Hip Pain at Night: Why You Can’t Sleep on Your Side

This article about hip pain at night is written by Leslie Budzynski DC, GCC-registered chiropractor (GCC No. 00043) with 39 years of clinical experience. Principal chiropractor at Bournemouth Chiropractic.

Few things wear a person down like hip pain at night that keeps them from sleeping. Someone might cope perfectly well through the day, keeps walking, keeps working, then dreads bedtime because the moment they lie on their side the outside of their hip causes them pain. They wake when they roll over, shuffle onto their back, drift off, then wake again, interrupted sleep is torment. By the time they reach me here at the clinic in Bournemouth they are not just sore, they are exhausted and the tiredness has started to impede everything else. If pain in the side of your hip at night sounds like your last few weeks, then this post is for you. The good news is that this pattern usually has a specific, recognisable cause and the even better news is that it responds well to the right approach.

This is a companion piece to my longer guide on whether your hip pain is actually coming from your hip or your back. That one is about daytime discomfort. This one is about the night.

Why hip pain is so often worse at night

The single most common reason for a hip that hurts at night and specifically for a hip you cannot lie on is a condition called greater trochanteric pain syndrome, or GTPS. The greater trochanter is the bony point you can feel on the outer side of your hip. Your gluteal tendons attach there and when those tendons become irritated and deconditioned, a state clinicians call gluteal tendinopathy, they dislike being compressed. Lying on the painful side presses the tendon directly against the bone. Lying on the other side lets the top leg drop across, stretching and squeezing the sore tendon from a different angle. Either way, the position that should be restful becomes the position that hurts most.

This matters because night pain when lying on your side is not an incidental detail, it is one of the defining features of the condition. In the large clinical trial that shaped how we treat gluteal tendinopathy, difficulty lying on the affected side was so characteristic it formed part of how patients were identified in the first place.^[1] So if that is your exact complaint, you are describing something clinicians will recognise immediately.

pinpointing the location of the radiating discomfort you might experience from hip pain during the night

Who gets it, and why it arrives out of nowhere

Gluteal tendinopathy has a clear demographic. It is far more common in women than men and it most often appears from the mid-forties onwards, with hormonal changes around menopause thought to play a part.^[2] In the trial I mentioned, the average age was in the mid-fifties and the great majority of participants were women.^[1] That is not to say men and younger adults never get it, they do, but if you fit that profile and your outer hip is keeping you awake, gluteal tendinopathy should be high on the list.

What frustrates people most is that it often seems to arrive from nowhere. In truth there is usually a trigger and the condition is rarely caused by an injury. Tendons object to sudden changes in load. A walking holiday along the coast path, a new fitness class taken up with enthusiasm after a quiet winter, a burst of hill walking or simply a stretch of doing more standing than usual can all tip a tendon that was quietly coping into one that complains. I see this pattern regularly particularly in keen walkers around Bournemouth and Poole, who are, if anything, punished for their good habits. The activity did not damage the hip, it simply asked more of the tendon than it was conditioned for at that moment.

The mistakes that keep you awake longer

Two well-meant instincts tend to make things worse. The first is stretching. When something feels tight, stretching seems the obvious answer, but the classic stretches for the outer hip and the practice of pulling the knee across the body both compress the gluteal tendon against the bone, which is exactly what it cannot tolerate. Many people stretch diligently for weeks and cannot understand why the pain deepens. The second is complete rest. Tendons respond to being loaded correctly, not to being protected entirely, and a hip that is rested and guarded tends to grow weaker and more irritable rather than settling.

There are, however, some things you can change tonight. A firm pillow placed between your knees when you sleep on your side keeps the top leg from dropping across and compressing the tendon and it is often the most helpful adjustment I can suggest. Sitting matters too: avoid crossing your legs and avoid sitting with your knees higher than your hips, both of which compress the tendon through the day so it is already irritable by bedtime. And standing evenly on both feet rather than hitching onto one hip, the classic hip-jutting parent stance, takes a surprising amount of daily load off the tendon.

What actually helps and how chiropractic care fits in

The encouraging takeaway from the research is that the treatment most likely to help is one you can largely carry out yourself, with guidance. The landmark trial compared a programme of education and progressive exercise against a corticosteroid injection and against just waiting and the education and exercise approach produced the best results at one year, clearly outperforming both the injection and the wait-and-see group.^[1] That is a very hopeful finding, because it means the road to recovery does not depend on needles or on luck, it depends on loading the tendon correctly over time.

My role as a chiropractor is to confirm that this is a condition you actually have, since outer hip pain can occasionally come from the joint itself or from the back, then to help you through the two things that matter most. The first is settling the irritable tendon and removing the daily compression that keeps provoking it, where hands-on treatment of the surrounding muscles and gentle work on the hip, pelvis and lower back may help ease symptoms and give the exercise programme room to work. The second and the real driver of recovery, is a graded strengthening programme for the gluteal muscles that builds gradually week by week. This is a condition measured in weeks and months rather than days, so I will always be realistic about the timescale, but the direction of travel is reliably good and getting your nights rest back on track tends to come earlier than the full recovery. You can read more about the full picture on my lateral hip pain and GTPS page, which sits within the wider hip and pelvic pain section of the site.

If your nights have become something you dread, I would be glad to help you reclaim them. You can book a free 15-minute consultation to talk through what is going on or call the clinic directly on 01202 937568 for a chat.

When night hip pain needs a doctor first

Almost all outer hip pain at night is mechanical and not a sign of anything serious. A few patterns do warrant seeing your GP before anything else. Constant, deep pain that is present in every position and does not ease when you find a comfortable spot is different from the position-dependent pain of a tendon problem and should be checked, particularly if it comes with unexplained weight loss, a fever or a general feeling of being unwell. Pain following a significant fall where you cannot take weight through the leg needs urgent assessment. And a hot, swollen, rapidly worsening hip should be seen promptly. These situations are uncommon, but they are worth knowing, and if any apply, please start with your GP, 111, or A&E first.

Frequently asked questions about hip pain at night

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

Your hip may hurt at night but not during the day because lying down compresses the irritated gluteal tendon on the outer hip in a way that standing and walking do not. Lying on the painful side presses the tendon against the bone and lying on the other side lets the top leg drop across and squeeze it. This position-dependent pattern is typical of gluteal tendinopathy.

How should I sleep to ease hip pain at night?

To ease hip pain at night, place a firm pillow between your knees when lying on your side, which stops the top leg dropping across and compressing the sore tendon. Try to avoid lying directly on the painful hip. Many people find a period on their back helpful and keeping the daytime tendon compression down, no leg-crossing, no low soft chairs, means it is less irritable by bedtime.

Can a chiropractor help with hip pain at night?

A chiropractor may help with hip pain at night by first confirming the cause, then easing the irritable tendon with hands-on care and guiding the education and exercise programme that carries the strongest evidence for gluteal tendinopathy. The emphasis sits on progressive gluteal strengthening and reducing daily tendon compression, with treatment supporting that process rather than replacing it.

Is it bad to sleep on the side that hurts?

Sleeping on the painful side is not dangerous, but it does directly compress the sore gluteal tendon, which tends to keep it irritated and disturb your sleep. Most people are more comfortable avoiding that side while the tendon settles, using a pillow between the knees when they turn onto the other side. As the tendon recovers with strengthening, lying on it usually becomes comfortable again.

How long does gluteal tendinopathy take to get better?

Gluteal tendinopathy improves over weeks and months rather than days, because tendons respond to gradual, progressive loading rather than quick fixes. Many people notice their nights improving before full recovery, which is often the change that matters most. A structured strengthening programme, guided and built up over time, gives the best long-term results according to the current evidence.

Losing sleep to hip pain is miserable and you do not have to simply wait it out. If pain on the side of your hip is keeping you awake, come and find out what is behind it. Call me on 01202 937568 or book a free 15-minute consultation at Bournemouth Chiropractic, 42 Branksome Hill Road, Bournemouth BH4 9LE.

This post is for information only and does not constitute medical advice. If you are experiencing severe or worsening symptoms, please consult your GP or call 111.

References

[1] Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial (LEAP trial). BMJ 2018;361:k1662. doi:10.1136/bmj.k1662

[2] Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy 2015;45(11):910-922. doi:10.2519/jospt.2015.5829

[3] Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation 2007;88(8):988-992. doi:10.1016/j.apmr.2007.04.014

[4] Fearon AM, Cook JL, Scarvell JM, et al. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. Journal of Arthroplasty 2014;29(2):383-386. doi:10.1016/j.arth.2012.10.016

[5] Rompe JD, Segal NA, Cacchio A, et al. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. American Journal of Sports Medicine 2009;37(10):1981-1990. doi:10.1177/0363546509334374