Do you struggle to sleep at night because your hips start hurting as soon as you roll onto your side? Does sudden hip pain wake you when you change sleeping position, or do you spend the night swapping from one side to another, trying to find a position that doesn’t hurt?
Type “hip pain” into Google and many of the suggested search terms focus on pain at night and/or when lying down, which shows how common this issue is.
Hip pain at night can be particularly frustrating because it can really affect sleep. You might be able to walk around during the day without too much trouble, yet something as seemingly undemanding as lying in bed brings the pain on.
If your pain is mainly around the outside of your hip, the position you sleep in may be putting pressure on tissues that are already sensitive. Understanding why they have become sensitive in the first place can help you find a longer-term solution.
Where exactly does your hip hurt?
When someone tells us they have hip pain, one of the first things we want to know is where they feel it.
Some people point to the groin or front of the hip. Others feel pain in the buttock, down the thigh or around the bony area on the outside of the hip. Occasionally, pain that feels as though it’s coming from the hip may be referred from the lower back.
Pain when lying on your side is commonly felt around the outside of the hip, over or close to the greater trochanter, i.e. the bony prominence you can feel at the top of your thigh.
This is where several important muscles and tendons attach, including the gluteal tendons. These tissues help to stabilise your pelvis when you walk, run, climb stairs or stand on one leg.
If they become irritated or sensitive, lying in certain positions can become surprisingly uncomfortable.
Why can lying on your side make your hip hurt?
One common cause of pain on the outside of the hip is gluteal tendinopathy. This happens when one or more of the tendons that connect your gluteal muscles to the top of your thigh bone become irritated and painful when they are put under too much pressure or asked to do more than they can comfortably cope with.
You may also hear a physio or doctor use the term greater trochanteric pain syndrome (GTPS). This is an umbrella term for pain around the outside of the hip, which can involve the gluteal tendons and sometimes the nearby bursa, a small fluid-filled sac that helps reduce friction between tissues.
In the past, pain in this area was often described simply as hip bursitis. We now understand that the gluteal tendons are often involved too, particularly when the pain has been troublesome for some time.
As well as discomfort when lying on your side, you may notice pain when you:
- Walk or run, particularly if you have recently increased how much you are doing
- Climb stairs or walk uphill
- Stand on one leg, perhaps while getting dressed
- Sit with your legs crossed
- Get up after sitting for a while
- Press around the outside of your hip
You certainly don’t need to experience all these symptoms to have gluteal tendinopathy, and pain in this area can have other causes. A physiotherapy assessment can help us establish which structures are likely to be involved and whether anything else may be contributing to your symptoms.
Why has my hip suddenly started hurting?
This is a question we hear a lot, particularly when there hasn’t been an obvious injury.
Tendons respond to the demands we place on them. Sometimes symptoms develop when those demands change more quickly than the tissues have had time to adapt.
Perhaps you have recently increased your running mileage, started walking further, introduced more hills or returned to the gym after a break. Even a holiday involving far more walking than usual can be enough to expose the hip to a different level of load.
Changes elsewhere in the body can have an effect too. If an ankle, knee or back problem has altered the way you move, your hip may have been working differently without you consciously noticing it.
This is why, when we assess hip pain, we’re interested in much more than what happened on the day you first noticed it. We’ll want to know what you have been doing over the previous days and weeks, how your activity has changed and what your body needs to cope with in everyday life, work or sport.
How can you make sleeping with hip pain more comfortable?
If lying directly on the painful side consistently aggravates your symptoms, it makes sense to avoid that position for a while if you can.
When sleeping on your other side, try placing a pillow between your knees and thighs. This can help to stop your upper leg dropping too far forwards or across your body, reducing compression around the painful hip.
You don’t need to achieve a textbook sleeping position. Experiment with the thickness and position of the pillow and see what feels comfortable for you.
It may also help to think about the positions you adopt before you go to bed. If sitting with your legs crossed or standing with most of your weight resting through one hip tends to aggravate your symptoms, reducing the amount of time you spend in those positions may give the irritated tissues a chance to settle.
And before you decide your mattress must be the culprit, try some simple positioning changes first. A mattress can certainly affect comfort but replacing it won’t necessarily address the reason your hip has become sensitive.
Should you stretch a painful hip?
When your hip feels tight or uncomfortable, stretching can seem like the obvious thing to do. For some types of hip pain, appropriate mobility work may be useful. However, repeatedly stretching an irritated gluteal tendon can sometimes make symptoms worse.
Some common stretches take the leg across the body or move the hip into positions that increase compression around the gluteal tendons. If you keep stretching because the area feels tight, only to find that it aches more afterwards or that night, it is worth reconsidering whether that particular stretch is helping you.
We wouldn’t recommend avoiding movement altogether. The aim is to choose movements and exercises that are right for what is causing your pain and for the stage you’re at in your recovery.
Should you exercise if your hip hurts at night?
In many cases, yes. The important questions are what exercise you do, how much you do and how your hip responds.
Complete rest may calm things down temporarily, but it doesn’t necessarily help your hip become better able to tolerate the activities you want to return to.
With gluteal tendinopathy, for example, a carefully progressed strengthening programme can help improve the capacity of the muscles and tendons around the hip. We may initially modify activities that could cause discomfort, then gradually increase the load as your symptoms and strength improve.
What that looks like will depend very much on you.
Someone who wants to walk comfortably to work without their hip aching has different physical demands from someone preparing for a marathon or hoping to return to tennis several times a week. Your rehabilitation should reflect the life you want to lead.
When should you get hip pain at night checked?
If your hip pain is regularly disturbing your sleep, affecting the way you walk or stopping you from exercising, it’s worth finding out what is causing it. You should also consider an assessment if you have already tried changing your sleeping position and changing your activity, but the problem isn’t improving.
There’s a difference between hip pain that is clearly affected by position and severe or persistent night pain that doesn’t change when you move.
If your pain is constant, getting progressively worse or accompanied by other symptoms such as feeling generally unwell, unexplained weight loss, fever, significant weakness or numbness, seek medical advice. The same applies if you have severe hip pain following a fall or other injury or are unable to put weight through the leg.
How can physiotherapy help with hip pain at night?
The first step of hip pain treatment is working out what’s contributing to your symptoms.
At The Physio Box, we’ll talk to you about when your pain started, exactly where you feel it and which positions or activities make it better or worse. We may assess the movement and strength of your hip, but we may also look at your lower back, knees and ankles, as well as how you walk, squat or run where relevant.
If you have recently changed your training, increased your activity or returned to sport, we’ll consider that too.
Once we have a clearer picture of what’s happening, we can help you manage the things that are currently aggravating your hip while working on the strength, movement and capacity you need for the longer term.
That might include advice about sleeping positions and day-to-day activity, hands-on treatment where appropriate and a progressive exercise programme tailored to you.
Changing the way you sleep can make nights much more comfortable, particularly if pressure or compression is aggravating sensitive tissues around your hip, but if you keep having to arrange pillows around yourself every night just to get some sleep, it’s worth looking beyond your sleeping position.
Understanding why your hip has become painful gives you a much better starting point for getting back to comfortable nights and the activities you want to enjoy during the day.
If pain on the outside of your hip is disturbing your sleep or limiting your activity, book a hip pain assessment at The Physio Box in Kensington. We can help you understand what is contributing to your symptoms and put together a treatment and rehabilitation plan that fits your goals.
Hip pain keeping you awake?
If pain around your hip is regularly disturbing your sleep or limiting your activities, a physiotherapy assessment can help identify what may be contributing to it and what to do next.
Clinically reviewed by Giuseppe Salustri, Clinical Director, Senior Consultant Physiotherapist & MSK Sonographer
Giuseppe, Founder & Clinical Director of The Physio Box, has extensive experience across UK hospitals, elite sports and private practice. He has also worked as a team physiotherapist for multiple rugby teams, including the Italian national squad, and has particular expertise in injury rehabilitation.
Qualifications: MSc Physiotherapy, BSc Sport Rehabilitation
Regulatory bodies: HCPC, MCSP, AACP, BASRAT