Why Does My Hip Hurt When I Lie on My Side?

You settle into bed, roll onto your side, and a deep ache spreads across the outside of your hip. Maybe it wakes you a few hours later and makes you shift to the other side, only for that hip to start complaining too. By morning the first few steps feel sore and stiff before things loosen up.

Outer hip pain that shows up when you lie down can be genuinely frustrating. It interrupts sleep, and sleep is exactly what a sore body needs. It can also feel confusing, because there is often no fall, no twist, and no single moment you can point to as the cause.

The outer hip is a crowded area. A bony bump on the side of the thigh bone, called the greater trochanter, sits just under the skin. Over it lie fluid-filled cushions and the tendons of the muscles that stabilize the hip. When you lie on your side, your body weight presses directly onto all of it.

The encouraging news is that the most common causes of this pain are not dangerous, and many improve with changes you can start on your own long before anything more involved is needed.

The key is learning to read the pattern. Where exactly does it hurt, when does it flare, and what makes it ease? Those details help point toward the cause and toward the right next step.

The Short Answer

Hip pain that worsens when you lie on your side is most often caused by greater trochanteric pain syndrome, an umbrella term for irritation of the structures over the outer hip bone. The two main contributors are trochanteric bursitis, inflammation of a fluid-filled cushion called a bursa, and gluteal tendinopathy, irritation or wear of the tendons that attach the hip muscles to the bone.

The greater trochanter is the bony prominence you can feel on the side of your hip. A bursa and the gluteus medius and gluteus minimus tendons sit directly over it. When you lie on that side, your weight compresses these tissues against the bone, which is why the pain so often flares at night or when sleeping.

Other causes are possible. Hip osteoarthritis, a labral tear inside the joint, and pain referred from the lower back can all produce hip discomfort, though these more often cause pain felt in the groin or with certain movements rather than pure outer-hip tenderness. Less commonly, a stress reaction in the bone, an inflammatory arthritis, or, rarely, an infection can be responsible.

The location and the timing help narrow the cause. Tenderness right over the bony point on the side of the hip, worse when lying on it, points strongly toward bursitis or gluteal tendinopathy. Pain deep in the groin that worsens with squatting or rotating the hip points more toward the joint itself. Pain that travels down the leg with numbness or tingling suggests the back may be involved.

Most causes begin with nonsurgical care. Recognizing the warning signs that call for a timely evaluation is the part that matters most.

Key Symptoms

Outer hip pain can feel different depending on the structure involved. Paying attention to the specific pattern helps separate a common irritation from a problem that needs a closer look.

Common features include:

• An aching or burning pain over the outer point of the hip
• Pain that flares when you lie on that side or sleep at night
• Tenderness when you press directly on the bony bump on the side of the hip
• Soreness and stiffness with the first steps after resting
• Pain with climbing stairs, getting out of a car, or standing on one leg
• Discomfort that spreads down the outer thigh, usually not past the knee
• Pain when crossing your legs or lying with the top knee dropped forward

Features that make the pain more meaningful include:

• Pain that follows a fall or a direct blow to the hip
• Inability to bear weight or a sense that the leg will give way
• Deep groin pain that worsens with rotating or squatting
• Pain that travels below the knee with numbness, tingling, or weakness
• Redness, warmth, or swelling over the hip, especially with fever
• A sudden, severe increase in pain without an obvious cause

The location, the timing, and whether the pain sits over the bony point or deeper in the groin are usually more informative than how intense the pain feels on a single day.

Why Does It Hurt More When I Lie on That Side?

Many people first notice this pain in bed, and that timing is a clue rather than a coincidence.

When you lie on your side, the full weight of your pelvis and upper leg presses the outer hip into the mattress. The bursa and the gluteal tendons are sandwiched between your body weight and the greater trochanter, the bony bump underneath. If those tissues are already irritated, that direct compression can turn a mild daytime ache into a pain sharp enough to wake you.

Lying on the opposite side can hurt too. When the painful hip is on top and the leg drops forward and across the body, the gluteal tendons are stretched and squeezed against the bone. This compressed position is thought to be a major driver of gluteal tendon irritation, which is why crossing the legs or standing with the hip jutted out to one side can also aggravate it.

Small changes to sleep position often help. Lying on the pain-free side with a pillow between the knees keeps the top leg from dropping across the body. A softer surface or a mattress topper reduces direct pressure on the outer hip. When the pain continues to wake you despite these adjustments, a closer evaluation can help confirm the cause and guide treatment.

What Could Be Causing It?

Several conditions can produce pain on the outer hip. Most are treatable, and understanding them helps explain why the location and the triggers matter so much.

Trochanteric Bursitis

A bursa is a small, fluid-filled sac that reduces friction where soft tissue glides over bone. The trochanteric bursa sits over the greater trochanter on the outside of the hip. Trochanteric bursitis is inflammation of that cushion.

It often develops from repetitive friction, a period of increased walking or running, prolonged standing, or a direct bump to the hip. The pain is usually a deep ache over the outer hip that worsens when lying on that side, climbing stairs, or standing up after sitting. Tenderness is typically right over the bony point. Bursitis frequently occurs alongside gluteal tendon irritation, which is why the two are grouped together and treated in similar ways.

Gluteal Tendinopathy

Gluteal tendinopathy is irritation, degeneration, or partial tearing of the tendons that connect the gluteus medius and gluteus minimus muscles to the greater trochanter. These muscles keep the pelvis level when you stand on one leg or take a step.

It tends to develop gradually, often from a change in activity, weakness in the hip muscles, or repeated compression of the tendons in positions where the leg crosses the body. The pain sits over the outer hip, flares when lying on that side, and can make single-leg activities such as stairs or getting out of a car difficult. Modern imaging suggests the tendons, more than the bursa, are usually the main source of greater trochanteric pain syndrome. It is most common in middle-aged and older adults and more frequent in women.

Hip Osteoarthritis

Osteoarthritis is the gradual wearing of the smooth cartilage that lines the hip joint. As the cartilage thins, the joint can become painful and stiff.

Hip arthritis pain is classically felt in the groin or front of the thigh, and sometimes in the buttock, though some people also notice outer-hip discomfort. It often causes stiffness after rest, reduced range of motion, and pain that worsens with prolonged walking. Deep groin pain with squatting, pivoting, or putting on shoes and socks points more toward the joint than the bursa. Arthritis becomes more common with age and after prior hip injuries.

Hip Labral Tear or Impingement

The labrum is a rim of cartilage that lines the socket of the hip and helps keep the joint stable. A labral tear or a shape mismatch between the ball and socket, called impingement, can irritate the joint.

This more often causes pain deep in the groin or a catching, clicking, or pinching sensation with certain movements, such as deep bending or rotating the hip. It can occur in younger, active adults as well as older ones. While it is a less typical cause of pain when lying on the side, it belongs on the list when hip pain is linked to movement and joint position rather than tenderness over the bony point.

Referred Pain From the Lower Back

Pain felt in the hip does not always start there. Irritation of a nerve in the lower back, or arthritis in the spine, can refer pain into the buttock and outer hip and mimic a hip problem.

Clues that the back may be involved include pain that travels down the leg below the knee, numbness or tingling in the leg or foot, and symptoms that change with bending, sitting, or arching the back rather than with pressure on the hip itself. Because a spine problem is managed differently from a hip problem, distinguishing the two is an important part of the evaluation.

Iliotibial Band and Muscle-Related Pain

The iliotibial band is a thick band of tissue that runs along the outside of the thigh from the hip to the knee. Tightness or irritation of this band and the nearby muscles can contribute to outer hip and thigh discomfort.

This is often linked to training changes, hill or distance running, weakness in the hip stabilizers, or biomechanical factors. The pain may be felt along the outer thigh and can overlap with gluteal tendon problems. It is more common in runners and cyclists and in people who have recently increased their activity.

Less Common Causes

Other conditions can occasionally cause hip pain that is worse when lying down. These include a stress reaction or stress fracture in the femur or pelvis, inflammatory forms of arthritis, a joint or bursal infection, and problems with blood supply to the hip bone. Pain from these causes is less frequent, but they are among the reasons that hip pain which is persistent, worsening, or paired with warning signs such as fever, an inability to bear weight, or pain after a fall should be evaluated rather than assumed to be minor.

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Who Is Most Likely to Develop It?

Outer hip pain can affect nearly anyone, but certain people and habits raise the likelihood.

Middle-aged and older adults are the most commonly affected by greater trochanteric pain syndrome, and it occurs more often in women, in part because of differences in pelvis shape and the angle of the hip. That does not mean younger or male patients are exempt, only that the pattern is more frequent in certain groups.

Runners, walkers, and people who have recently increased their activity are also prone to it, because repetitive loading can irritate the tendons and bursa. A sudden jump in mileage, a return to exercise after time off, or long periods of standing can tip an already sensitive hip into pain.

Other factors that can contribute include:

• Weakness in the gluteal muscles that stabilize the hip and pelvis
• Habits that compress the tendons, such as standing with the hip jutted to one side or sitting with legs crossed
• A prior fall or direct blow to the outer hip
• Differences in leg length or gait
• Being overweight, which increases load on the hip tissues
• Lower back or knee problems that change how you walk
• Existing hip osteoarthritis

These factors do not guarantee pain, and many people who have them never develop a problem. They simply help explain why one person feels it and another does not.

When Should You Be Concerned?

Most outer hip pain is not an emergency, so the goal is to recognize which patterns can be watched briefly and which deserve timely care.

Consider scheduling an evaluation if:

• Pain lasts more than a few weeks despite sleep changes and activity adjustments
• Pain keeps waking you at night or disrupts sleep regularly
• Stairs, walking, or standing on one leg are becoming difficult
• The pain limits your work, exercise, or daily routine
• Symptoms keep returning whenever you resume activity
• You are unsure whether the pain is coming from the hip, the joint, or the back

Seek prompt medical attention if you develop:

• Inability to bear weight on the leg
• Hip pain following a fall, a direct blow, or another injury
• A visible deformity, or a leg that looks shortened or turned outward
• Severe pain that comes on suddenly without an obvious cause
• Redness, warmth, and swelling over the hip, especially with fever
• New numbness, weakness, or tingling in the leg, or pain that travels below the knee

Hip pain after a fall, an inability to bear weight, or redness and warmth with fever are the patterns that most warrant timely evaluation rather than watchful waiting, since these can signal a fracture or infection. For a sudden injury without emergency signs, orthopedic urgent care can be an efficient option. Emergency care is more appropriate for a severe injury, a suspected hip fracture, loss of circulation, or a hip that looks clearly deformed.

How Is It Diagnosed?

When outer hip pain warrants attention, the aim of an evaluation is to identify which structure is responsible so treatment can match the cause.

Medical History

Your orthopedic specialist may ask:

• Where exactly is the pain, over the outer bony point or deeper in the groin?
• Is it an ache, a burning feeling, or a sharp, catching pain?
• When did it start, and was there a fall, a blow, or a change in activity?
• What makes it worse or better, including lying on either side at night?
• Does the pain travel down the leg, and is there numbness, tingling, or weakness?
• Are stairs, single-leg standing, or getting out of a car difficult?
• Do you have arthritis, prior hip or back problems, or a previous injury?
• Has your walking, standing, or exercise routine changed recently?

These answers often narrow the possibilities before any testing is done.

Physical Examination

The examination may assess:

• Exactly where tenderness is located, especially over the greater trochanter
• Hip range of motion and whether certain positions reproduce the pain
• Strength of the gluteal muscles that stabilize the hip
• Whether standing on one leg or specific positions bring on symptoms
• Your gait and whether the pelvis drops when you walk
• Signs that the pain comes from the joint, such as groin pain with rotation
• An assessment of the lower back to check for referred pain
• Leg length and alignment

Your specialist may press over specific structures and move the hip in certain ways to reproduce the symptoms and localize the source.

Imaging

Imaging is not needed for every case, but it can be valuable when the diagnosis is unclear or the pain does not improve. Options may include:

• X-rays, which show arthritis, alignment, bone spurs, and many fractures
• MRI, which shows the gluteal tendons, bursa, labrum, and soft tissue in detail and can detect a stress fracture
• Ultrasound, which can evaluate the tendons and bursa and guide an injection
• Additional imaging in selected cases

Because greater trochanteric pain syndrome is often diagnosed from the history and examination, many people do not need advanced imaging right away. It becomes more useful when symptoms persist, the cause is uncertain, or a procedure is being considered.

Other Testing

In selected cases, additional testing may help. Blood tests can support a diagnosis of inflammatory arthritis or, when infection is a concern, help guide care. A diagnostic injection over the bursa or into the hip joint can sometimes clarify whether the pain is coming from the outer hip structures or from the joint itself. Not every patient needs these tests, and they are chosen based on the pattern of symptoms.

Treatment Options

Most causes of outer hip pain are managed without surgery, and treatment is directed at the specific cause. Care usually begins with the simplest, least invasive measures.

Activity and Position Changes

Because compression of the tendons and bursa drives many cases, adjusting daily habits is often the first and most effective step. This can include avoiding crossing the legs, not standing with the hip jutted to one side, and easing off activities that reproduce the pain. Reducing high-impact loading for a time, while staying active with gentler movement, gives irritated tissues a chance to settle.

Sleep Adjustments

Since the pain so often flares in bed, changing how you sleep can make a real difference. Lying on the pain-free side with a pillow between the knees keeps the top leg from dropping across the body and compressing the tendons. A mattress topper or softer surface reduces direct pressure on the outer hip. Some people rest more comfortably on their back with a pillow under the knees.

Home Care

Simple measures such as ice over a painful area or gentle heat before activity, along with a gradual return to movement, can help during a flare. These support recovery but do not replace addressing the underlying cause, so pain that persists still deserves attention.

Medication

Over-the-counter pain relievers or anti-inflammatory medications may ease discomfort during a flare. Medication choices should account for your health history, and they treat symptoms rather than correcting the underlying tendon or muscle problem. For that reason, medication is usually one part of a plan rather than the whole plan.

Physical Therapy

Physical therapy is a cornerstone of treatment for greater trochanteric pain syndrome, particularly when gluteal tendinopathy is involved. A program commonly includes strengthening the gluteal muscles that stabilize the hip, gradual loading of the irritated tendons, gait guidance, and coaching to avoid positions that compress the tendons. Because tendon problems respond to controlled loading over time, progress can be gradual, and the exercises should be tailored to your specific diagnosis and stage.

Injections

In selected cases, a corticosteroid injection over the bursa or outer hip may be considered to reduce inflammation and pain, particularly when it can help you participate in rehabilitation. Injections can provide relief but do not by themselves rebuild a weakened tendon, and their effect may be temporary. Other injection options are sometimes discussed depending on the situation. Injections are chosen carefully rather than used as an automatic first step.

Surgery

Surgery is not the starting point for outer hip pain and is reserved for selected situations. It may be considered when a clearly identified problem, such as a significant gluteal tendon tear or persistent gluteal tendinopathy, does not respond to appropriate nonsurgical care over an adequate period. Procedures may aim to repair a torn tendon or address the tissue causing the compression. When hip osteoarthritis is the true source and has become advanced, joint-preserving or joint-replacement options may be discussed. The specific procedure depends entirely on the diagnosis, and recovery varies with the operation performed.

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Recovery Expectations

Recovery from outer hip pain depends heavily on the cause. Greater trochanteric pain syndrome often improves over several weeks to a few months, but because tendon problems heal gradually, progress can feel slow and is not always steady. A flare after a busy day does not necessarily mean a setback.

Several factors influence how quickly things settle, including how long the pain has been present, the strength of the surrounding muscles, sleep habits, activity load, and consistency with a rehabilitation program. Rest alone is often not enough, since the tendons usually need to be loaded correctly through exercise to build tolerance again.

It helps to measure progress by function as much as by pain. Being able to climb stairs, sleep through the night, or walk farther without a flare are meaningful signs of improvement. Returning to full activity too quickly, before the hip muscles have regained strength, is a common reason symptoms come back.

Can It Be Prevented?

Not every cause of outer hip pain is preventable, but several practical habits lower the risk and help keep the hip comfortable.

You can support healthy, comfortable hips by:

• Building and maintaining strength in the gluteal and core muscles
• Increasing walking, running, or training volume gradually rather than in sudden jumps
• Avoiding prolonged positions that compress the outer hip, such as sitting with legs crossed
• Not standing for long periods with your weight shifted onto one hip
• Using a pillow between the knees if you are a side sleeper
• Wearing supportive, well-cushioned shoes and replacing worn-out athletic shoes
• Warming up before exercise and progressing hills and distance gradually
• Addressing early aches before they become persistent

Staying aware of early warning signs, and easing off before a minor ache becomes a firmly established problem, is often the most effective prevention of all.

From the Orthopedic Exam Room

One of the most common things orthopedic specialists hear is that outer hip pain must be a worn-out hip joint that will eventually need replacing.

That worry is understandable, but it is often not what the examination shows. Most pain over the outer point of the hip, especially pain that flares when lying on that side, comes from the bursa and gluteal tendons on the outside of the bone rather than from the joint itself. Hip arthritis more often announces itself with groin pain and stiffness with deep bending. Sorting out which structure is involved changes the treatment entirely.

Another frequent belief is that rest is the answer. With gluteal tendon problems, complete rest can allow the muscles to weaken further, and the pain often returns as soon as activity resumes. Controlled strengthening and gradual loading of the tendons, guided by a therapist, tend to work better than simply waiting for the pain to fade.

Patients are sometimes surprised at how much a few sleep and posture changes can accomplish. Because so many of the outer-hip structures are compressed by lying on the side or by crossing the legs, relieving that pressure is one of the most effective early steps, and it costs nothing to try.

Seeing a specialist for outer hip pain does not mean you are headed toward surgery. Far more often, it is the fastest way to confirm where the pain is coming from, rule out concerns like a fracture or a referred back problem, and build a simple plan that helps you sleep and move comfortably again.

What We Hope You Take Away

When your hip hurts as you lie on your side, the most common cause is greater trochanteric pain syndrome, an irritation of the bursa and gluteal tendons over the outer hip bone, often driven by compression, weakness, or a change in activity.

Other causes are possible and worth recognizing. Deep groin pain that worsens with squatting or rotating the hip points more toward the joint and possible arthritis or a labral problem. Pain that travels down the leg with numbness or tingling suggests the lower back may be involved. Pain after a fall, an inability to bear weight, or redness and warmth with fever calls for prompt attention.

The location and the timing help narrow the cause more than the intensity of the pain on any single day. Many cases improve with sleep adjustments, activity changes, and a focused strengthening program for the hip muscles.

Do not ignore hip pain after a fall, an inability to bear weight, spreading numbness or weakness, or redness and warmth with fever. Those patterns deserve timely evaluation.

If your outer hip pain is persistent, keeps disrupting your sleep, or is limiting your daily activity, the hip and knee specialists at Mississippi Sports Medicine can help identify the cause and guide treatment. You can schedule an appointment when you are ready to take the next step. The goal of an orthopedic evaluation is not to rush you toward a procedure. It is to identify what is causing your pain, protect the joint, tendons, and muscles of your hip, and help you return to comfortable, restful sleep and confident movement.

Continue Learning

You may also find these MSMOC resources helpful:

• Meet Our Hip and Knee Specialists
• Explore Sports Medicine Care
• How to Relieve Knee Pain
• Schedule an Appointment

Frequently Asked Questions

Why does my hip hurt more at night when I lie on my side?

Lying on your side presses your body weight directly onto the outer hip, where the bursa and gluteal tendons sit over a bony bump called the greater trochanter. If those tissues are already irritated, that compression turns a mild ache into a sharper pain. Sleeping on the opposite side can also strain the top hip as it drops forward. This nighttime pattern is common with greater trochanteric bursitis and gluteal tendinopathy. Pain that keeps waking you is worth having evaluated.

Is hip bursitis the same as gluteal tendinopathy?

They are closely related and often occur together, which is why specialists group them under greater trochanteric pain syndrome. Bursitis is inflammation of the fluid-filled cushion over the outer hip bone. Gluteal tendinopathy is irritation or wear of the tendons that attach the hip muscles to that same bone. Both cause tenderness on the outer hip and pain when lying on that side. Imaging often shows the tendons as the main problem, but the two frequently overlap and are treated in similar ways.

How should I sleep to reduce hip pain?

Try sleeping on the side that does not hurt, with a pillow between your knees to keep the top leg from dropping across your body and straining the sore hip. A softer mattress topper can reduce direct pressure on the outer hip. Some people find relief lying on their back with a pillow under the knees. Avoid pulling the top knee up toward your chest. If pain still wakes you nightly despite these changes, an evaluation can help.

Will hip bursitis go away on its own?

Many cases of greater trochanteric pain syndrome improve over weeks to months with simple steps such as activity changes, sleep adjustments, and a focused physical therapy program. Because the problem often involves tendon irritation rather than only inflammation, recovery can be gradual and may require loading the tendons correctly through exercise. Rest alone does not always resolve it. Pain that persists beyond several weeks, worsens, or limits daily activity is worth having evaluated so treatment can match the cause.

Can lower back problems cause outer hip pain?

Yes. Irritation of a nerve in the lower back, or arthritis in the spine, can refer pain into the buttock and outer hip, sometimes mimicking bursitis. Clues that the back may be involved include pain that travels below the knee, numbness or tingling in the leg, or symptoms that change with bending, sitting, or arching the back. Because the treatments differ, an evaluation can help distinguish a true hip problem from pain referred from the spine.

What exercises help hip bursitis and gluteal tendinopathy?

Physical therapy usually focuses on strengthening the gluteal muscles that stabilize the hip, along with gradual loading of the irritated tendons. Programs often avoid positions that compress the tendons, such as crossing the legs or heavy stretching across the body. Exercises are progressed slowly to build tolerance without flaring symptoms. The right program depends on your specific diagnosis and stage, so working with a physical therapist or specialist is more effective than guessing at exercises from a general list.

When should I see a doctor for hip pain when lying down?

Consider an evaluation when outer hip pain lasts more than a few weeks, keeps waking you at night, or limits walking, stairs, or daily activity. Seek prompt care if you cannot bear weight, have hip pain after a fall or injury, or notice a visible deformity. Redness, warmth, and fever with hip pain, or new numbness, weakness, or leg swelling, also warrant timely attention, since these can point to infection, a fracture, or a nerve or circulation problem.