of the hip. If it sags, the pelvis drops and the hip tendons are stretched; turning or replacing the mattress helps. There is no single best mattress for everyone, so focus on comfort and keeping the spine aligned.
What to change during the day
- Avoid crossing your legs and standing with your weight on one hip.
- Use higher chairs and avoid deep sofas that bend the hips sharply.
- Break long walks into shorter ones and reduce hills and stairs temporarily.
- Avoid stretching the outer hip (for example the IT band) aggressively, which compresses irritated tendons.
- Ice or heat for 15 minutes before bed can ease pain.
Exercises that help
- Isometric hip abduction: lying on your back with a belt around the knees, push gently outwards and hold for 30 to 45 seconds, five times.
- Bridges: lift the hips with knees bent, 2 to 3 sets of 10 to 15.
- Sit to stand from a chair, slowly, 10 to 15 times.
- Side-stepping with a band around the knees once pain allows.
- Single-leg balance with the pelvis level.
Progress over 8 to 12 weeks. For more ideas see hip muscles and hip mobility exercises.
When to see a physiotherapist
If pain disturbs sleep for more than a few weeks, a physiotherapist can confirm the cause, guide a tendon loading programme, correct movement patterns and advise on activity. Shockwave therapy may help persistent tendinopathy. Steroid injections can give short-term relief but are less effective long term than exercise. For osteoarthritis, exercise and weight management are the first line, and joint replacement is considered when pain is severe despite treatment.
When to see a doctor
- Hip pain after a fall, especially in older people: possible fracture.
- Fever, feeling unwell, or a hot, swollen joint.
- Constant pain at night that is not affected by position.
- Unexplained weight loss or a history of cancer.
- Numbness, weakness in the leg or bladder changes.
- Inability to bear weight.
Key points to remember
- Outer hip pain at night is usually gluteal tendinopathy or bursitis.
- Sleep on your back or the other side with a pillow between the knees.
- Avoid crossing the legs and low chairs.
- Gradual hip strengthening is the most effective treatment.
Questions about hip pain while sleeping
These answers are general information and do not replace an examination or individual medical advice.
Why does my hip hurt when I lie on my side?
Usually because the tendons and bursa on the outside of the hip are compressed. Lying on the other side can stretch them.
What is the best sleeping position for hip pain?
On your back with a pillow under the knees, or on the other side with a firm pillow between the knees.
Can a mattress cause hip pain?
A very firm or sagging mattress can make it worse. A topper may help.
Should I stretch my IT band for hip pain at night?
Aggressive outer hip stretches can worsen tendon pain. Strengthening is more effective.
How long does hip bursitis take to heal?
Often several weeks to a few months with activity changes and exercise.
When is hip pain at night serious?
After a fall, with fever, constant pain unrelated to position, weight loss or leg weakness.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.