Hip Pain at Night: Causes, Sleeping Positions and Help

Why a hip hurts more once you lie down

Two things change at bedtime. Lying on one side presses the outside of the hip into the mattress, and the top leg drops across the body unless something holds it apart, which squeezes the gluteal tendons against the bony point at the top of the thigh bone (Grimaldi and colleagues, 2015). Those tendons are now believed to be the main local source of pain on the side of the hip (Grimaldi and Fearon, 2015). So the position itself is doing the loading, even though you are resting.

The second change is attention. A review of prospective and experimental studies found that poor sleep reliably predicts new and worsening chronic pain, and that it predicts pain more consistently than pain predicts poor sleep (Finan and colleagues, 2013). A hip that grumbles quietly all day can feel much louder at 2 in the morning, and a bad night then leaves you more sensitive the following day.

Worth separating two patterns. A hip that hurts when you lie on it and settles when you move off it is behaving like a compression problem. A hip that aches at night, at rest, in any position, and is getting worse week by week is a different pattern, and the warning signs below say what to do about it.

What causes hip pain at night?

These are the usual explanations, not a diagnosis. Where the pain sits, and what happens when you change position, is what separates them.

The tendons on the outside of the hip

Pain over the bony point on the side of the hip, tender to press, sometimes spreading down the outer thigh, and clearly worse lying on that side. This is greater trochanteric pain syndrome, most of it coming from the gluteal tendons (Grimaldi and Fearon, 2015). It is far more common in women than in men (Segal and colleagues, 2007), and it is described as most prevalent in women after the menopause (Grimaldi and Fearon, 2015). The greater trochanteric pain syndrome program is the staged treatment for it, and outer hip pain covers the daytime triggers and the fuller exercise progression.

Hip osteoarthritis

Here the pain usually sits in the groin or the front of the thigh, and it can spread to the buttock or the knee. OrthoInfo describes pain that flares with vigorous activity at first and, as time goes on, appears more often during rest or at night, with stiffness that makes walking and bending harder. Getting comfortable in bed can take longer, and the first few steps to the bathroom are often the stiffest part of the day. The hip osteoarthritis program sets out the exercise side of treatment.

Pain sent from the lower back

A nerve irritated in the lower back can be felt in the buttock, the hip and down the leg. The NHS describes sciatica as affecting the bottom and the back of one leg, often reaching the foot and toes, with burning pain, tingling, numbness or weakness, and pain that can be worse when you move, sneeze or cough. If turning over in bed produces a shooting line down the leg rather than a deep ache over the hip, the back is a likelier source. Numbness in both legs, or any change in bladder or bowel control, is an emergency, and it is listed in the warning signs.

After a hip replacement

OrthoInfo says some discomfort with activity and at night is common for several weeks after a total hip replacement. Your surgeon and the hospital team set the positions, the timings and how long to keep a pillow between your knees, and their plan comes before anything on this page. The total hip replacement rehab program explains the usual stages. New or rapidly worsening pain, a wound that is red, hot or leaking, a fever, or a calf that is newly swollen, warm or tender all mean contacting that team the same day rather than waiting.

If you are pregnant

Hip, back and pelvic pain during pregnancy is common, and it is managed differently from everything above, so this page does not give advice on it. The pregnancy back and pelvic pain program covers that, and your midwife or maternity physio comes first. If you are pregnant, check with your midwife or physio before you start.

One thing on this page changes. From about 28 weeks the NHS advises going to sleep on your side rather than on your back, because going to sleep on your back in the last months is linked to a higher risk of stillbirth. So use the side-lying set-up below, on the pain-free 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.

Sleeping positions for a sore hip

The aim is to stop the top leg falling across the body and to keep direct pressure off the painful side. Both NHS leaflets behind this page say the same thing in slightly different words. If you are more than about 28 weeks pregnant, use position 2 rather than position 1. If you cannot get comfortable on the pain-free side that late in pregnancy, position 3 counts as a side position rather than a back one, so it is still open to you, but ask your midwife or maternity physio before you settle on it.

On your back. The simplest option, and the one the Kingston and Richmond leaflet names first.
On the pain-free side, with a firm pillow between your knees so the hips stay level and the upper thigh stays out of the compressed position (Cambridge University Hospitals; Kingston and Richmond). In practice a pillow long enough to carry the shin and ankle works better than a small one, since the leg then has nowhere to sag.
Semi-prone, roughly halfway between your side and your front, with pillows under the top leg. The Cambridge leaflet offers this when the first two do not work.
Off the painful hip. Both leaflets advise against lying on the sore side while it is settling.

Turning over is where people lose the position. Bring the pillow with you rather than rolling out of it, and move your knees together as one unit instead of letting the top leg swing across first.

Mattresses come up in every conversation about this, and none of the sources here backs a particular one. The Cambridge leaflet does suggest an eggshell topper, on the grounds that it spreads the pressure through the hip, so it is reasonable to try if you cannot avoid side lying. Spend the rest of the effort on the pillow between your knees, because that is what changes the position of the hip.

What else helps at home

Daytime load feeds night pain. Cut the walking distance for a while, stay off hills and take fewer stairs where you can, and an irritated tendon gets a chance to quieten down (Cambridge University Hospitals). Standing with your weight hung on one hip and sitting with your legs crossed both press the tendon against the bone, so they are worth breaking as habits.

For day-to-day relief the NHS suggests an ice pack wrapped in a towel on the painful area for up to 20 minutes every 2 to 3 hours, along with paracetamol (acetaminophen) or an ibuprofen gel. If you are unsure whether a painkiller is right for you, ask a pharmacist. The same NHS page suggests keeping too much strain off the hip while still keeping moving, wearing shock-absorbing shoes with a soft sole, avoiding low chairs and losing weight if you are carrying extra.

Leave the outer hip stretches alone while the hip is irritable. Stretches that pull the leg across the body hold the tendon in the compressed position, and the Cambridge leaflet advises against them for this reason.

Exercises for a hip that hurts at night

Strength work does not settle a hip overnight. What it does, over weeks, is raise how much the tendon or joint will tolerate. In the LEAP trial a physio led program of education about positions plus daily home exercises beat both a steroid injection and a wait and see approach at 8 weeks, with better overall improvement than the injection a year later (Mellor and colleagues, 2018). The four below are the gentlest starting point: two lying down, then weight shifting and a small squat.

If you have had a hip replacement, get the go-ahead from your surgeon or physio before you try the isometric clamshell, the glute bridge, the side to side weight shift or the mini squat. Some operations limit this kind of work for the first months, so the timing depends on your surgery. If you are pregnant, check with your midwife or physio before you start.

Exercises that can help

Use these on settled days rather than in the middle of a flare, and judge them by the next morning: a mild ache that has gone by breakfast is fine, a hip that keeps you awake is not. Most start with holds of 5 to 10 seconds repeated 5 to 10 times, or 2 to 3 sets of 10 to 15 repetitions, once a day to begin with. Each exercise page gives its own numbers, and your physio will adjust them.

Once these feel easy, outer hip pain carries the standing progression, and the greater trochanteric pain syndrome program sets it out stage by stage.

When to see a physio (physical therapist)

The NHS suggests seeing a doctor if hip pain is affecting your sleep, is getting worse or keeps coming back, or has not improved after 2 weeks of looking after it at home. Stiffness lasting more than 30 minutes after you wake is on the same list. A physio can work out whether the pain is coming from the tendons, the joint or the back, check how you are lying at night, and set the load so the hip is no worse the following morning.

Bring the details with you. Which side you lie on, how long it takes for the pain to wake you, whether it eases when you roll over, and what the hip is like on the stairs the next day all help narrow it down quickly. If you have had hip surgery, ask your surgical team before starting any new exercise.

Related exercise programs

See a doctor promptly if

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).
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.
Same day: severe hip pain that came on suddenly without a fall or injury. 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: a calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
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. 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. If you are being treated for cancer now, contact your cancer team the same day.
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

What is the best sleeping position for hip pain?

There is no single best position, but two are usually kinder to a sore hip. Lying on your back is the simplest. Lying on the pain-free side with a firm pillow between your knees is the other, because the pillow stops the top leg dropping across the body, which is the movement that compresses the tendons on the outside of the hip. The Cambridge University Hospitals and Kingston and Richmond NHS leaflets both give that advice and both suggest staying off the painful side. If neither position works, the Cambridge leaflet describes a semi-prone position, halfway between lying on your side and on your front, with pillows supporting the top leg.

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

Because it is the position, not the activity, that loads it. Lying on one side squashes the outside of the hip in a way that standing and walking do not, and the ache often builds slowly after you have settled, so it wakes you later rather than keeping you from dropping off. Daytime also gives you plenty of other things to notice. In bed there is nothing competing for your attention. A review of the research on sleep and pain found the two travel together, with sleep problems the more reliable predictor of later pain (Finan and colleagues, 2013).

Is hip pain at night arthritis?

It can be. OrthoInfo says hip osteoarthritis pain often flares with vigorous activity early on and, over time, turns up more often during rest or at night, and that it is usually felt in the groin or thigh rather than over the bony point on the side. NICE advises that from age 45, osteoarthritis can be diagnosed without an X-ray when the joint hurts with use and morning stiffness either lasts no longer than 30 minutes or is absent. Sore tendons on the outside of the hip are another common reason for waking in pain, so where it hurts tells you more than the hour does.

Can hip pain at night be a sign of cancer?

It is rare, and it is not the usual explanation for a hip that hurts when you lie on it. The pattern that matters is pain at night or at rest that does not ease when you change position and keeps getting worse, particularly alongside unplanned weight loss or a history of cancer. That combination appears in the warning signs on this page, with how quickly to act. Pain that stops as soon as you roll onto your back is a different story.

Does menopause cause hip pain at night?

The honest answer is that nobody has shown that it does. Gluteal tendinopathy is described as prevalent particularly among women after the menopause (Grimaldi and Fearon, 2015), Cambridge University Hospitals puts it as most common in the years around and after it, and in a US study of 3,026 adults aged 50 to 79 it was found in 23.5% of the women and 8.5% of the men (Segal and colleagues, 2007). Those figures describe who gets it, not why, and none of the sources on this page tested hormones as a cause. What they do tell you is that new night pain over the side of the hip is common at this stage of life, and that it usually answers to changing the load and building the hip muscles.

Is hip pain at night in pregnancy normal?

Hip and pelvic pain during pregnancy is common, and it is looked after differently, so this page does not cover it. The pregnancy back and pelvic pain program on this site is the place to start. Your midwife or maternity physio leads the plan, and anything you try in pregnancy goes past them first.

References

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
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
Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. Journal of Orthopaedic and Sports Physical Therapy. 2015;45(11):910-922. https://doi.org/10.2519/jospt.2015.5829
Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC. Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation. 2007;88(8):988-992. https://www.archives-pmr.org/article/S0003-9993(07)00302-4/abstract
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
American Academy of Orthopaedic Surgeons. Osteoarthritis of the hip. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/osteoarthritis-of-the-hip/
American Academy of Orthopaedic Surgeons. Total Hip Replacement. OrthoInfo. https://www.orthoinfo.org/en/treatment/total-hip-replacement/
National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. https://www.nice.org.uk/guidance/ng226
NHS. Hip pain in adults. https://www.nhs.uk/symptoms/hip-pain/
NHS. Sciatica. https://www.nhs.uk/conditions/sciatica/
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/
Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. Journal of Pain. 2013;14(12):1539-1552. https://doi.org/10.1016/j.jpain.2013.08.007

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-30.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.

Hip pain at night: why it happens and how to sleep