The most common reason your hips hurt when you sleep on your side is sustained pressure on the bony prominence at the outside of your hip, the greater trochanter, which compresses irritated tendons and surrounding soft tissue against the mattress. This condition, broadly called greater trochanteric pain syndrome, affects a large number of adults and is specifically triggered or worsened by lying on the affected side. But the pain you feel at night can also stem from hip osteoarthritis, referred pain from the lower back, or simple biomechanical strain from sleeping posture, and sorting out which one matters for deciding what to do about it.
Greater Trochanteric Pain Syndrome and Why It Hurts at Night
Greater trochanteric pain syndrome (GTPS) is a blanket term for pain and tenderness around the bony point on the outer edge of your hip. It is one of the most frequent reasons people see a doctor about hip pain. Patients with GTPS consistently report that lateral hip pain gets worse with weight-bearing activities like walking, running, and climbing stairs, and that lying on the affected side is a reliable trigger.1Europe PMC / British Journal of General Practice. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice When you lie on your side, your body weight presses directly into that trochanter, compressing the tendons and bursa beneath it against the bone for hours at a time. Unlike walking, where the pressure is momentary and shifts, side-sleeping holds the load in one spot for long stretches without relief.
For years, the go-to explanation was trochanteric bursitis, inflammation of the fluid-filled sac cushioning the trochanter. That diagnosis is still sometimes given, but research has shifted the focus. The primary driver of symptoms in most people with GTPS turns out to be tendinopathy of the gluteus medius or gluteus minimus tendons, the tendons that attach your deep buttock muscles to the outer hip. Over time these tendons can degenerate, develop partial tears, and in advanced cases tear completely.2SAGE Journals. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation When already-weakened tendons get compressed against bone all night, it makes sense that you wake up sore.
Who Gets This and Why
Gluteal tendinopathy disproportionately affects women, particularly between their 40s and 60s. Hormonal changes around menopause appear to play a role, as tendon structure and repair capacity shift during that period. But you do not have to be postmenopausal to develop it. Runners, people who have recently increased their walking or stair-climbing, and those with a wider pelvis (which changes the angle at which the tendons pull on the bone) are all at higher risk. Sedentary habits contribute too, since weak gluteal muscles place more strain on the tendons they are supposed to support.2SAGE Journals. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation
A common pattern is the person who starts a new walking routine, ramps up too quickly, and within a few weeks notices an ache on the outside of the hip that is worst at night. The tendon was already somewhat degenerated, perhaps silently, and the new load tipped it into painful territory. Side-sleeping then keeps the area irritated, creating a cycle where daytime activity sets things off and nighttime positioning prevents recovery.
Is It Really Your Hip, or Something Else?
Not all nighttime hip pain is GTPS. The location of your pain is the biggest clue. GTPS produces pain on the outer side of the hip, right over or just behind that bony bump. If your pain is in the groin, the front of the hip, or deep in the buttock, the culprit may be hip osteoarthritis instead. A study of patients with confirmed hip osteoarthritis found that groin pain was by far the most common complaint, present in roughly 84% of those with hip joint dysfunction.3Europe PMC / Annals of the Royal College of Surgeons of England. Hip osteoarthritis: where is the pain? Buttock pain was also significantly associated with osteoarthritis. So if you are pointing to the outside of your hip, GTPS is high on the list. If the pain is in your groin or deep inside the joint, osteoarthritis or a labral tear deserves investigation.
Lower back problems also deserve a mention. Lumbar disc issues and nerve irritation can refer pain to the hip area, sometimes mimicking lateral hip pain closely enough to cause confusion. The distinguishing feature is often that back-related hip pain changes with spinal movement, not hip movement. If rolling over in bed sends a jolt down your thigh or into your buttock, your spine may be involved.
There are less common causes too. Hip flexor tendinitis can make the front of the hip ache when the hip stays in a flexed position for hours, as it does in fetal-position side-sleeping. Sacroiliac joint dysfunction can radiate pain toward the outer hip. And in rare cases, stress fractures of the femoral neck cause nighttime hip pain, typically in athletes or people with weakened bones. If your pain started suddenly after a fall or new high-impact exercise, and especially if it hurts even when you are not lying on it, that warrants prompt medical evaluation.
The Sleep-Pain Cycle
Pain and sleep have a two-way relationship that compounds the problem. Research on hip osteoarthritis found that poor sleep quality over the preceding week was linked to roughly 70% higher odds of a pain flare, and greater fatigue was associated with almost double the odds of a pain exacerbation.4The Journal of Rheumatology. Sleep Quality and Fatigue Are Associated with Pain Exacerbations of Hip Osteoarthritis: An Internet-based Case-crossover Study While that study focused on osteoarthritis rather than GTPS specifically, the broader principle holds: when pain disrupts your sleep, the resulting poor sleep and fatigue make the pain worse. You do not just lose rest, you sensitize your nervous system to the same stimulus, so the same amount of pressure on the trochanter starts feeling more painful.
Interestingly, the same study found that total sleep duration alone was not significantly linked to pain exacerbations. It was sleep quality that mattered. Tossing and turning, waking repeatedly, and feeling unrested in the morning correlated with worse pain, regardless of how many hours you technically spent in bed.4The Journal of Rheumatology. Sleep Quality and Fatigue Are Associated with Pain Exacerbations of Hip Osteoarthritis: An Internet-based Case-crossover Study This matters practically: sleeping longer on a surface that aggravates your hip is not better than sleeping fewer hours in a position that does not hurt.
Practical Adjustments for Sleeping
The simplest intervention is reducing pressure on the affected trochanter. A pillow between your knees when you lie on your side keeps the top leg from dropping inward, which reduces the stretch on the iliotibial band and the compression of the gluteal tendons against the bone. This single change makes a meaningful difference for many people. Some find that a body pillow along their front, which they can drape the upper leg over, achieves the same effect more consistently because it prevents the knees from sliding apart during the night.
If you can only sleep on one side and it happens to be the painful side, placing a soft foam pad or folded blanket under the hip can distribute the pressure across a wider area. A mattress topper with some give can help similarly, especially if your current mattress is firm. The goal is not a specific mattress firmness but rather enough cushion at the hip to prevent the trochanter from bearing a concentrated load.
Sleeping on your back eliminates lateral hip compression entirely and is worth trying, though many lifelong side-sleepers find it difficult to maintain. A thin pillow under the knees in the back-sleeping position takes tension off the hip flexors and lower back, which can help if front-of-hip or groin pain is part of the picture. For people who unconsciously roll onto their side during the night, placing a pillow behind the back can act as a barrier.
These adjustments treat the symptom. They make the night bearable, but they do not fix the underlying tendon problem. For lasting improvement, the daytime matters more than the nighttime.
Exercise and Rehabilitation
Structured exercise paired with education about load management is the first-line treatment for gluteal tendinopathy, and the evidence behind it is reasonably solid. A systematic review of treatments for gluteal tendinopathy found that exercise and education had a medium-sized effect on both pain and function in the short term, with smaller but still meaningful effects lasting into the medium and long term.5PubMed Central. The efficacy of gluteal tendinopathy treatments: A systematic review That may not sound dramatic, but for a condition that tends to become chronic, maintaining improvements over months is significant.
The type of exercise matters. Isometric exercises, where you contract the gluteal muscles without moving the joint, are usually the starting point because they load the tendon gently and can actually reduce pain in the short term. As symptoms improve, you progress to slow, controlled strengthening exercises for the gluteus medius and minimus. Think side-lying leg lifts, standing hip abduction, single-leg balance work, and eventually resistance-band or weighted exercises. The key principle is gradual loading: the tendon needs to be stressed enough to adapt and strengthen, but not so much that it flares up.
What to avoid during rehabilitation is almost as important. Stretching the iliotibial band by crossing the affected leg behind the other and leaning sideways, a common recommendation you will find online, can actually compress the gluteal tendons further against the trochanter and make things worse. Sitting with legs crossed, standing with the hip hitched out to one side, and climbing excessive stairs can all aggravate the condition during the early phase. A physiotherapist familiar with tendinopathy can tailor the program to where you are on the spectrum from irritable tendon to partial tear.
Injections and When They Make Sense
Corticosteroid injections into the trochanteric area have been a standard treatment for decades. They can provide rapid pain relief, sometimes within days, by reducing local inflammation. The catch is that the relief tends to be short-lived. One randomized controlled trial directly compared a single corticosteroid injection to a single platelet-rich plasma (PRP) injection in patients with chronic gluteal tendinopathy. At two weeks and six weeks, both groups had similar pain and function scores. But by 12 weeks, the PRP group had significantly better outcomes: about 82% of PRP patients achieved a meaningful improvement in their scores, compared to roughly 57% in the corticosteroid group.6PubMed. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection
Longer follow-up from related research suggests that PRP benefits can persist for up to two years, while corticosteroid injections offer maximum relief for about six weeks and no benefit beyond six months.7PubMed Central. Greater Trochanteric Pain Syndrome and the Efficacy of Platelet-Rich Plasma Injections: A Systematic Review This does not mean corticosteroids are useless. If you are in severe pain and need relief to start a rehabilitation program, a steroid injection can bridge that gap. But relying on repeated steroid injections without addressing the tendon through exercise is a losing strategy, and there is some concern that repeated steroid exposure weakens tendons further over time.
PRP involves drawing your own blood, concentrating the platelets, and injecting them into the affected area. The idea is that growth factors in platelets stimulate tendon healing. Access and cost vary widely; PRP is not universally covered by insurance and is not available everywhere. The evidence is promising but still evolving, so it is typically reserved for cases where exercise alone has not been enough after several months of consistent effort.
When Surgery Comes Into Play
Most people with GTPS never need surgery. It becomes a consideration when conservative treatment, meaning a genuine, sustained course of physiotherapy plus possibly an injection, has been exhausted without adequate improvement, or when imaging reveals a significant tendon tear that is unlikely to heal on its own.
Endoscopic (keyhole) surgery has become the preferred approach. It allows surgeons to remove inflamed bursal tissue, release a tight iliotibial band, and repair torn gluteal tendons through small incisions. A systematic review of endoscopic management found that these procedures carry a low complication rate and a high likelihood of returning patients to their pre-injury activity levels.8PubMed Central. Endoscopic management of greater trochanteric pain syndrome (GTPS): a comprehensive systematic review Another review found that pain and function improved significantly in nearly all studies reporting outcomes after endoscopic repair of gluteal tendons.9PubMed. Labral Tears and Chondral Lesions Are Common Comorbidities Identified During Endoscopic Repair of Gluteal Tendon Tears for Greater Trochanteric Pain Syndrome: A Systematic Review
One small but notable prospective study followed patients with refractory GTPS who had confirmed gluteal tendon tears on MRI and underwent open surgical repair. Seven out of eight patients achieved complete remission of both spontaneous and provoked pain over a mean follow-up of about 22 months, and follow-up MRIs showed good tendon reinsertion.10PubMed. Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair That is a tiny sample, but the results illustrate that for the subset of people with actual tendon tears that do not respond to anything else, surgical repair can be genuinely restorative.
An additional finding from the endoscopic literature is that labral tears and cartilage damage inside the hip joint are common alongside gluteal tendon tears. That means some people undergoing surgery for GTPS may have concurrent joint pathology that contributes to their symptoms, which is another reason imaging and careful diagnosis matter before attributing all your nighttime pain to a single cause.
Mattress and Pillow Considerations
You will find a staggering amount of advice online about which mattress cures hip pain. The honest answer is that no single firmness level is right for everyone. Your body weight, body shape, and the specific condition causing your pain all influence what surface works for you. A very firm mattress can be brutal on a trochanter that is already irritated because it creates a pressure point at the widest part of the hip. A very soft mattress can let the pelvis sink unevenly, tilting the spine and creating its own set of problems.
The practical approach is to experiment. If your current mattress is hard and you are waking up with lateral hip pain, a memory-foam topper in the range of 5 to 8 centimeters thick is a low-cost first step. It lets the hip sink slightly, spreading the load. If you sleep hot, gel-infused foam or a latex topper can achieve similar pressure relief without trapping as much heat. Beyond the mattress itself, the pillow between the knees makes more consistent difference for side-sleepers with hip pain than any particular mattress upgrade.
Red Flags Worth Knowing
Most nighttime hip pain is musculoskeletal and, while annoying, not dangerous. But certain features warrant prompt attention rather than a wait-and-see approach with pillows and exercises:
- Night pain at rest: Pain that wakes you regardless of position, rather than only when you are lying on the hip, can be a sign of something beyond tendinopathy, including infection, inflammatory arthritis, or rarely a bone tumor.
- Fever or weight loss: Unexplained systemic symptoms alongside hip pain raise the suspicion of infection or inflammatory disease.
- Recent trauma: If you fell or had an impact and the pain started immediately afterward, a fracture needs to be ruled out, especially in older adults or anyone with osteoporosis.
- Rapid weakness: If you suddenly cannot lift your leg sideways without it giving way, that could indicate a complete gluteal tendon tear rather than simple tendinopathy, and early evaluation can improve surgical outcomes.
- Groin pain with clicking: Deep groin pain accompanied by a catching or locking sensation points more toward a labral tear inside the hip joint, which has a different treatment pathway.
These situations do not necessarily mean something serious is wrong, but they change the urgency of getting assessed. For the more common scenario, where you have a dull ache on the outer hip that flares with side-sleeping and eases when you shift position, the conservative approach outlined above is where to start.