Hip Pain When Lying on Your Side at Night: Causes and What to Do

Short answer: Hip pain when lying on your side commonly comes from pressure and compression around the outer hip, particularly the gluteal tendons and nearby bursa. However, hip-joint arthritis, a lower-back or nerve problem, injury, bone stress and less common medical conditions can also cause pain at night. The exact location, whether changing position relieves it, and the presence of walking pain, stiffness, fever, weight loss or neurological symptoms help determine what should be assessed.

“Hip pain at night” is not one diagnosis. One patient may hurt only when the outer hip presses against the mattress. Another may have deep groin pain that wakes them in every position. A third may have buttock pain and tingling down the leg. These patterns require different examination questions, tests and treatment plans.

When night hip pain needs urgent medical assessment

Seek urgent assessment if hip pain is accompanied by:

• inability to stand or bear weight after a fall, collision or sudden injury;
• a shortened, rotated or visibly deformed leg;
• fever, chills, serious illness, rapidly increasing swelling, redness or warmth;
• new loss of bladder or bowel control, saddle numbness or rapidly worsening leg weakness;
• a cold, pale or blue leg, or substantial new one-sided leg swelling;
• severe, rapidly worsening or unremitting pain that is not altered by position;
• progressive night pain with unexplained weight loss, an enlarging mass or a history of cancer; or
• chest pain, breathlessness, collapse or coughing blood.

Older adults and people with osteoporosis may sustain a fracture after a relatively minor fall. Being able to take a few steps does not completely exclude a fracture. For a life-threatening emergency in Singapore, call SCDF 995.^[1] The Pain Relief Clinic is not an emergency service.

Is night pain itself a warning sign?

Night pain is common in musculoskeletal conditions and does not automatically indicate a dangerous cause. Pain that occurs only when lying on the affected side and eases after changing position often suggests pressure-sensitive outer-hip tissues.

Earlier medical review is more important when pain is severe and progressive, occurs in every position, does not ease after getting up, or is accompanied by fever, unexplained weight loss, a mass, marked weakness or other warning features. The pattern matters more than the clock time alone.

Where is the pain centred?

• On the bony outer side of the hip: suggests greater trochanteric pain syndrome, often involving gluteal tendons.
• Deep in the groin or front of the thigh: raises a hip-joint question such as osteoarthritis.
• In the buttock: may relate to the lower back, deep gluteal tissues, sacroiliac region or hamstring origin.
• Burning or tingling down the leg: raises a nerve-related question.
• Focal pain after trauma: requires assessment for soft-tissue or bone injury.

Pain may spread, and more than one problem can coexist. Location guides the assessment but does not establish the diagnosis by itself.

1. Greater trochanteric pain syndrome and gluteal tendinopathy

Greater trochanteric pain syndrome, or GTPS, is a common cause of pain over the outer hip. It often involves the gluteus medius or minimus tendons where they attach near the greater trochanter. The nearby bursa may also be involved.

Typical features may include:

• tenderness over the outer hip;
• pain lying on the affected side or sometimes either side;
• pain during walking, stairs, hills or prolonged standing;
• pain standing on one leg to dress; and
• discomfort rising from a chair.

Cambridge University Hospitals describes pain when lying on either side, tenderness over the outer hip and pain during activities such as walking and stairs as features of gluteal tendinopathy.^[2] Compression can occur when lying directly on the painful side and also when the upper leg drops across the body while lying on the opposite side.

Although the term “trochanteric bursitis” is still widely used, isolated bursal inflammation is not the only—and often not the main—explanation. Repeatedly treating the bursa without assessing tendon capacity, hip mechanics and activity load may not address the full problem.

2. Hip osteoarthritis

Hip osteoarthritis may cause groin, thigh, buttock or outer-hip pain. Stiffness, reduced rotation, difficulty putting on socks, discomfort rising from a low chair and reduced walking tolerance support a joint-related pattern.

Symptoms can disturb sleep, but night pain alone does not show how advanced the arthritis is. NICE advises that osteoarthritis can often be diagnosed clinically in people aged 45 or older who have activity-related joint pain and either no morning stiffness or morning stiffness lasting no longer than 30 minutes, unless atypical features suggest another diagnosis.^[3]

X-ray findings do not always match pain severity. Treatment decisions should be based on symptoms, function, previous care and patient goals rather than the imaging grade alone.

3. Gluteal muscle or tendon injury

A fall onto the side of the hip, sudden force or substantial increase in activity may strain or tear gluteal tissues. Pain may occur during side-lying, walking, stairs or moving the leg away from the body. Marked weakness, bruising, a sudden pop or a persistent limp warrants assessment.

Some tendon changes develop gradually rather than through one memorable injury. MRI or ultrasound may help when the examination raises a management-changing question about a tear, but not every painful tendon needs a scan.

4. Pain referred from the lower back or nerves

The lumbar spine can refer pain into the buttock, side of the hip or thigh. Nerve involvement may cause burning, electric pain, tingling, numbness or weakness, sometimes extending below the knee.

The relationship to spinal position, coughing or sneezing and neurological examination helps distinguish referred pain from an outer-hip tendon problem. A patient can also have both. A normal hip X-ray does not exclude a lumbar or neurological contributor.

5. Hip impingement, labral or other joint problems

Femoroacetabular impingement and symptomatic labral problems more commonly produce deep groin pain, clicking, catching or pain with hip flexion and rotation. Sleep may be affected because the hip remains flexed, rotated or compressed in a particular position.

Clicking by itself does not prove a labral tear. Imaging findings need to correspond with symptoms and examination before they guide a procedure or surgical referral.

6. Bone stress injury, occult fracture or osteonecrosis

Bone stress injury may follow a rapid increase in running, walking or military training. Deep groin or hip pain can progress from activity-only pain to pain during ordinary walking or at rest. Early X-rays may be normal, and MRI can be useful when clinical concern remains.

Osteonecrosis is loss of blood supply to part of the femoral head. Risk factors can include substantial corticosteroid exposure, heavy alcohol use, previous trauma and certain medical conditions, although it can occur without an obvious risk factor. Persistent deep hip pain requires medical assessment rather than repeated pressure-relief measures alone.

7. Less common medical causes

Infection, inflammatory arthritis, tumour, vascular disease and abdominal or pelvic conditions can cause pain around the hip. Fever, systemic illness, unexplained weight loss, progressive rest pain, a mass, immune suppression, cancer history or unusual abdominal, urinary or reproductive symptoms change the investigation pathway.

Questions that help organise the diagnosis

• Does pain occur only when the painful hip contacts the mattress?
• Does lying on the opposite side also hurt when the top leg drops inward?
• Does the pain ease on your back or after standing up?
• Is the centre of pain at the outer hip, groin, buttock or lower back?
• Are walking, stairs, hills, standing on one leg or rising from a chair painful?
• Is there clicking, catching, stiffness or reduced hip rotation?
• Does pain travel below the knee or include tingling, numbness or weakness?
• Was there a fall, sudden pop, activity increase or medication change?
• Are there fever, weight loss, night sweats or pain unaffected by position?
• How much sleep is being lost, and what daytime work or caregiving must continue?

What may be examined?

A structured assessment may include walking, single-leg balance, sit-to-stand, hip and lumbar movement, strength and neurological testing. Depending on the pattern, the clinician may assess:

• tenderness over the greater trochanter and nearby tendons;
• pain or weakness during resisted hip abduction;
• single-leg loading and pelvic control;
• active and passive hip rotation;
• selected hip-joint provocation tests;
• lumbar movement, leg strength, sensation and reflexes; and
• the painful sleep position where practical and appropriate.

One tender point or positive test does not prove a diagnosis. Findings are interpreted as a pattern and compared with competing hip, spinal and medical causes.

When may X-ray, ultrasound, MRI or blood tests help?

X-ray

X-rays may be appropriate after trauma or when osteoarthritis, fracture, hip shape or another bone-related condition is suspected. The American College of Radiology rates pelvis and hip radiography as usually appropriate initial imaging for chronic hip pain.^[4]

Ultrasound

Ultrasound can assess gluteal tendons, the superficial bursa and selected soft-tissue abnormalities. It can guide certain injections. Its usefulness depends on the clinical question and operator, and it does not provide the same overview of bone marrow and the deep joint as MRI.

MRI

MRI may be considered when symptoms persist despite an appropriate plan, a significant tendon tear or occult fracture is suspected, X-rays do not explain the problem, or the result is likely to alter treatment or referral. The area scanned—hip, pelvis or lumbar spine—should match the suspected source.

Scan abnormalities can occur without symptoms. Imaging should support, rather than replace, the history and examination.

Blood tests and other investigations

Blood tests may be appropriate when infection, inflammatory disease or another systemic condition is suspected. Other investigations may be needed if symptoms suggest vascular, abdominal, urinary or pelvic causes.

Sleep-position changes you can try

For mild symptoms without warning features:

• avoid sleeping directly on the painful side temporarily;
• when lying on the opposite side, place a sufficiently supportive pillow between the knees and ankles so the painful top leg does not drop across the body;
• try lying on your back with a pillow under the knees if comfortable;
• avoid aggressively pressing or deep-massaging the tender outer hip;
• change position before pain becomes severe rather than repeatedly testing the painful side; and
• track whether walking, stairs and daytime loading alter that night’s symptoms.

NHS hospital guidance similarly advises avoiding the painful side and using pillows to reduce hip compression.^[5] A softer mattress topper may help some patients, but buying a new mattress is not automatically the solution. Position changes can reduce irritation while the underlying load and diagnosis are addressed.

Treatment options depend on the cause and the person

For gluteal tendon-related pain, treatment commonly includes education, reducing provocative compression, modifying load and progressively strengthening the hip. The programme should build toward the patient’s actual needs: sleeping, walking, stairs, prolonged standing, work or sport.

For hip osteoarthritis, NICE recommends tailored therapeutic exercise and weight management where appropriate as core care.^[3] A walking aid, medication or other symptom-relief options may be considered according to clinical need and individual risks.

Medication suitability depends on allergies, pregnancy, other medicines and stomach, kidney, heart and bleeding risks. A licensed doctor or pharmacist should advise on individual choice and dosing.

Hands-on treatment, heat or cold, and selected physical modalities may give some patients short-term relief. They should have a defined role and review point. Passive care alone does not necessarily rebuild tendon capacity or address joint, spinal or systemic causes.

Are injections appropriate?

A targeted injection may be considered for selected patients after the likely pain source, expected benefit, risks and alternatives have been discussed. Short-term symptom reduction may sometimes help sleep or rehabilitation participation, but an injection does not automatically correct tendon capacity or movement load.

The medication, target, imaging guidance and frequency matter. Repeated injection without reassessing the diagnosis and longer-term plan is not a complete strategy.

What about shockwave or other technologies?

Shockwave therapy may be considered as an adjunct for selected persistent tendon-related presentations after assessment. It is not suitable for every cause of night hip pain and should not delay investigation of fracture, infection, tumour or another serious condition.

Evidence, regulatory status and availability differ across devices and emerging procedures. Patients should ask what diagnosis is being treated, what evidence applies to that diagnosis, what risks and costs are involved, and how success will be measured.

When is surgery considered?

Surgical opinion may be appropriate for fracture, selected significant tendon tears, advanced osteoarthritis with substantial disability, or another defined structural problem that has not responded to reasonable non-surgical care. Referral for an opinion does not commit a patient to surgery.

Patient-specific treatment scenarios

If the pain occurs only when lying on that side

Outer-hip compression becomes more likely. A short trial of sleep-position modification may be reasonable while walking, stairs, tenderness and hip strength are assessed. Persistent symptoms still require evaluation because tendon, bursal and referred causes overlap.

If both sides hurt at night

This may reflect compression of the lower hip and inward drop of the upper hip, bilateral tendon problems, spinal referral or another condition. A pillow supporting both knees and ankles can test the compression hypothesis, but bilateral or progressive symptoms should not be dismissed as a mattress problem.

If you have already tried physiotherapy

Review whether the programme addressed compression as well as strength, used tolerable but progressive loading, and advanced toward walking and sleep goals. Confirm the working diagnosis and whether hip-joint, lumbar or systemic features were reassessed. If a well-delivered programme has not helped, selective imaging or medical review may be more useful than repeating identical exercises.

If you are not keen on exercise or prefer passive treatment

Discuss whether pain, time, fatigue, fear or a previous flare is the main barrier. Symptom-relief options may support participation, but their limitations should be clear. The active component can begin with sleep-position changes and a very small number of tolerable movements rather than a long generic routine.

If poor sleep is affecting work

The immediate plan may prioritise sleep positioning, daytime load adjustment and clinically suitable symptom control while the diagnosis is clarified. Work demands, commute, stairs and prolonged standing should be considered. No treatment can guarantee uninterrupted sleep within a fixed number of days.

If you need to return to sport quickly

Night pain may indicate that current loading exceeds tissue tolerance. Return decisions should consider walking, single-leg loading, strength and the response in the following 24 hours—not pain during exercise alone. Temporary symptom suppression should not be mistaken for restored capacity.

Integrated doctor and physiotherapy management

The Pain Relief Clinic has in-house physiotherapists for integrated management with the licensed medical doctor. Where physiotherapy is clinically appropriate, this can align the working diagnosis, hip and lumbar examination, sleep and activity modification, progressive rehabilitation, imaging decisions and referral planning.

Integrated care may be useful when previous physiotherapy has not helped, pain location is unclear or gluteal, joint and spinal features overlap. Physiotherapists practising in Singapore are regulated by the Allied Health Professions Council and require registration and a valid Practising Certificate.^[6]

Insurance referrals and supporting paperwork

The clinic may assist with clinically appropriate referrals and supporting paperwork for insurance claims. Coverage, required documents, pre-authorisation and reimbursement depend on the patient’s policy and insurer. A referral, form or medical report does not guarantee approval or payment.

Before physiotherapy, imaging, an injection or specialist consultation, patients may wish to ask whether their insurer requires a doctor’s referral, panel provider, pre-authorisation, itemised invoice, imaging report or medical report.

Frequently asked questions

Why does my hip hurt only when I sleep on it?

Direct compression of sensitive outer-hip tendons or the nearby bursa is a common explanation. A clinical assessment is needed if symptoms persist, because referred spinal, joint and other causes can overlap.

Is it hip bursitis?

Possibly, but many cases labelled bursitis also involve the gluteal tendons. Greater trochanteric pain syndrome is a broader term that does not assume the bursa is the only source.

Should I sleep on the painful side to get used to it?

Repeatedly compressing a painful outer hip can aggravate symptoms. Temporarily change position and use suitable pillow support while the cause and longer-term loading plan are addressed.

Do I need an MRI for night hip pain?

Not automatically. History and examination may be sufficient to begin treatment. X-ray, ultrasound or MRI may be considered when a defined result could change management, or when injury, persistent unexplained pain or warning features warrant investigation.

Why does the opposite hip hurt when I lie on my “good” side?

The upper leg may fall inward and compress the outer-hip tendons. Supporting both the knee and ankle with a pillow may reduce this position. Persistent pain on either side still deserves assessment.

What if my hip also hurts when walking?

The painful phase of walking, distance tolerance, stiffness and limp provide useful clues. Read Why Does My Hip Hurt When Walking? and arrange assessment if symptoms persist or limit ordinary activity.

Key points

• Side-lying hip pain commonly involves outer-hip compression and the gluteal tendons, with or without bursal involvement.
• Groin, buttock and nerve-like symptoms point toward different assessment pathways.
• Night pain is not automatically dangerous, but progressive, position-independent pain with systemic or neurological features needs earlier review.
• X-ray, ultrasound and MRI answer different questions and are not required for every patient.
• Treatment should reflect the diagnosis, previous care, sleep loss, exercise preferences and walking, work or sporting goals.

Arrange a hip-pain assessment in Singapore

If hip pain repeatedly interrupts sleep, also limits walking or stairs, or has not improved with a reasonable initial plan, a structured assessment can help determine whether rehabilitation, selective imaging, medical treatment or referral may be appropriate.

The Pain Relief Clinic
350 Orchard Road, #10-00 Shaw House
Singapore 238868
Call or WhatsApp: +65 9068 9605

Not every investigation or treatment discussed on this page is required, offered or recommended by the clinic. Availability and permissible use of tests, medicines, devices, injections, procedures and emerging treatments in Singapore may change with evolving Ministry of Health, Health Sciences Authority and Singapore Medical Council requirements. Individual decisions require clinical assessment and should follow current Singapore regulations and professional guidance.

References

1. Singapore Civil Defence Force. Emergency Medical Services.
2. Cambridge University Hospitals NHS Foundation Trust. Gluteal Tendinopathy.
3. National Institute for Health and Care Excellence. Osteoarthritis in Over 16s: Diagnosis and Management.
4. American College of Radiology. ACR Appropriateness Criteria: Chronic Hip Pain.
5. Royal Orthopaedic Hospital NHS Foundation Trust. Gluteal Tendinopathy.
6. Allied Health Professions Council Singapore. Registers of Allied Health Professionals.

Disclaimer: This information is provided for general reference only and should be used in consultation with your licensed medical doctor. It is not a diagnosis or a substitute for personalised medical advice. Seek urgent care for severe, rapidly worsening or warning-feature symptoms.

Reviewed by Dr Terence Tan — 13 September 2026