Why Does Lateral Hip Pain Hurt More at Night? - And the Best Sleeping Positions for Gluteal Tendinopathy
- Emma Glynn
- 1 day ago
- 5 min read
By Emma Glynn - The Hip & Knee Physio
Quick take:
Pain on the outside of the hip is often blamed on “bursitis.” In many active adults, especially walkers and runners, the gluteus medius/minimus tendon is a major driver (gluteal tendinopathy). Getting the label roughly right matters because the first steps can differ.
This article is general information only and not a substitute for personalised assessment.
What do we mean by bursitis vs. gluteal tendinopathy?
why-does-lateral-hip-pain-hurt-more-at-night-and-the-best-sleeping-positions-for-gluteal-tendinop
Trochanteric bursitis: irritation of the fluid-filled bursa over the outside of the hip.
Gluteal tendinopathy: load-related sensitivity of the gluteus medius/minimus tendons where they attach at the greater trochanter.
They can co-exist. Early management usually focuses on pacing load, reducing compressive positions, and introducing strength work you can tolerate.
Why the label matters (for early management)
Bursae dislike compression and spikes in pressure (e.g., lying directly on the sore side).Tendons dislike sudden load jumps and respond best to graded strengthening. Both benefit from sensible activity modification, sleep position tweaks, and a progressive plan rather than long stretches of rest or endless stretching.
Scans rarely change these first steps unless there are red flags. If pain is severe, night-waking, or not improving, book an assessment.
Simple self-checks
These aren’t diagnoses, just patterns you can notice this week:
Side-lying increases pain (especially on the sore side) → consider tendon compression sensitivity.
Long walks/standing/stairs flare later that day or the next morning → common in tendon overload.
Recent bump/fall onto the outside hip with warmth/swelling → can point more bursal.
Deep outside-hip stretching gives temporary relief but symptoms return or worsen later.
If you’re unsure, start with pacing and basic strength; avoid deep stretch holds into pain.
Common mistakes that keep lateral hip pain hanging around
More stretching, less strength. Tendons adapt to progressive loading, not just mobility work.
Big step-count spikes after a “rest week.” Tendons hate sudden jumps.
Sleeping on the sore side without knee support, compresses the tendon area overnight.
Running with a narrow step width → more pelvic drop → higher lateral hip load.
Chasing scans first. Imaging often doesn’t change early, evidence-informed care.
Safe first steps this week
Adjust daily loads
Keep walking (most days), but clip distance/pace so pain settles within 24 hours.
Reduce long single-leg stances (e.g., when brushing teeth, lightly rest the free foot on a step).
Start simple strength (3–4×/week)
Aim for mild, manageable effort (muscle working is fine; sharp pain is not).
Isometric wall lean — Stand side-on to a wall, feet slightly away, lean gently through the hip.20–30 seconds × 3 per side.
Supported step-downs — Small step, slow control, slight hip hinge, hold rail for balance. 6–8 reps per side.
Side-lying hip abduction — Neutral hip, small range, slow tempo.2 × 8–10 per side.
If pain spikes sharply or lingers beyond 24–36 hours, reduce range/reps and try again.
Walking & sleep tweaks that help
Walking
Try a slightly wider step to reduce pelvic drop.
Keep distance at a level that settles within 24 hours (slight ache is OK; sharp/lingering pain = too much).
Build gradually week to week.
Sleep
If side-lying, place a small pillow between knees to reduce outside-hip compression.
If you prefer the sore side, add a second pillow under the top leg so it doesn’t roll across and compress the hip.
These adjustments don’t replace rehab - they simply make it easier to tolerate daily load while you build strength.
When to get help
Pain wakes you regularly or isn’t improving.
You’re unsure if it’s tendon, bursa, or something else.
You’ve tried DIY changes for 2-3 weeks without progress.
Next step options
Take the 2-minute self-assessment quiz for general guidance. →
Explore the Gluteal Tendinopathy Kickstarter (6-week home plan with clear progressions) →
Want to see a physio in-person?
Booking an initial consult is the best way to get clear on your options. You’ll leave with a personalised plan, a clearer understanding of what’s driving your pain, and evidence-based strategies you can use straight away.
If you’re in Melbourne or Camberwell and need experienced hip and knee physio, book a consultation with APA Titled Hip and Knee Physio - Emma, today.
👉 Call now on 9978 9833 or book online to take the first step toward pain-free movement.
FAQs
Do I need a scan first?
Often no. Early management is guided by symptoms and function. Scans are considered if there are red flags or if you’re not responding as expected.
Can I keep walking?
Yes, with pacing. Choose distances that settle within 24 hours, then build gradually.
How long does improvement take?
Varies by person. Many notice change over 6–8 weeks with consistent, progressive loading and sensible activity tweaks.
Who this article is (and isn’t) for
This guide is for adults with lateral hip pain who want safe first steps at home. It’s not designed for post-op care, acute inability to weight-bear, or pain with systemic symptoms. If that’s you, book an assessment (in-person Camberwell or telehealth).
What to do now
Take the 2-minute self-assessment quiz (general info only). → [Quiz]
Explore the Gluteal Tendinopathy Kickstarter (6-week, physiotherapist-designed home plan). → [Program]
Book an assessment for personalised care. → [Bookings]
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The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.
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References
Clifford, C., Malliaras, P., Kautman, L., & Mellor, R. (2019). Isometric versus isotonic exercise for greater trochanteric pain syndrome: A randomised controlled pilot study. BMJ Open Sport & Exercise Medicine, 5(1), e000558.
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.
Grimaldi, A., Mellor, R., Hodges, P., Wajswelner, H., Littlewood, C., & Bennell, K. (2015). Gluteal tendinopathy: A review of mechanisms, assessment and management. Sports Medicine, 45(8), 1107–1119.
Kinsella, R., Semciw, A. I., Hawke, L. J., Stoney, J., Choong, P. F. M., & Dowsey, M. M. (2024). Diagnostic accuracy of clinical tests for assessing greater trochanteric pain syndrome: A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 54(1), 26–49.
Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H., & 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.
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