Why Does My Hip Hurt at Night? 4 Common Causes and What You Can Do

By Emma - The Hip & Knee Physio

Hip pain at night can make a manageable daytime problem feel much more concerning. You may struggle to lie on one side, wake when rolling over or notice aching after a busy day.

The pain location and the positions that aggravate it can provide useful clues, but night pain does not confirm one diagnosis.

In brief: Pain directly over the outside of the hip that worsens when lying on that side commonly fits gluteal tendon pain. Deep groin pain with stiffness may fit hip osteoarthritis. Buttock or leg pain influenced by your back position may be referred from the spine. Persistent, severe or unusual night pain should be assessed.

I am Emma Glynn, an APA Titled Musculoskeletal Physiotherapist with more than 13 years of experience. I consult in Camberwell and work with active adults experiencing hip and knee pain.

Why can hip pain feel worse at night?

Night pain does not necessarily mean that your hip has suddenly deteriorated.

Several factors can make symptoms more noticeable after you go to bed.

Your hip may be reacting to the day’s activity

A longer walk, repeated stairs, gardening, gym training or prolonged standing may exceed what the hip can currently tolerate.

The pain may not peak during the activity itself. It can become more noticeable later that evening or after you have been still for some time.

Side-lying can compress sensitive tissues

Lying directly on the outside of the hip places pressure over the gluteal tendons and surrounding tissues.

The opposite side can also become uncomfortable if the upper leg drops forward and across the body without support.

The hip may stiffen during rest

Some hip conditions feel worse after sitting or lying still.

You may notice aching when you first get into bed, stiffness when turning or pain during the first few steps in the morning.

Poor sleep can make pain harder to manage

Pain can interrupt sleep, and poor sleep can make pain feel more intense the following day.

This can create an unpleasant cycle in which pain disrupts sleep and reduced sleep lowers your tolerance for pain and activity.

Cause 1: Gluteal tendinopathy and lateral hip pain

Pain directly over the outside of the hip commonly fits greater trochanteric pain syndrome.

This term includes conditions involving the gluteal tendons and sometimes the nearby bursa. The problem is often called hip bursitis, but the tendons are frequently an important part of the presentation.

Symptoms may include:

• pain over the bony outside of the hip;

• tenderness when pressing the area;

• pain lying on the affected side;

• pain when lying on the opposite side without leg support;

• aching down the outside of the thigh;

• pain climbing stairs or walking uphill;

• discomfort standing on one leg;

• pain after increasing walking or exercise.

Side-lying is often aggravating because it places direct pressure over the outside of the hip.

Treatment commonly involves reducing aggravating compression, adjusting activity and progressively rebuilding the capacity of the hip muscles and tendons.

Read more about gluteal tendinopathy and lateral hip pain.

Cause 2: Hip osteoarthritis

Hip osteoarthritis is another possible explanation, particularly in adults over 45.

A hip-joint pattern may include:

• pain in the groin or front of the hip;

• aching into the thigh or buttock;

• stiffness after sitting or sleeping;

• difficulty putting on shoes and socks;

• reduced hip movement;

• pain getting out of a low chair or car;

• reduced walking tolerance;

• pain with stairs or hills.

Night pain can occur when hip osteoarthritis becomes more symptomatic. It does not, by itself, show how advanced the arthritis is or mean that you require surgery.

X-ray findings and symptoms do not always match neatly. Some people have substantial imaging changes with manageable symptoms, while others experience considerable functional limitations with less dramatic findings.

Assessment should consider your symptoms, movement, activity limitations and imaging where it is likely to change management.

Learn more about hip osteoarthritis symptoms and physiotherapy.

Cause 3: Referred pain from the lower back

Pain felt around the buttock, side of the hip or thigh can sometimes be referred from the lumbar spine.

You do not always need prominent lower-back pain for the spine to contribute.

Features that may increase suspicion of spinal or nerve involvement include:

• pain extending below the knee;

• tingling or numbness;

• burning or electrical pain;

• symptoms altered by your back position;

• pain with prolonged sitting;

• weakness in the leg or foot;

• symptoms affecting a broad area rather than one tender point.

Hip-joint, tendon and spinal pain can overlap. Symptoms alone may not clearly establish which area is contributing most.

An assessment may need to include both the hip and lower back rather than choosing a diagnosis from pain location alone.

Cause 4: Another hip or medical condition

Not all night-time hip pain fits arthritis, gluteal tendinopathy or referred back pain.

Other possible explanations include:

• hip-flexor or proximal hamstring tendon pain;

• femoroacetabular impingement;

• hip dysplasia;

• stress fracture;

• inflammatory arthritis;

• infection;

• recent trauma;

• less commonly, another medical condition.

The likelihood of these conditions depends on factors such as your age, training history, medical history, injury mechanism and associated symptoms.

New, severe or rapidly worsening pain deserves assessment rather than being automatically attributed to a familiar arthritis or bursitis diagnosis.

Does pain when lying on your side mean bursitis?

Not necessarily.

Pain when lying on the side commonly occurs with gluteal tendon pain, but the term bursitis may not capture the whole presentation.

Side-lying pain can also be influenced by:

• hip osteoarthritis;

• referred lower-back pain;

• a gluteal tendon tear;

• recent trauma;

• pressure from the mattress;

• the position of the upper leg.

Tenderness over the outside of the hip is a useful clue, but it does not independently confirm the diagnosis.

Could your mattress be causing the pain?

A mattress can affect comfort, but it is rarely the only explanation for persistent hip pain.

A very firm surface may increase pressure over the outside of the hip. A mattress that allows the pelvis to sink deeply may also place the hips and back in an uncomfortable position.

Before buying an expensive new mattress in a hopeful act of household medicine, try changing your sleeping position first.

How should you sleep with hip pain?

If the painful side is on the mattress

Temporarily avoid lying directly on that side if pressure clearly aggravates symptoms.

Try lying on your back or the opposite side.

If the upper hip hurts when lying on the opposite side

Place a firm pillow between your knees and lower legs.

The pillow should support the whole upper leg rather than allowing the knee to fall forward and across the body.

If you keep rolling onto the painful side

Place a pillow behind your back to make rolling less likely.

If lying on your back feels better

A pillow beneath the knees may reduce strain through the hips and lower back for some people.

There is no single correct sleep position. The best position is the one that reduces

symptoms without creating discomfort elsewhere.

What can you do before bed?

Review the day’s activity

Consider whether the night pain followed:

• a longer walk;

• additional hills or stairs;

• a new gym exercise;

• gardening;

• prolonged standing;

• several active days without adequate recovery.

Temporarily reduce the aggravating dose rather than stopping all activity.

Use gentle movement

A short period of comfortable movement may reduce stiffness.

Options may include:

• easy stationary cycling;

• a short flat walk;

• gentle hip movement;

• sit-to-stands from a higher chair;

• a light bridge exercise if comfortable.

Avoid forcing the hip into a painful stretch.

Try heat or cold

Heat may feel helpful when stiffness is the main problem.

Cold may feel more comfortable when the hip feels reactive after activity.

Neither treats the underlying cause, but either may provide temporary relief.

Discuss medication appropriately

Your GP or pharmacist can advise whether pain relief or anti-inflammatory medication is appropriate.

Medication safety depends on your general health and other medicines, so this should not be decided by whichever box happens to be lurking in the bathroom cupboard.

What should you avoid?

Avoid:

• forcefully stretching into groin or lateral hip pain;

• repeatedly rolling or pressing directly over a tender outer hip;

• suddenly stopping all activity for weeks;

• pushing through exercise that causes a worsening limp;

• assuming night pain automatically means severe arthritis;

• assuming the mattress is the entire problem;

• starting several new treatments simultaneously.

Changing one or two factors at a time makes it easier to understand what your hip tolerates.

When should hip pain at night be assessed?

Arrange an assessment when:

• pain repeatedly disrupts your sleep;

• symptoms are worsening over time;

• you cannot lie comfortably on either side;

• walking, stairs or exercise are becoming harder;

• you are developing a persistent limp;

• the hip feels increasingly stiff;

• exercises repeatedly aggravate your symptoms;

• changing your sleeping position has not helped;

• you are unsure whether the pain is coming from the hip joint, gluteal tendons or lower back.

A physiotherapy assessment may include:

• clarifying where the pain is located;

• reviewing how symptoms behave during the day and night;

• assessing hip and spinal movement;

• testing relevant strength;

• examining walking, stairs or single-leg activities;

• deciding whether imaging or medical review may be useful;

• establishing an exercise and activity starting point.

If your pain is persistent but not urgent, learn more about hip physiotherapy in Camberwell.

When does night pain need prompt medical review?

Seek medical advice promptly if you have:

• sudden or severe pain;

• pain following a fall or other trauma;

• an inability to bear weight;

• fever or feeling generally unwell;

• redness, heat or marked swelling;

• rapidly worsening symptoms;

• unexplained weight loss;

• new numbness or weakness;

• bladder or bowel changes;

• pain that feels substantially different from your usual symptoms.

Healthdirect recommends prompt medical assessment for sudden or intense hip pain, pain following a fall, inability to move the hip or bear weight, swelling or fever.

Call Triple Zero on 000 for a medical emergency.

What this means for you

Hip pain at night can come from several sources.

The pattern may provide useful clues:

• Pain directly over the outside of the hip: may fit gluteal tendon pain.

• Deep groin pain with stiffness: may fit hip osteoarthritis.

• Buttock or leg pain with tingling or numbness: may involve the lower back or nerves.

• Sudden, severe or medically unusual pain: needs prompt medical assessment.

Symptoms can overlap, and one feature does not confirm a diagnosis. Research supports considering the broader history and examination because hip, tendon and lumbar presentations can produce overlapping pain patterns.

If hip pain is repeatedly disturbing your sleep or limiting your walking and exercise, an assessment can help establish the most likely explanation and provide a clearer plan.

Book an in-person hip assessment with Emma in Camberwell.

Emma

References

Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: Integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 910–922. https://doi.org/10.2519/jospt.2015.5829

Healthdirect Australia. (2026). Hip pain. https://www.healthdirect.gov.au/hip-pain

Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., & Vicenzino, B. (2018). 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, 361, k1662. https://doi.org/10.1136/bmj.k1662

Reiman, M. P., Goode, A. P., Hegedus, E. J., Cook, C. E., & Wright, A. A. (2021). Diagnostic accuracy of patient history in the diagnosis of hip-related pain: A systematic review. Archives of Physical Medicine and Rehabilitation, 102(9), 1847–1858. https://doi.org/10.1016/j.apmr.2021.02.014

Medical disclaimer

This article provides general educational information and is not a substitute for individual medical advice, diagnosis or treatment. Seek prompt medical advice for severe or worsening pain, recent trauma, inability to bear weight, fever, unexplained weight loss, neurological symptoms or other symptoms that concern you.