Hip Pain When Sleeping on Your Side: Causes, Positions and What Helps

The short answer: Outer hip pain when lying on your side is often gluteal tendon irritation, called greater trochanteric pain syndrome (GTPS), though other causes exist. Sleep on your back or your pain-free side with a pillow between your knees, avoid crossing your legs, and build hip strength gradually. Get checked after a fall or if pain keeps worsening.

• The outer hip is the usual culprit. Pain on the side of the hip that is worse lying on that side is typical of GTPS [2][3].
• Tendons, not just a "bursitis". A sports-medicine review says gluteal tendinopathy and partial tendon tears are the most common causes [2]. Other sources call it trochanteric bursitis [3][4].
• Change the position first. Sleep on your back or the unaffected side with a pillow between your knees [2][3].
• Exercise beat injection in a trial. In people with gluteal tendinopathy, an 8-week education and exercise program had better results than a corticosteroid injection at 8 and 52 weeks [1].
• Be patient. Improvement can start within weeks, but a committed program for at least 3 to 6 months is advised [7].
• Not every night hip pain is the outer hip. Groin or thigh pain can come from the hip joint itself [5]. See the "when to get medical help" box for signs that need checking.

The outer hip has a bony bump, the greater trochanter, with the gluteal tendons attached to it. Pain on or around that bump is called greater trochanteric pain syndrome. MedlinePlus describes it as pain on the outside of the hip that may extend to the outer thigh, and lists lying on the affected side among the things that make it worse, along with getting out of a chair or bed, sitting for long periods and climbing stairs [3]. Cleveland Clinic gives a similar picture [4].

Lying on your side can press directly on the sore tendon for hours, which is why night is often the worst time. That is our plain-language explanation of the pattern the sources describe. Arthritis Foundation adds that the hip you are not lying on can also hurt if it strains forward [5], which is why a pillow between the knees comes up so often.

Is it a tendon problem or bursitis?

Sources use different names, so here they are side by side.

You do not need to settle the name to start. The self-care steps overlap, and a clinician can assess which fits.

Could it be something else?

Possibly. The sources suggest a few clues:

These are clues, not a diagnosis. The sources we read do not say how often each cause is behind night hip pain.

Follow these steps tonight.

1. Avoid lying on the sore hip. MedlinePlus says not to lie on the affected side [3], and a sports-medicine review says to sleep on your back or on the unaffected side [2].
2. If you sleep on your side, use the pain-free side and put a pillow between your knees [2][3]. Mayo Clinic also suggests a pillow between the knees for side sleepers [8].
3. Keep the top leg from dropping across your body. The pillow does this, and it also avoids the crossed-leg position that a review advises against [2]. (Our suggestion: choose a pillow thick enough to keep your knees about level with your hips.)
4. Stop yourself rolling onto the sore side. Arthritis Foundation suggests a pillow slightly behind your back [5].
5. Consider back sleeping. Arthritis Foundation calls it the suggested best solution for hip pain [5]. Mayo Clinic suggests a pillow under the knees for back sleepers [8].
6. Try a mattress topper. The sports-medicine review and Arthritis Foundation both say a topper may help [2][5]. Our mattress guide covers what the evidence says, mostly for back pain.
7. If you wake on the sore side, roll back to a better position instead of lying there. Cleveland Clinic lists avoiding lying on one side for too long as a prevention tip [4].

For another condition where pillow placement matters, see how to sleep with sciatica.

Night pain often reflects what the tendon was asked to do all day. The sources point to a few triggers:

• Crossed legs and low chairs. Hip Pain Professionals lists sitting in low chairs, especially with crossed legs, as an aggravator [7]. The BJSM review advises reducing time in cross-legged or deep hip flexion positions and avoiding excessive hip adduction, such as crossing the legs [2].
• Standing on one leg. Hip Pain Professionals lists standing on one leg, for example while dressing, as an aggravator [7]. (Our suggestion: sit to put on socks and trousers.)
• Stairs, hills and first steps. Both Hip Pain Professionals and MedlinePlus list stairs, walking uphill and getting up from a chair among aggravators [3][7]. The BJSM review suggests monitoring step count and temporarily reducing incline or cambered running terrain [2].
• Long standing. MedlinePlus advises avoiding standing for long periods, standing on a soft, cushioned surface with weight evenly distributed, and wearing comfortable, cushioned, low-heeled shoes [3].
• Body weight and core strength. MedlinePlus lists losing weight if overweight, and strengthening core muscles [3].

If your job involves long shifts, see back and foot pain on long shifts.

Education plus exercise has the best evidence we found

The main trial randomised 204 adults aged 35 to 70 with more than three months of lateral hip pain from gluteal tendinopathy (confirmed by exam and MRI; 82% were women) to three groups [1]:

• Education plus exercise: 14 physiotherapist-led sessions over eight weeks covering tendon load management, plus a daily home program targeting the hip abductors and control of hip adduction [1].
• Corticosteroid injection: one ultrasound-guided injection [1].
• Wait and see: one information session with reassurance and advice to stay active [1].

At 52 weeks, education plus exercise was still better than injection and waiting for overall improvement, while the pain scores of the exercise and injection groups did not differ significantly [1]. No serious adverse events were reported, and average weekly adherence to the exercise program was above 80% [1]. Participants knew which treatment they received, which the authors note could bias self-reported results [1]. This was one trial in people with confirmed gluteal tendinopathy, so it may not apply to every cause of outer hip pain.

What a loading plan looks like

The BJSM review describes a stepped approach that progressively loads the tendon at high intensity without provoking symptoms, with an emphasis on the frontal plane (side-to-side movement), starting with gluteal strength and control, then hip abductor strength [2]. Generic activity such as walking, swimming or cycling may also help [2]. Hip Pain Professionals says to maintain a committed program for at least 3 to 6 months, though improvements can come within a couple of weeks [7].

The plan below is our suggested structure built on that approach. It is not the trial's protocol, and the doses are common clinical starting points, not sourced prescriptions.

Exercises

(Our suggestion for the side plank: start from the knees. We chose these moves because the trial and review emphasize hip abductor and side-to-side control; the sources we read do not name specific exercises. Side plank may press on the lower hip, so skip it if it flares your pain.)

Mild discomfort that settles within a day is usually acceptable; pain that is sharp, climbs, or is still worse the next day means do less (our rule of thumb, for the clinician to confirm). The BJSM review's wording is to load the tendon "without provoking symptoms" [2].

Stop if you get sharp pain, new numbness or weakness, or pain that travels down the leg [3].

Use the exercise and rest timer for sets and rests. The glossary entry on tendons explains why they respond slowly. Kai, Loosn's AI physio coach, can help you progress a plan like this, but it does not replace assessment if your symptoms are severe, getting worse or unusual. For hip strength more broadly, see hip exercises for runners.

Ice, pain relievers and injections

MedlinePlus suggests ice packs 3 to 4 times a day for the first 2 to 3 days, and ibuprofen or naproxen to ease pain and swelling [3]. Cleveland Clinic lists over-the-counter pain relievers and advises not taking them for more than 10 days in a row without talking to a provider [4]. We do not give doses. Cleveland Clinic also lists corticosteroid injections and, rarely, surgery after more than six months of other treatments [4]. In the trial above, injection helped more than waiting at 8 weeks, but by 52 weeks it did not differ from waiting [1].

What about stretching?

Several outer-hip stretches pull the knee across the body, which is a form of hip adduction. The BJSM review advises avoiding excessive hip adduction positions such as crossing the legs [2]. We infer from this that cross-body stretches may irritate the tendon, but the sources we read do not test this, so treat it as a caution, not a rule. For why stretching alone often does not fix tight hips, see why stretching alone never loosens tight hips.

Cleveland Clinic says recovery from trochanteric bursitis often takes a few weeks with rest from irritating positions [4]. MedlinePlus says to call a provider if symptoms return or do not improve after 2 weeks of treatment [3]. For tendon-related pain, Hip Pain Professionals suggests improvement can come within a couple of weeks but a committed program should be kept up for at least 3 to 6 months [7]. In the trial, the exercise program ran 8 weeks with results measured at 8 and 52 weeks [1].

These timelines differ because they describe different conditions and goals. If you are not clearly improving after a couple of weeks of self-care, get assessed.

Most outer hip pain is not dangerous, but some symptoms need checking. Loosn gives no diagnosis. Night pain on its own is common with this condition, but night pain that persists or keeps getting worse deserves assessment.

Emergency: call 911 (or your local emergency number) or go to the emergency department if [3][6][9]:

• your hip pain follows a serious fall or injury and you cannot move your hip or put weight on the leg [3][6]
• the hip or leg looks deformed or out of place, or you have intense pain or sudden swelling after an injury [3][6]
• you have new bladder or bowel problems [3][9]
• you have a fever or chills with a painful, swollen hip after an injury [6]

(Other common emergency numbers are 999 in the UK, 112 across the EU and 000 in Australia.)

Get seen the same day if (our tiering) [3]:

• your pain travels down the leg, or you cannot stand on one leg [3]. MedlinePlus lists both under "right away", so go to urgent care or an emergency department if you cannot be seen quickly
• your leg weakness or numbness is getting worse quickly (standard teaching; see reviewer notes)

See your provider soon if [3][4][5][6][9]:

• the pain keeps you awake or prevents you from sleeping [5]
• pain is getting worse, or has not improved after 1 to 2 weeks of home care [3][4]
• you have weakness, numbness or tingling in a leg [9]
• redness and swelling persist despite home remedies [5]
• self-care steps are not helping [6]

Loosn is not a substitute for assessment when symptoms are severe, getting worse or unusual.

Why does my hip hurt when I sleep on my side? 

Pain on the outside of the hip that is worse lying on the affected side is a typical sign of greater trochanteric pain syndrome (GTPS) [2][3]. The most common causes are gluteal tendinopathy and partial tears of the gluteal tendons [2]. Other causes, such as hip osteoarthritis, can also hurt at night [5].

Is it hip bursitis or a tendon problem? 

Sources differ. MedlinePlus and Cleveland Clinic use the name trochanteric bursitis [3][4]. A sports-medicine review says gluteal tendinopathy and partial tendon tears are the most common causes, and that bursa changes are almost exclusively a friction phenomenon, with primary bursitis rarely seen [2]. A clinician can tell which fits you.

What is the best position to sleep with hip pain? 

Sleep on your back, or on your pain-free side with a pillow between your knees, and avoid lying on the sore hip [2][3][5]. A mattress topper may also help [2][5]. If you keep rolling onto the sore side, a pillow slightly behind your back can help you stay put [5].

Should I stretch a painful outer hip? 

Be careful. A sports-medicine review advises avoiding excessive hip adduction positions, such as crossing your legs [2]. That suggests stretches that pull your knee across your body could aggravate the tendon, though the sources we read do not test this. Strengthening has better evidence [1]. Ask a clinician which stretches suit you.

How long does outer hip pain take to improve? 

Some people feel better within a couple of weeks, but a committed exercise program for at least 3 to 6 months is advised for the full effect [7]. In a trial of people with gluteal tendinopathy, an 8-week education and exercise program gave better results than injection or waiting at 8 and 52 weeks [1].

Download the Loosn app through how Loosn works and ask Kai, Loosn's AI physio coach, for a hip strengthening plan that adapts to your pain. Before bed, try our breathing pacer as a way to wind down. We do not claim it treats hip pain.