Some hip pain relief sleeping can make a big difference to your wellbeing. Many people lie awake for hours each night, unable to sleep as a direct result of their pelvic or hip pain. Reduced sleep can have many negative impacts on your life. This may be directly on your hip pain, and your healing capacity, but also in all facets of your life and coping with the day to day of living, and your overall mental health.

In this blog, we’ll first provide you with our 3 top strategies to find hip pain relief sleeping, and then you’ll find lots more helpful information to help you understand your pain and get a great night’s sleep. Here are the topics we’ll cover:

• How can you reduce your hip pain when sleeping
• Other hip pain relief sleeping strategies – sleep hygiene and relaxation
• What is the cause of your hip pain at night?
• How to prevent hip pain at night
• How a Hip Pain Professional can help with hip pain at night
• When to call your doctor about hip pain

1. How can you reduce your hip pain when sleeping

Here are a few strategies you could try to help give you some hip pain relief sleeping. Medications may need to be addressed in addition so please make sure you discuss this with your doctor, general practitioner or specialist.

Hip pain at night lying on side – Hip Pain Relief Sleeping Strategy 1

If you are a side sleeper, try sleeping with a pillow between your knees and ankles.

When you lie with your top leg resting down on your bottom leg, this can create more of an angle of the top thigh dropping across your body.  This may have an impact on pain coming from your hip joint, for example, in conditions such as FAI syndrome, hip dysplasia, and hip OA.

If you are a side sleeper, try sleeping with a pillow between your knees and ankles.

When you lie with your top leg resting down on your bottom leg, this can create more of an angle of the top thigh dropping across your body. This may have an impact on pain coming from your hip joint, for example, in conditions such as FAI syndrome, hip dysplasia, and hip OA.

This position may also have an impact on the soft tissue structures (muscles, tendons, and bursa) around the hip and pelvis, such as in conditions like gluteal tendinopathy, or greater trochanteric pain syndrome.

Nerve related conditions may also become aggravated, such as with hip-related sciatica.

Having the top and bottom legs slightly separated may help position the top leg in a way that takes stress and strain away from these soft tissues, reducing overall pain.

Try sleeping with a pillow between your knees and ankles. Experiment with different pillow thicknesses …..it is far easier to just deal with only one pillow in the night that is the correct size, rather than two pillows!!!

Hip pain at night lying on back- Hip Pain Relief Sleeping Strategy 2

If you sleep on your back, try sleeping with a pillow under your knees. This can relax tension through the lower back and buttock area as well as in the front of the hip. This in turn can help reduce pain related to the front and back of the hip and pelvis, for example in conditions related to the hip joint, the labrum, soft tissue structures (such as the hip flexors) and nerve structures (referred from either the low back or from local nerves involved around the hip or pelvis).

Hip Pain Relief Sleeping Strategy 3 – use a mattress topper

Use a mattress topper – if you struggle to lie on your side because the hip you are lying on becomes sore from the pressure of lying on it, then something softer over the mattress may be of benefit. In conditions such as gluteal tendinopathy or greater trochanteric pain syndrome, the ideal is to avoid side lying. If this is not possible, then a mattress topper may help reduce the pain from compression on the lower hip. You could try to sleep on a thick soft duvet you have at home first to see if there is any benefit before heading out and spending money on a more expensive mattress topper.

Other Hip Pain Relief Sleeping Strategies

Sleep Hygiene

This is another topic that we will explore in much more detail in the future.

Sleep hygiene considers many aspects around making sure you select the best internal and external environment to help facilitate better sleep. As a brief overview, here are a few simple things you may include:

• Consider what you eat and drink before you sleep
• Don’t exercise immediately prior to sleep
• Stay clear of screens for at least an hour before you sleep
• Ensure a dark room
• Block out noise – earplugs are so simple and so effective
• Routine: keep a routine trying to go to sleep and wake up at similar times day to day.

Look at relaxation strategies prior to sleep – meditate

This may be through learning to meditate and calm the mind. It may be through reading or listening to music. There are endless possibilities here.

Meditation: many people through this idea out before even trying – “headspace” is a great, easy app with a free trial where you can give meditation a go in many different forms – there may actually be something here that works for you.

Visit our Pain Locator Map to learn more about soft tissue related pain in different regions around the hip and pelvis. 

What is the cause of your hip pain at night? – reasons for hip pain while sleeping

There are many different reasons you may experience hip pain at night. In this section we will cover some of the more common causes of hip pain that can affect your sleep quality, preventing you from getting a restful sleep.

Hip joint pain at night – osteoarthritis pain at night

People with hip osteoarthritis, the most common form of arthritis, often experience aching in their hips at night. Hip osteoarthritis is a degenerative joint condition, involving inflammation and gradual deterioration of the smooth cartilage surfaces of the ball-and-socket joint.

Hip osteoarthritis pain at night can be related to inflammation in the joint, which is affected by what you have been doing during the day. You’ll usually notice that if you’ve pushed your hip a bit too much during the day, your hip can ache much more that night. Controlling what you do during the day will help with your night time pain.

Hip osteoarthritis pain at night can also be related to spending hours in positions that stretch or compress sensitive structures in the joint.

For those with hip osteoarthritis, often the worst sleeping positions are:

• sleeping flat on your back, or
• side sleeping with the knee up high.

Sleeping flat on the back with the hips extended puts the hip capsule on increased tension. When the hip is inflamed with increased fluid in the joint, this extended hip position may be difficult to sustain for a prolonged period, resulting in aching.

Sleeping with the knee up close to the chest can also bring sensitive structures at the front of the hip together, causing discomfort over a period of time.

Continue reading to find more information on reducing pain in particular sleeping positions.

Read more about hip osteoarthritis here.

Hip joint pain at night – labral tear hip pain at night

The smooth cartilage lining the hip joint socket merges into a more fibrous cartilage that sits around the edge of the bony socket, like a fringe. This is called the labrum (acetabular labrum). Changes within this labrum, including a labral tear, can cause hip pain at night, especially in certain positions that put more stress in the area where the labral irritation exists.

For those with a labral tear, often the worst sleeping positions are:

• back sleeping with the bent leg turned out,
• tummy sleeping with the knee up to the side, or
• side sleeping with the knee up high.

Sleep positions that are most painful for those with a labral tear vary depending on which part of the labrum is affected. Back sleeping or tummy sleeping with the bent leg out to the side, can put quite a lot of stretch across the front of the hip capsule and labrum.

Side sleeping with the knee up close to the body can compress an irritated labrum. Try to note which position aggravates your hip pain most, and then try our suggested modifications for that position. Read more on sleep positions below.

Hip bursitis, greater trochanteric pain syndrome, or gluteal tendinopathy pain at night

These conditions are all interlinked. Pain over the side of the hip is commonly related to changes in the health of the tendons that join the gluteal (buttock) muscles to the hip, and sometimes of the nearby bursae (fluid filled sacks that help reduce friction between tendons and bones). The condition may be diagnosed as gluteal tendinopathy or tendinitis, trochanteric bursitis or Greater Trochanteric Pain Syndrome (GTPS) which encompasses both.

For those with hip bursitis, greater trochanteric pain syndrome, or gluteal tendinopathy hip, often the worst sleeping positions are:

• side sleeping on the sore hip,
• side sleeping on the good hip, or
• back sleeping with the ankles crossed

The painful structures in this condition are located on the outer side of the greater trochanter – the bony point at the side of the hip. Sleeping on your side will compress these tender structures against the bed.

The top hip is also often sore when side sleeping with the condition. This is because of the relative stretch of these structures when your knee is lower than your hip in side lying. 

If you have pain at the side of the hip at night, some simple strategies can go a long way in improving your overall pain from this condition. Read more on sleep positions below.

Read more about hip bursitis, greater trochanteric pain syndrome and gluteal tendinopathy here.

Lower back pain causing hip pain at night

The lower back can be linked to hip pain at night. Low back structures like discs and facet joints, can directly refer pain to the hip area. Irritation of the nerve roots from the low back may also cause pain in the hip area, as well as down the thigh, lower leg and foot (radicular pain).

For those with hip pain referred from the lower back, often the worst sleeping positions are:

• back sleeping,
• tummy sleeping, or
• side sleeping with the lower back excessively rotated.

These positions tend to increase the arch in the lower back, increasing compression of painful structures. Read more about modifying these sleep positions below.

The relationship between the back and hip pain can be a complex area to understand. You can read more about it by clicking here.

Sciatic nerve related pain, known as deep gluteal syndrome or piriformis syndrome causing hip pain at night

The sciatic nerve is a large thick nerve that comes together in the upper to mid buttock region, running deep through the lower buttock and then down the back of the leg. When the nerve is irritated in the buttock area, it is called Deep Gluteal Syndrome or Piriformis Syndrome. When the sciatic nerve causes hip pain sleeping, this is usually felt through the back of the hip in the buttock, and frequently travels down the back of the leg.

Worsening of nerve pain at night is very common. This can be due to i) lack of daytime distractions and ii) congestion of fluid around a nerve in tight nerve tunnels or pathways.

For those with deep gluteal syndrome or piriformis syndrome, often the worst sleeping positions are:

• side sleeping, where the sore hip is on top, and the knee is up high, or
• back sleeping

During the day, movement and higher blood pressure helps normal fluid around nerves move through tight tunnels or pathways that might be constricted by tight muscles. Night-time positions that put the muscles in the buttock on tension, like side lying with the knee high, can further constrict the nerve.

You can read more about deep gluteal syndrome and piriformis syndrome by clicking here.

If you have buttock pain, check out our course and see if it is suitable for you.

Pregnancy related hip pain at night

Pregnant women frequently experience pain in the hip and pelvic region at night, resulting in sleep deprivation before the baby even arrives! 

This may be due to the hormonal changes happening in the body, the positioning of the baby, or as a result of the effects of carrying the baby, such as the increased weight and changes in the way a pregnant woman moves. 

For those with pregnancy related hip pain at night, often the worst sleeping positions are:

• sleeping flat on the back, or
• side sleeping with no support

Pregnancy related pelvic pain at night can come from the sacroiliac joints or SIJs, which become a little more flexible in the later stages of pregnancy. This SIJ pain is usually felt through the back of the hip/pelvis and buttock area.

Read more about modifying sleep positions below. Aim to support the extra weight of the baby with pillows and keep your legs in a fairly symmetrical position to avoid twisting strain across the pelvis.

And one more tip, draw up your pelvic floor and draw in your tummy to roll in bed when pregnant. This can help reduce those sharp little pains that can happen when moving after you’ve been lying in one position for a while.

Other causes of hip pain sleeping

Night-time pain should always be treated with caution. There are many other medical reasons that night-time pain can occur. Should the night pain persist, you must see a health care provider, such as your doctor, to discuss and investigate this further.

How to prevent hip pain at night

This blog has already covered 3 common strategies on how to reduce hip pain while you are lying down. Below you will find more position-specific sleep strategies to help you find the best sleeping position for hip pain at night. We will briefly summarise these below.

How to relieve hip pain while sleeping – a summary by position

These are the positions that the Hip Pain Help clinicians most frequently are asked about. There is not a single best sleep position that will suit everyone, or work throughout the whole night.

To ensure a good night’s sleep you may need to change between positions. Although you might find a comfortable sleep position when you first go to sleep, you might wake up later with hip pain.

Spending long periods of time in just one position is often not great for anyone after a period of time. Having a couple of options that you can swap between can help you get through the night.

Hip pain when sleeping on the side

Conditions that are most likely to be painful when side sleeping:

• Hip bursitis, greater trochanteric pain syndrome, or gluteal tendinopathy
• Hip joint pain – osteoarthritis or labral tear
• Deep gluteal syndrome or piriformis syndrome
• Pregnancy related pelvic pain

Ways to reduce hip pain when side sleeping:

• Try a mattress topper. This is particularly helpful if you sleep on a firm bed and can also reduce shoulder pain.
• Keep your knees further from your chest (knees below the hips).
• Use a pillow between your legs or under your top hip and thigh. You can try anything from a small pillow between the knees to a full body pillow. The aim is to keep your lower back, pelvis and hips in a neutral position.
• Support your tummy with a small pillow, especially when pregnant – support the weight of the baby. 

You can read more about memory foam, mattress toppers for hip pain relief here.

Hip pain when lying on your back

Conditions that are most likely to be painful when back sleeping:

• Hip and leg pain referred from the lower back
• More advanced or irritable hip joint conditions like osteoarthritis
• Pelvic pain, including pregnancy related pelvic pain or SIJ pain

Ways to reduce hip and pelvic pain when back sleeping:

• Try a mattress topper over your bed to reduce pain from pressure in lying.
• However, be cautious of a bed that is too soft if you think your hip pain is related to your low back. Back sleepers often find that a bed that is too soft may further irritate back and hip pain. Just because you have a new mattress, doesn’t mean it is always right for you!
• Try putting a pillow under your knees, allowing them to rest in a slightly bent position. This can often be a comfortable position for hip, pelvic and low back pain.
• Don’t cross your ankles
• If you are in the last trimester of pregnancy, you will not be able to lie flat on your back for long – either create an incline with pillows to bring your chest higher than your pelvis or try side sleeping.

You can read more about memory foam, mattress toppers for hip pain relief here.

Hip pain lying on the back with the leg dropped out

Conditions that are most likely to be painful when back sleeping with the leg dropped out:

• Hip joint related hip pain – osteoarthritis, labral tear, impingement at the back of the hip
• Pubic pain, most commonly pregnancy-related pelvic pain
• Groin pain – adductor or inner thigh muscles and tendons
• Hip flexor related pain

Ways to reduce hip, groin and pelvic pain when back sleeping with the leg dropped out:

• Try resting a pillow between the knee and the bed. This will prevent your leg from dropping as far out, taking pressure off the hip, groin and pubic regions.
• Limit time spent in this position – bring your leg in to a parallel position and add a pillow under the thighs or try lying on your side.

Hip pain lying on your tummy

Conditions that are most likely to be painful when stomach sleeping:

• Hip and leg pain referred from the lower back
• More advanced or irritable hip joint conditions like osteoarthritis 

Apart from these conditions, often the most problematic thing about lying flat on your stomach, is having your neck twisted to the extreme. This may also result in neck pain. Modifying your position can improve comfort for your hip and neck!

Ways to reduce spinal and hip pain when stomach sleeping:

• Try sleeping with a pillow under your lower abdomen/pelvis. This can slightly bend the hips, taking pressure off the low back, pelvis and hips, resulting in less pain for stomach sleepers.
• Try sleeping with a pillow or body pillow wedged under one side of your body, pelvis and thigh – this reduces the twist at the neck too.
• Try a firm mattress. Be cautious of a bed that is too soft as you may sink into it placing your hips and back at a more extreme angle, further irritating your pain.

Better daytime care = less hip pain at night

In addition to finding a comfortable sleeping position at night and practising good sleep hygiene, you should establish better daytime care of your condition. You can see a physical therapist / physio to help. Physiotherapy / physical therapy will help to provide a treatment plan that will:

• Include advice and education on ways to manage your pain
• Prescribe an exercise program to help your condition. This is likely to include strength exercises, stretching, exercises that work on correcting how you move and balance exercises. The common muscle groups to be addressed will include the gluteals, or glutes, which are your buttock muscles. The hip flexors, or muscles at the front of the hip will also be targeted. The deep gluteals or hip abductor muscles on the outside of the hip also frequently need to be addressed.
• Use manual therapy such as massage, mobilisation, cupping, and dry needling to help reduce your pain

How a Hip Pain Professional Can Help:

A Hip Pain Professional will help assess you in more depth, look at different sleep strategies and assist you in finding ways that will help to reduce your night time pain. Night time pain is often reflective of how well you are managing your condition. For example, if you have been pushing through painful activities or doing too much-too soon, this will often be reflected in an increase in night time pain. Your Hip Pain Professional can help give you specific, personalised advice about better managing your condition by controlling aggravating activities in everyday life and activity.

Depending on your condition, a targeted exercise program or other treatments may be helpful – see the section on “prevent hip pain at night” earlier in this blog (LINK)

If your sleep issues persist, despite better management of your hip or pelvic condition, other sleep strategies may be considered such as checking out your sleep hygiene (e.g. night time routine, sleep habits), and other health conditions that may be effecting your sleep (e.g. sleep apnoea, hormonal changes, mental health/stress). Changing night time routine, trying some meditation or mindfulness or in some cases medication can be helpful. Any underlying health conditions should be addressed.

Sleep disturbance should not be underestimated in its ability to impact on your health and quality of life. If the simple tips in this blog do not assist, seek help as soon as possible from your Hip Pain Professional or General Medical Practitioner.

When to Call Your Doctor About Hip Pain

Should your hip pain at night persist (chronic hip pain) despite the suggestions in this blog, then you must consult with your doctor. Your doctor can discuss other possible causes such as other medical conditions, or other forms of pain management (such as medication, injections or referral for example to an orthopedic surgeon if nothing else is helping).

At Hip Pain Help we continue to strive to bring you, those with hip pain, the most up to date, evidence-based information to help you on your journey to hip and pelvic pain relief. 

As healthcare providers, we have tried and tested these strategies for reducing pain over many years with great results. Check out the read-more section below for other useful blogs on ways to help reduce your hip and pelvic pain.

Check Out More You Can Read on Hip Pain Releif at HipPainHelp:

Causes, Effects & Exercises for Lordosis to Reduce Hip and Back Pain: learn about pelvic posture and how adjustments may help provide hip or pelvic pain relief

Hip Hanging is Easy – But May Not Be A Good Way to Stand For Hip Pain Relief: Hip hanging is easy, but for prolonged periods may be contributing to your hip or pelvis pain. Learn more and learn strategies on how to correct this.

Top Tips for Hip Pain Relief Sitting, when Socialising or Travelling: here we discuss strategies that may help reduce your hip and pelvis pain when sitting, for example with work, travel and play.

What is the Best Good Posture for Hip Pain Relief: Is there any one good posture that could best help with hip pain relief is not such an easy question to answer!

Don’t miss our next blog……

Our next series of blogs will focus on hip dysplasia, a condition often detected at childbirth and well treated, but also often missed resulting in many younger people struggling with early-onset hip pain, and often earlier requirements of having hip surgery when misdiagnosed.  Check out our next blog to find out more!

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