Part of Greater trochanteric pain syndrome
Why does hip bursitis hurt more at night?
Warning signs, and when to get help
Why does hip bursitis hurt more at night?
There are two ways the hip gets loaded in bed. Most advice deals only with the first, which is why following all of it often half works.
Lie on the painful side and your body weight pins the tendons at the side of the hip between the mattress and the bony point they attach to. That bony point is the greater trochanter, and the gluteus medius and gluteus minimus tendons attach there. Those tendons are now regarded as a main local source of the pain, so the condition is called greater trochanteric pain syndrome or gluteal tendinopathy rather than trochanteric bursitis (Grimaldi and colleagues, 2015). The greater trochanteric pain syndrome program is the treatment page for it.
The second way is indirect, and it is the one people miss. Tendons are thought to cope worst with being squeezed against bone and pulled hard at the same time, and for these tendons the squeeze happens when the thigh travels across the midline of the body (Grimaldi and colleagues, 2015). Roll onto your good side with nothing between your knees and the upper thigh does precisely that. The hip that is not touching the bed is still being compressed.
OrthoInfo lists pain that is typically worse at night and worse lying on the affected hip, so none of this is unusual or a sign you have something rarer. Hip pain at night covers the other conditions that produce it, including the hip joint itself.
Why does it hurt on the other side too?
Because of that second mechanism. It is the commonest complaint from people who have already taken the obvious step, got off the sore hip, and found it only half worked.
Whether the good side is comfortable comes down to where the upper knee finishes, and one landmark settles it: the upper hip. Held roughly level with that hip, the thigh is in line with your body and the tendon is not being pressed. Sagged down toward the lower knee, the thigh has crossed the line and the tendon is. That is the entire reason both NHS leaflets behind this page, from Cambridge University Hospitals and from Kingston and Richmond, ask for a pillow between the knees rather than simply asking you to turn over.
It also explains the common experience of a set-up that works for the first part of the night and fails later. A pillow that has compressed flat under the weight of a leg by one in the morning is no longer holding anything apart.
Why does the night do what a day of walking does not?
A day on your feet loads these tendons harder than a night in bed does. Each step asks the muscles at the side of the hip to hold the pelvis level, and stairs and hills ask for more. So why is the night worse?
The difference is continuity. Walking delivers load in bursts, with the hip changing position constantly and getting a moment of relief between steps. A sleeping position delivers compression without interruption for as long as you stay in it, and lying still gives the tissue no break from it. That reasoning follows from the compression mechanism Grimaldi and colleagues describe; no study has measured hours in bed.
It is also why the night position deserves more attention than it sounds as though it should. The pillow between the knees is working for seven hours. The best exercise on the program is working for perhaps forty seconds at a time.
Does night pain mean it is getting worse?
No, and this is the question most people are really asking at two in the morning.
Night pain and pain lying on the affected side are listed by OrthoInfo among the features of this problem. They are part of what the condition is, not a reading on how much damage has been done. Nothing in the evidence base suggests that a painful night harms a tendon, and the treatment that works best for this condition is loading rather than protection. In the LEAP trial, a program of education about positions plus daily home exercise produced more people rating themselves improved at 8 weeks than a steroid injection or waiting, and better overall improvement than the injection a year later (Mellor and colleagues, 2018).
What should change your mind is a change in the pattern, not a bad night. Pain that depends on the position, and eases once you move off it, is behaving mechanically. Pain that is there in every position, ignores what you do with pillows and keeps building week on week is a different pattern, and the last section of this page says what to do about it.
A bad night can tip the hip into a flare over the following days, and outer hip pain flare ups answers that separately. If the pain is not sitting where this page says it should, start with where outer hip pain is felt and where it travels, because night pain from the hip joint and night pain from the back behave differently.
Why is the morning after a bad night the worst part?
The tendons have been held in a compressed position for hours without moving, and the opening demand of the day is to take your entire body weight on one leg, repeatedly, on the way to the bathroom. A few steps in it usually begins to ease.
That first-few-steps pattern comes from what people describe in clinic, not from anything a trial has measured. It still has a practical use. Physios judge whether yesterday was too much by how the hip is on waking, so a sore morning after a long walk and a sore morning after a night on the wrong side mean different things, and you want to know which one you have had.
What to do about it tonight
Keep off the painful side while it is settling, and put something between your knees that is thick enough to hold the upper knee level with the upper hip, long enough to carry the shin so the leg cannot sag. Lying on your back is the other option. If the surface itself is the problem and side lying is unavoidable, a softer top layer is reasonable to try, and no trial has tested it.
If you have had a hip replacement or other hip surgery, follow the sleeping positions your surgical team gave you instead of the ones on this page, because theirs come first.
From about 28 weeks of pregnancy the NHS advises going to sleep on your side rather than on your back, because it says sleeping on your back after that point can double the risk of stillbirth. So use your good side with a pillow between your knees, and leave lying on your back until after the birth. The NHS also says not to worry if you wake up on your back: settle onto your side again and carry on.
For the rest of it, the parent program's section on nights, mattresses and chairs has the detail. Hip pain at night has the full list of positions and what else helps at home, and sleeping positions and night pain with hip arthritis covers turning over and getting out of bed. Daytime load feeds the night, and sitting and crossing your legs with outer hip pain is where most of it builds up.
When night pain is a reason to get checked rather than managed
Everything above is about pain that answers to a position. One pattern does not.
Hip pain at night or at rest that does not ease when you change position, and keeps getting worse, needs a doctor within a few days. If you have had cancer, now or in the past, or are losing weight without trying, that becomes sooner, within a day or two, and say so when you call. The warning list below carries both in full, along with the faster routes for a hot swollen hip, a fall on fragile bone, and new weakness in the leg or foot.
The rest of the time, a routine appointment is the right pace. Book one if outer hip pain is stopping you sleeping or doing what you normally do, or if it has not improved after 2 weeks of looking after it at home (NHS). If you have been doing the program properly for 6 to 8 weeks and the nights are no better, ask for the diagnosis and the plan to be reviewed instead of buying another pillow. Overlapping conditions are common in this area, hip osteoarthritis and the lower back included, which the ISHA physiotherapy agreement names among the things to screen for (Disantis and colleagues, 2023), and outer hip pain sets out the wider list.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: tingling or loss of feeling in the hip or leg after a fall or injury. Call emergency services or go to an emergency department.
- Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
Get help today
- Same day: the hip is hot and swollen, the skin around it has changed color, or you have hip pain with a high temperature or feel hot, cold or shivery. Get medical help the same day, and go to an emergency department if you feel very unwell. A joint infection needs treatment quickly. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: severe hip pain that came on suddenly without a fall, or pain that is getting worse quickly over a few days. Get medical advice the same day.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a child or teenager has sudden pain in the hip, thigh or knee, is limping, or cannot put weight on one leg. Get an urgent appointment with a doctor the same day. If they have a high temperature or seem very unwell, go to an emergency department. This page is for adults, and hip pain in children has different causes.
- Same day: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. See your doctor within a few days.
- Within a few days: new pain in the groin or buttock, and you take steroid tablets long term, or have in the past, or you regularly drink a lot of alcohol. This can be a sign of a problem with the blood supply to the top of the thighbone (avascular necrosis). Book an appointment with your doctor within a few days and mention the steroids or alcohol.
- Within 2 weeks: pain that spreads down the leg below the knee, especially with numbness or tingling in the leg or foot. The pain may be coming from your lower back rather than the hip tendons. Book an appointment with a doctor or physio.
- Within 2 weeks: the pain is mostly in the groin rather than on the outside of the hip, or the hip is stiff and hard to bend, for example when you put on socks. This points more toward the hip joint itself, such as hip osteoarthritis. Book an appointment with a doctor or physio so the cause can be checked.
Common questions
Why does hip bursitis hurt more at night?
Because the hip spends the night in a loaded position instead of a moving one. On the painful side, your own body weight presses the gluteal tendons into the bony point at the top of the thigh bone. On the other side, the top leg falls across the midline unless something holds it apart, and that is the position that compresses those same tendons against the bone (Grimaldi and colleagues, 2015). OrthoInfo lists pain that is typically worse at night and worse lying on the affected hip. Both of those are positions, which is why the fix is a position rather than a painkiller.
Why does it hurt when I lie on the other side too?
Because the compressed position does not need you to be lying on the sore hip. With the painful hip uppermost, the top thigh drops inward across your body unless a pillow stops it, and that squeezes the tendon against the bone just as side lying presses it from underneath. The two NHS leaflets behind this page, from Cambridge University Hospitals and Kingston and Richmond, both ask for a pillow between the knees for exactly this reason. A pillow that has flattened under the weight of the leg by midnight has stopped doing the job.
Why does it wake me up rather than stop me going to sleep?
Because the loading is cumulative rather than instant. Settling onto a hip is usually tolerable for a while, and the ache builds over the following hour or two until it crosses the threshold that wakes you. That is the common description in clinic rather than something a trial has measured. What it means practically is that getting comfortable at lights out tells you very little about how the night will go, so judge a change of set-up over three or four nights rather than on how it feels as you drop off.
Does night pain mean it is getting worse?
Not on its own. Pain at night and pain lying on that side are among the characteristic features of this condition, not a measure of how much tendon change there is, and OrthoInfo lists them as typical rather than as warning signs. Nobody has shown that a bad night damages a tendon. What matters is the pattern: pain that depends on the position, and eases when you move off it, is behaving mechanically. Pain that is there in every position, takes no notice of pillows, and keeps building week after week is the pattern on the warning list on this page, and that one needs a doctor.
Why is it worse the morning after a bad night?
Two things land at once. The tendons have been held in a compressed position for hours with no movement, and then the first thing you ask them to do is take your whole body weight on one leg as you stand up and walk to the bathroom. Several steps in, it usually eases. That first-few-steps pattern is a clinical observation rather than a measured finding, and it is also the reason physios use the next morning as the reading on whether yesterday was too much.
Does a softer mattress or a mattress topper help?
It is reasonable to try, and no trial has tested mattresses in this condition. The thinking is simple enough, which is that a firm surface presses straight onto the bony point, so spreading that pressure over a softer surface should hurt less. An eggshell topper is named for that purpose in the Cambridge University Hospitals leaflet. We name no brand and no product, because the thing doing the work is thickness and give rather than a label. The pillow between your knees is still the higher-value change, because it alters the position of the hip rather than the pressure on it.
References
- Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine. 2015;45(8):1107-1119. https://doi.org/10.1007/s40279-015-0336-5
- Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. 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. BMJ. 2018;361:k1662. https://doi.org/10.1136/bmj.k1662
- Disantis A, Andrade AJ, Baillou A, et al. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement. Journal of Hip Preservation Surgery. 2023;10(1):48-56. https://doi.org/10.1093/jhps/hnac050
- American Academy of Orthopaedic Surgeons. Hip bursitis. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/hip-bursitis/
- Cambridge University Hospitals NHS Foundation Trust. Gluteal tendinopathy. Patient information. Approved 14 January 2025. https://www.cuh.nhs.uk/patient-information/gluteal-tendinopathy/
- Kingston and Richmond NHS Foundation Trust. Greater trochanteric pain syndrome. Patient leaflet. Last updated 9 December 2024. https://www.kingstonandrichmond.nhs.uk/patients-and-families/patient-leaflets/greater-trochanteric-pain-syndrome
- NHS. Hip pain in adults. Page last reviewed 20 November 2025. https://www.nhs.uk/symptoms/hip-pain/
- NHS. 27 weeks pregnant: the best sleeping positions during pregnancy. Best Start in Life week by week guide. https://www.nhs.uk/best-start-in-life/pregnancy/week-by-week-guide-to-pregnancy/2nd-trimester/week-27/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-17.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.