Why does my hip hurt at night when I sleep on my side?
Pain on the bony point of the hip that wakes you when you lie on it is usually gluteal tendinopathy — irritation where the glute tendons attach to the side of the hip. Lying on that side compresses those tendons directly against bone, which is why nights are the worst part.
What you’re feeling
This is one of the most commonly misidentified problems in the body, and it has a very specific signature:
- Pain over the bony point on the outside of the hip, which you can usually find with one finger
- Worst lying on that side — often the thing that wakes you
- Frequently sore lying on the *other* side too, when the top leg drops across the body
- Tender to press, sometimes too tender for a mattress
- Worse after walking, standing on one leg, or stairs
- An ache spreading down the outside of the thigh, but not past the knee
If your pain is in the groin rather than the outside of the hip, this isn’t your page — groin pain points at the hip joint itself and needs a different approach.
Why it’s happening
Tendons dislike two things: too much load too quickly, and compression. This one gets both, and most people unknowingly add more of the second while trying to help.
Compression, all day and all night
The tendons wrap over a bony prominence. Anything that presses them into it irritates them: sleeping on that side, sitting cross-legged, standing hitched onto one hip, sitting with knees together and feet apart. Small positions, held for hours.
Glutes that can’t tolerate the load
Gluteus medius and minimus stabilise your pelvis every time you stand on one leg — which is every step you take. When their capacity drops, usually gradually and unnoticed, the tendon takes strain it can’t absorb.
Hanging on one hip
Standing with your weight dumped onto one leg, hip pushed out sideways, is the most compressive position available and most people hold it for hours a day without noticing. Waiting in queues, cooking, holding a child on one hip.
Stretching it, which makes it worse
This is the important one. The instinctive fix — a figure-four stretch, pulling the knee across the body — compresses the tendon harder against the bone. It feels like relief for ninety seconds and sets the tendon back by days.
Stop and see a doctor if any of these are true
- Hip pain following a fall, particularly if you’re over sixty — fracture until proven otherwise
- Pain in the groin rather than the outside of the hip, or pain deep in the joint on rotation
- Night pain that doesn’t change at all when you move position
- Unexplained weight loss, fever, or a history of cancer
- Numbness or weakness travelling down the leg
Gluteal tendinopathy hurts more in some positions and less in others — that variability is characteristic. Pain that is unchanged by position, or that follows a fall, is a different matter and needs assessment.
How to fix it
Reduce the compression first. No amount of strength work will settle a tendon that’s being squashed for eight hours a night. Then load it, slowly, in positions that don’t compress it.
Stop stretching it — properly stop
For six weeks, no figure-four, no knee-across-the-body, no lying pigeon on that side. This will feel like giving up your only relief. It is the single most effective thing on this page, and most people’s pain drops noticeably within a fortnight of doing nothing more than this.
Starting todayRebuild the night setup
Sleep on the unaffected side with a firm pillow between your knees and ankles, thick enough that the top leg stays level with the hip rather than dropping across. If you must lie on the sore side, a mattress topper reduces the direct pressure.
Every nightIsometric hip abduction
Standing side-on to a wall, press the outside of your knee into it and hold. No movement at all. Isometrics calm irritable tendons and build tolerance without the compression that comes with moving through range.
30 seconds × 5 each side, dailySide-lying leg raise — lower side first
Lie on the *good* side, top leg straight and slightly behind the line of your body, lift about thirty degrees. Slightly behind matters: it keeps the tendon off the bone. Slow up, slower down.
10 reps × 3, every other dayUncross, unhitch, unstack
Through the day: don’t cross your legs, don’t stand hanging on one hip, don’t sit with knees together and feet apart. Set a phone reminder for the first fortnight. Habit change is doing as much work here as the exercises are.
All day, every dayTendons are slow. Three months is a realistic timeline and the first thing to improve is usually your sleep rather than your walking. If nothing has shifted in twelve weeks of genuinely avoiding the compression, see a physiotherapist — a supervised loading programme is well evidenced for this and worth the money.
Hips without the stretching
A guided routine built specifically for irritable glute tendons — strength and control, no compressive stretches.
Start the free classQuestions people ask next
Isn’t this bursitis?
That was the standard label for years and it’s largely been abandoned. When these hips are scanned, the tendons show changes far more often than the bursa does. It matters because the treatments differ: tendons need progressive load, and an inflamed bursa doesn’t.
Why does stretching make it worse?
Because the tendons pass over a bony point, and every stretch that pulls your knee across the body presses them harder into it. You’re relieving the muscle sensation while compressing the structure that actually hurts. It’s the most common reason this drags on for years.
Should I have a steroid injection?
It often gives real short-term relief, and there’s a place for that if you can’t sleep. Trials comparing it with exercise find the injection wins early and loses by a year. If you have one, use the window it buys to do the loading work.
Can I keep walking?
Yes, and you should. Reduce hills and long stretches if they leave you worse the next morning, but walking on flat ground at a comfortable pace is usually fine and helps. Avoid crossing one foot over the other as you walk.