Why Your Hip Hurts When You Lie on Your Side at Night
Hip Sore Lying on Your Side at Night? Here Is What Is Going On
You roll onto your side and that dull ache in the outside of your hip flares up. You switch sides and it hurts there too. Wake through the night, roll over, ache again. Hip pain lying on your side is one of the most common reasons women over 40 come to see our physio team at PHYZFIT Bexley North and Marrickville. Here is exactly what is causing it and how we settle it.
Short Answer
Hip pain lying on your side at night is most commonly caused by gluteal tendinopathy (also called greater trochanteric pain syndrome), an overload condition of the gluteus medius and minimus tendons where they attach to the outer hip. It is far more common in women aged 40 to 60, particularly around menopause. Side lying compresses the tendons against the bone, flaring the pain overnight. Other common causes are hip bursitis, hip osteoarthritis and referred pain from the lumbar spine. Most cases settle in 6 to 12 weeks with the right loading program, sleep setup changes and hands on physiotherapy.
Below we walk you through the most common causes, why side lying makes it worse, sleep positions that help, and how our team at PHYZFIT treats it.
Why does my hip hurt more at night when I lie on it?
Three main things stack up to make hip pain worse at night in the side lying position:
- Compression of the gluteal tendons. The outer hip bone (greater trochanter) presses up into the mattress. The gluteus medius and minimus tendons that wrap over this bone get squashed between the bone and the surface
- Hip adduction. When you lie on your side, the top leg naturally falls across the midline. This stretches and compresses the already irritated gluteal tendons even more
- Reduced pain distraction. At night, your brain has less competing input, so background pain signals come to the surface
If you also side sleep without a pillow between the knees, add long days of standing, running or walking, and hormonal changes around menopause that reduce tendon capacity, the tendons protest.
What are the common causes of hip pain lying on your side?
Gluteal tendinopathy
The most common cause by a wide margin. Overload of the gluteus medius and minimus tendons where they insert onto the outer hip. Classic night pain lying on either side. Peak in women 40 to 60.
Greater trochanteric bursitis
Inflammation of the fluid filled sac over the outer hip. Often coexists with tendinopathy. Localised tenderness directly over the bony point.
Hip osteoarthritis
Degenerative change of the hip joint itself. Pain deep in the groin or outside hip, worse with weight bearing and prolonged positions. More common past 60.
Lumbar referred pain
Lower back facet joints and nerve roots can refer pain into the outer hip and buttock, worse with sustained positions. Often has coexisting lower back symptoms.
Sacroiliac joint pain
Pain over the back of the pelvis and outer hip region, often worse with specific transitions (rolling in bed, getting up from a chair). Common in postnatal women.
Femoroacetabular impingement
Groin and outer hip pain with hip flexion and rotation. More common in younger active adults, particularly those with hip dysplasia.
Why is this so common in women 40 to 60?
Several factors stack up in this demographic:
- Hormonal change. Oestrogen supports tendon collagen quality. Perimenopausal and menopausal drops in oestrogen reduce tendon capacity to handle load
- Wider pelvis. Female pelvic anatomy creates a larger Q angle at the hip which loads the gluteal tendons more
- Walking and sitting patterns. Prolonged sitting shortens the hip flexors and inhibits the glutes
- Load changes. Picking up walking or a new exercise program suddenly ("I started walking 10km a day") is a common trigger
- Carrying children on one hip for years builds asymmetrical gluteal loading
- Running and gym returners after a few years off often outpace their tendon capacity
The good news: gluteal tendinopathy responds very well to a properly structured loading program. Studies show significantly better outcomes with physio led loading than with cortisone injection alone over 12 months.
Losing sleep to hip pain?
A proper physio assessment can settle night pain and get you sleeping through again.
How should I sleep with sore hips?
Small sleep setup tweaks can drop night pain significantly while the underlying issue is being treated:
- Pillow between your knees in side lying. Keeps the top leg from falling across the midline and reduces tendon compression
- Try sleeping on your back with a pillow under your knees
- Softer mattress topper if your mattress is firm and the hip bone is bearing all the load
- Side lying on the LESS sore side with a pillow between knees
- Avoid stomach sleeping — rotates the hips and lower back into provocative positions
- Avoid long drives, long sits or crossed legs during the day — the hip compresses in all of these
- Hot shower before bed to reduce muscle guarding around the hip
How does PHYZFIT treat hip night pain?
Our physio team (Julian De Rosa, Ari Moushis and Sam Nunan) treats gluteal tendinopathy and hip night pain every week. A first appointment includes a full hip and lumbar assessment, functional movement testing, specific tendon load tests and a personalised plan.
Most patients notice night pain settling meaningfully within 4 to 8 weeks, with full return to walking, running and daily life in 8 to 16 weeks.
Typical treatment approach
- Weeks 1 to 2 (settle): hands on release, dry needling, load management, sleep setup coaching, isometric glute holds
- Weeks 2 to 6 (restore): heavy slow resistance gluteal strengthening, hip abduction loading, posterior chain work, gradual return to walking
- Weeks 6 to 12 (build): progressive loading, return to running or gym, single leg strength work, hip stability drills
- Weeks 12 and beyond (resilience): maintenance program to reduce the risk of recurrence
What should I NOT do with hip tendinopathy?
- Stretch the ITB aggressively. It compresses the already irritated tendons and often flares symptoms
- Foam roll the outer hip bone directly — same issue
- Rush into high reps of clamshells early on — can aggravate the tendon if done too soon or too hard
- Cross your legs for long periods at your desk or in the car
- Stand with your hip jutted out to one side habitually ("hip hanging")
- Sudden big increases in walking or running volume without building up
- Rely on cortisone alone — short term relief but worse 12 month outcomes than loading
⚠ See a physio or GP promptly if you have
- Hip pain following a fall with inability to weight bear
- Severe pain not settling in any position
- Redness, heat or swelling with fever
- Numbness, tingling or weakness in the leg
- Night pain that is severe and unrelenting for weeks
How long does hip night pain take to settle?
- Gluteal tendinopathy: 6 to 12 weeks of structured loading plus hands on care
- Trochanteric bursitis: 4 to 8 weeks
- Hip osteoarthritis: variable, ongoing management with periodic flares, physio focuses on strength and function
- Lumbar referred pain: 6 to 12 weeks addressing the lower back
- Sacroiliac joint pain: 4 to 10 weeks
We support patients across Bexley, Kingsgrove, Beverly Hills, Bardwell Park, Earlwood, Rockdale, Kogarah and Hurstville from Bexley North, and Marrickville, Newtown, Enmore, Dulwich Hill and Petersham from Marrickville.
Frequently asked questions about hip night pain
Not always. Most gluteal tendinopathy is diagnosed clinically. Ultrasound or MRI is considered if there is suspicion of a significant tear, if symptoms are not settling with 6 weeks of quality rehab, or when a corticosteroid injection is being planned.
Cortisone can help severe night pain settle short term so rehab can progress, but studies show 12 month outcomes are better with physio led loading alone compared to cortisone alone. Best used as a short term bridge if pain is stopping you doing the rehab.
Usually yes at reduced volume. Complete rest often makes gluteal tendinopathy worse. Your physio can guide the specific loading dose during each phase.
They can be useful once the tendon has settled, but doing high rep clamshells too early often flares symptoms. We usually start with isometric glute holds, then progress to heavy slow resistance loading.
Hip arthritis typically causes groin pain, stiffness in the morning that eases over 15 to 30 minutes, and reduced hip rotation. Gluteal tendinopathy causes outer hip pain, tenderness over the bony point, and classic night pain lying on the side. A physio can tell the difference clinically in one appointment.
Yes. Medicare covers 5 sessions per year under a Chronic Disease Management plan. Private health Extras rebates through HICAPS on the day. Workers Compensation, CTP and NDIS (plan managed and self managed only) are all accepted.
Ready for Us to Help You With Your Pain?
If your hip is waking you up every night, book a physiotherapy assessment at PHYZFIT Bexley North or Marrickville with Ari Moushis, Sam Nunan or Julian De Rosa. Same day appointments are usually available and we will get you a clear plan on day one.
📍 20 Shaw Street, Bexley North 2207
📍 4 Carrington Road, Marrickville 2204 (inside World Gym)
✉ admin@phyzfit.com.au
PHYZFIT Health and Rehab | Bexley North and Marrickville, Sydney | Helping you rebuild trust in your body and live a life without limits.