Hip pain at night is most often caused by greater trochanteric pain syndrome, where lying on the side compresses the gluteal tendons, or by hip osteoarthritis, which can ache at rest as it advances. Lumbar spine problems can also disturb sleep. Night pain with fever, weight loss or constant pain in any position needs prompt evaluation.
Hip pain that wakes you up affects every part of the next day, from the drive to work to playing with the grandkids. The good news is that the most common causes of night pain are very treatable. The position that hurts, and whether pain shows up in any position, tells our team a lot about where it comes from.
Written and medically reviewed by Dr. Stride, MD, board-certified orthopedic surgeonLying on the painful side presses the gluteal tendons and bursa against the bony point of the hip. Lying on the other side lets the top leg drop across the body, which squeezes the tendon too. This is the most common cause of outer hip pain at night.
The clue: Pain on the outside of the hip when lying on either side, relieved by lying on the back, points here.
Early arthritis hurts mostly with activity. As it advances, the joint can ache at rest and at night. Night pain that regularly disturbs sleep is one of the signs that arthritis is significantly affecting quality of life.
The clue: A deep groin ache at night in someone with daytime stiffness and trouble with socks suggests arthritis.
Pinched nerves and arthritic spinal joints can cause buttock and leg pain that worsens when lying flat or in certain positions. Patients often blame the hip. A spine exam helps sort this out.
The clue: Night pain in the buttock or leg that shifts with changes in back position suggests the spine.
Sleeping with the knees pulled up and the leg rolled inward can pinch the front of the hip. A torn labrum can ache after a day of activity. Night pain is usually milder than in arthritis.
The clue: Waking with a deep groin ache in a curled-up sleeping position, in a younger active adult, suggests impingement.
A stress fracture of the femoral neck or loss of blood supply to the ball of the hip can cause aching that continues at rest and at night. Both may not show on early X-rays. An MRI makes the diagnosis.
The clue: Groin pain that started with running or without injury and now persists at rest needs an MRI.
Dr. Stride asks which sleeping positions hurt, when the pain started and whether any position relieves it, because these answers separate tendon pain from joint pain. He presses on the greater trochanter, tests single-leg stance and checks gluteal strength for tendon problems. He measures hip rotation and performs FADIR and FABER tests to look for arthritis or impingement, and examines the back for nerve problems. Standing X-rays show arthritis and bone shape. Ultrasound shows the tendons and bursa, and an MRI is ordered when a stress fracture, osteonecrosis or a tendon tear is suspected. Night pain with warning signs is worked up promptly.
“Bring your outside X-rays and MRI. I’ll go through them with you, but how your hip moves on the exam table tells me just as much as the pictures.”
Dr. Stride, MD
Sleeping on your back or on the good side with a firm pillow between the knees keeps the hips level and often helps within days.
Strengthening the gluteal tendons and improving hip motion addresses the cause of most night pain, with improvement typically over 6 to 12 weeks.
A short course of an anti-inflammatory taken in the evening can help, when safe for you. Our team avoids long-term sleep aids and opioids for hip pain.
An ultrasound-guided cortisone injection near the trochanteric bursa often calms tendon night pain enough to sleep while therapy takes effect.
A cortisone injection into the hip joint can relieve arthritis pain at night for weeks to months.
When arthritis pain steals sleep night after night despite good care, a hip replacement usually restores restful sleep within the first few months.
For outer hip pain, sleeping on your back or on the good side with a pillow between the knees is usually most comfortable. For arthritis, many people prefer the back with a pillow under the knees. Avoid lying directly on the sore hip.
Usually not. Most night hip pain comes from tendon irritation or arthritis. Pain that is constant in every position, or that comes with fever, weight loss or a history of cancer, should be evaluated promptly.
Night pain from arthritis that keeps waking you despite therapy, medicine and injections is one of the signs that a replacement may be the right step. Night pain from tendon problems does not call for a replacement and responds well to other treatment.
Sitting for long periods stiffens an arthritic hip and tightens the hip flexors, so the joint aches when you finally lie down. A short walk or gentle stretching before bed often helps.
A trochanteric bursa injection places cortisone and numbing medicine over the bony point on the outside of the hip to calm hip bursitis and gluteal tendon pain.
Read more →InjectionsA cortisone hip injection places a corticosteroid and numbing medicine directly into the hip joint, guided by ultrasound or X-ray.
Read more →Non-surgicalPhysical therapy helps many types of hip pain, including arthritis, gluteal tendinopathy, hip impingement and many labral tears.
Read more →ReplacementTotal hip replacement replaces the worn ball and socket of an arthritic hip with a metal, ceramic and medical-grade plastic implant.
Read more →Front of hip and groin pain usually comes from inside the hip joint itself.
Causes & treatment →Hip pain · Outside of hipPain on the outside of the hip is most often greater trochanteric pain syndrome, an irritation of the gluteus medius and minimus tendons and the bursa over the bony point of the hip.
Causes & treatment →Hip pain · Back of hipPain in the back of the hip and buttock most often comes from the lower back, such as a pinched nerve or sciatica, or from the sacroiliac joint.
Causes & treatment →Hip pain · symptomHip joint pain is usually felt in the groin or front of the thigh and flares with putting on socks or getting out of a car.
Causes & treatment →
Hip pain at night is rarely a sign of cancer.
Hip pain in women is most often caused by gluteal tendinopathy, the tendon problem usually called hip bursitis, which peaks between ages 40 and 60.
For most hip pain, sleeping on the side that does not hurt with a pillow between your knees is a good start.
Medically reviewed by Dr. Stride, MD against current guidance from these sources. Last reviewed October 2026. How we write and review content
