If you find yourself rolling over at night because the outside of your hip aches, you are not alone. Pain on the side of the hip when lying down is one of the most common hip complaints we hear about, and it can make a good night's sleep feel out of reach.
In many cases, this kind of pain comes from the tendons and soft tissues on the outer hip rather than the hip joint itself. Understanding why it happens can help you make simple changes that may ease night pain while you work on the underlying cause.
What is the most common cause?
The most common cause of pain on the outer hip is a condition called greater trochanteric pain syndrome, often shortened to GTPS. The greater trochanter is the bony point you can feel on the side of your hip. Several tendons from your gluteal muscles attach here, and there are small fluid-filled sacs called bursae nearby.
In the past, this pain was usually labelled as bursitis. Research now suggests that irritation of the gluteus medius and gluteus minimus tendons, known as gluteal tendinopathy, is often the main driver, with the bursa sometimes involved as well. You can learn more on our bursitis treatment and tendinopathy pages.
Why does lying on my side make it worse?
Tendons generally do not like being squashed. When you lie on the sore side, your body weight presses the tendons directly against the bone. When you lie on the other side, your upper leg tends to drop across your body, which stretches and compresses the same tendons from a different angle.
That is why many people find there is no comfortable side to sleep on. The same compression also explains why sitting with your legs crossed, standing with your weight hanging on one hip, or sitting in low chairs can aggravate symptoms during the day.
What else could be causing my hip pain?
Not all side hip pain is GTPS. Other possibilities your practitioner will consider include:
Hip joint osteoarthritis, which more often causes groin pain and stiffness, especially getting up after rest
Pain referred from the lower back, which can spread into the buttock and outer thigh
Irritation of the deep buttock muscles, sometimes called piriformis syndrome
Iliotibial band irritation, more common in runners and cyclists
Less commonly, stress fractures, labral tears or problems not related to the musculoskeletal system
Because the lower back and glute region can both refer pain to the hip, a thorough assessment matters.
What can I do to sleep more comfortably?
While you address the cause, a few simple strategies may help reduce compression on the tendons at night:
Place a pillow between your knees and ankles when lying on your side, so your upper leg stays level
Try lying on your back with a pillow under your knees
Consider a soft mattress topper if your mattress is firm
Avoid lying on the painful side where possible
During the day, try to stand with your weight spread evenly through both feet, avoid crossing your legs, and choose higher chairs. Many people are surprised to learn that stretches which pull the leg across the body can aggravate gluteal tendons, so it is worth checking your current routine with a practitioner.
How is it treated?
Treatment for GTPS usually focuses on education, load management and a gradual strengthening program for the hip and gluteal muscles. Research suggests that a structured exercise program combined with advice on reducing tendon compression can help many people improve their pain and function over a period of weeks to months.
Your plan may also include hands-on treatment to ease muscle tension, work on how you walk and climb stairs, and advice to help you stay active without flaring symptoms. A GP may discuss a corticosteroid injection for some people, which can provide short term relief, though symptoms may return if the tendons are not gradually loaded. Visit our hip pain treatment page for more on how we approach care.
When should I see a GP or seek urgent care?
Most side hip pain is not serious, but some symptoms need prompt medical attention. See a doctor urgently if you have:
Hip pain after a fall, especially if you cannot bear weight or your leg looks shortened or turned out
A hot, red, swollen hip or fever with hip pain
Night pain that does not change with position, unexplained weight loss or a history of cancer
Numbness in the groin or saddle area, or new changes to bladder or bowel control
A child or teenager with hip, thigh or knee pain and a limp
What might a strengthening program include?
Every program should be tailored to you, but many people start with gentle exercises that load the tendons without squashing them, then build up over time. Examples your practitioner may use include:
- Static holds where you press the leg outwards against resistance, often a starting point when pain is high
- Bridges to work the glutes and back of the thighs
- Sit to stand from a chair, progressing to lower seats or added weight
- Step ups and side steps to build strength in standing positions
- Single leg balance and control work as symptoms settle
It's normal for progress to feel slow at first. Tendons tend to respond to steady, consistent loading over weeks to months, so sticking with the program is usually more important than doing a lot at once. Our mobility, strength and movement therapy page and our osteopathy page explain more about how exercise and hands-on care can work together.
Frequently asked questions
Is side hip pain the same as hip arthritis?
Not usually. Hip arthritis tends to cause pain in the groin and stiffness in the joint, while GTPS is felt on the outer hip and is often tender to touch. The two can occur together, which is one reason an assessment is helpful.
How long does gluteal tendinopathy take to improve?
It varies from person to person. Many people notice changes within several weeks of reducing compression and starting a loading program, but tendons adapt slowly and a full program often runs for a few months.
Should I stop exercising?
Complete rest is not usually needed, and staying active is generally helpful. Your practitioner may suggest adjusting activities that aggravate pain, such as hill walking or long periods of standing on one leg, while you build strength.
Getting help on the Gold Coast
If hip pain is keeping you up at night, The Good Joint in Mermaid Beach can help work out what is causing it and guide you through a plan to get moving more comfortably. No referral is needed for most appointments, and you can claim on the spot with private health through HICAPS. Book online or call 07 5651 6594 to arrange an appointment with one of our physiotherapists.
Related reading: How long does sciatica take to go away? and What can help back and pelvic pain during pregnancy?
