Hip Pain at Night: Causes, Prevention, Treatment, and Best Exercises

There's no doubt that hip pain takes a big toll on your quality of life and daily routine. You may find it hard to do daily activities like walking the dog, getting in and out of the car, and doing household chores, let alone exercise. But while hip pain can wreak havoc during the day, it can be even more disruptive at night. Hip pain disrupts your sleep, creating a vicious cycle that can lead to even more pain.

Here, learn more about what causes hip pain at night, and how to prevent and treat it - especially with exercises from our Hinge Health physical therapists.

What Is Hip Pain?

Hip pain is very common, especially if you're active: In fact, up to 40% of adults who play sports report chronic hip pain. It also occurs in about 15% of adults over the age of 60.

Some common causes of hip pain include:

• Arthritis. There are several different kinds that can contribute to hip pain, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

• Bursitis, or inflammation of the fluid-filled sacs that sit near your hip joint.

• Hip tendinitis

• Hip fracture

• Hip labral tear

• Sprains and strains

• IT band syndrome. This is when the iliotibial (IT) band - the long band of connective tissue that runs from your hip to your knee - becomes swollen and inflamed.

Unfortunately, if you have any of the above conditions, you're more at risk to develop hip pain at night, says Steven Goostree, PT, DPT, OCS, a physical therapist at Hinge Health.

Causes of Hip Pain at Night

There are many common causes of hip pain. But you may particularly want to know what causes hip pain at night. Here are some of the most common reasons your hip hurts during the night.

Your sleep position. You may prefer sleeping on your side, but "this tends to be a major cause of nighttime hip pain," says Dr. Goostree. Here's why: You not only put pressure on one of your hip joints by lying directly on it, but you also strain the other joint by forcing it to shift forward.

Your mattress. The surface you sleep on can be a big source of nighttime hip pain. "Many folks who get hip pain at night may need a new mattress," explains Dr. Goostree. Wear and tear over time can lead to the mattress sagging, which means less support and more pressure applied to your hip joints. "This is especially true if you're a side sleeper, since the indent on the mattress can cause strain around the hip," he adds.

Pregnancy. Your growing bump means there's extra pressure on your spine and hips, which can lead to pain.

Hip bursitis or arthritis. This condition can worsen at night, because lying on your side can compress the bursa, or small sacs, increasing your level of pain. The same is true for hip arthritis, since sleeping on a hip with arthritis puts pressure on the joint.

Hip injuries. Whether it's a mild case of hip tendinitis, or an actual tear, injuries can ache more at night and when you wake up. "Muscles and ligaments tend to stiffen up overnight, since they're not moving," explains Dr. Goostree. This can be worsened if you're a side sleeper: "You're essentially compressing all the tissue on that side, which decreases blood flow to the area and can irritate it," he adds.

In addition, even mild pain can become particularly problematic at night. "You're lying in bed without distractions, so you finally have time to become aware of the pain, even if it wasn't causing you as much discomfort during the day," Dr. Goostree says.

When to See a Doctor

You usually don't need to see a doctor if your hip pain is minor. "It's common, especially if you're active, and really not something to worry about," reassures Dr. Goostree. You should, however, see a doctor if nighttime hip pain persists or worsens even after you've tried basic steps such as some rest, over-the-counter anti-inflammatories, ice and/or heat, and gentle stretching and strengthening exercises for a week or two. Also, "If your pain is still so bad that it's preventing you from sleeping, then it's a problem that needs to be addressed," stresses Dr. Goostree. See a doctor if you notice any of the following:

• You can't move your leg or hip

• You can't bear weight on the leg where you have hip pain

• You have intense pain ("that means on a scale of one to 10, your pain is registering at five or higher," says Dr. Goostree)

• You notice swelling around the hip joint

• You have signs of infection like fever, chills, and/or redness

Prevention Tips

If you're prone to hip pain at night, there are many things you can do to manage and prevent it.

Move more throughout the day. "If you can get up every hour for a few minutes to walk around, it moves your hip joints through a wide range of motion and helps prevent them from stiffening up," explains Dr. Goostree. Remember, movement is medicine.

Take a warm bath before bed. This will increase blood flow to the hip area, which is helpful if you're about to lie down for seven to eight hours.

Pump up your pillows. If you are a side sleeper, Dr. Goostree recommends that you place a pillow between your bent knees to keep your hips aligned. If that's still too painful, lie on your back with pillows under your knees to help take pressure off of your sore hip joint.

Invest in a new mattress. If you suspect your mattress could be a culprit in your hip pain, consider replacing it. Recommendations vary, but the National Sleep Foundation suggests every six to eight years, especially if you're getting poor sleep, you notice you sleep better at hotels, or you notice sagginess or damage. Look for a firm to hard mattress, Dr. Goostree recommends. If it sags a bit when you are on it, it's too soft.

Check your workspace. If you sit for long periods of time, you're more at risk for hip pain that can worsen at night. The following tweaks may make a big difference:

• Adjust the height of your desk chair so that your feet rest flat on the floor, to reduce pressure on your hips.

• Avoid crossing your legs when sitting as this can put extra pressure on one or both of your hips. 

• Sit with your buttocks and shoulders against the back of the seat to maintain a neutral upright posture. 

• Stand with feet shoulder width apart to avoid leaning and putting more stress on one side of your body.

Lose weight if you need to. There's no such thing as a perfect number on the scale, but losing even a small amount of weight if needed can reduce stress on your joints. "It takes pressure off of your hip joint when you're lying in bed," says Dr. Goostree. A 2020 review published in the Journal of Orthopedics and Sports Physical Therapy found that weight loss can reduce pain intensity among people with hip or knee pain.

Treatment for Hip Pain at Night

The course of treatment for nighttime hip pain depends a lot on the nature and cause of your pain. 

The following tips from our Hinge Health physical therapists and medical doctors can provide relief for mild to moderate pain.

• Over-the-counter (OTC) medication. Pain relievers, such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol), can be helpful for hip pain. It's important to make sure that you are safely able to take these medications, based on your medical history.

• Ice and heat. Alternate using an ice pack and heating pad for 20 minutes at a time as needed to reduce swelling and inflammation (ice) and increase blood flow to reduce stiffness (heat).

• Compression and elevation. To manage swelling, gently wrap a soft bandage around your hip and elevate your leg so your foot is above your heart.  

• Steroid injections. If over-the-counter medication does not offer sufficient pain relief, your doctor may suggest cortisone steroid injections to help counter pain and inflammation.

• Change your sleep position. If you like to sleep on your side, lie on the side of your body that does not have hip pain and put a pillow between your knees to support your top hip and keep your hips in their natural alignment while you sleep. If you prefer to sleep on your back, place a pillow under your knees. 

• Complementary treatments. Talk to your provider if you're interested in trying alternative treatments for hip pain relief, such as massage, acupuncture, or chiropractic care.

While all of the above steps can help nighttime hip pain, one of the most effective ones is exercise. "The hip is a large ball-and-socket joint that craves a lot of movement," says Dr. Goostree. "You want to make sure that you keep the structures around it strong and flexible, to ensure range of motion and decrease pain."

While high-impact exercise such as running could make hip pain worse, low-impact activities such as pool exercises, the elliptical, walking or tai chi may help. You may also benefit from physical therapy, where you can learn movements and stretches to increase the strength and flexibility of the structures in and around your hip. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Watch Your Back

Your nighttime hip pain may also be due to weakness in the lower back. “Your lower back can refer pain to your hip, so it’s important to keep your spine flexible and strong,” advises Dr. Goostree. Regular aerobic activity such as walking, along with exercises to strengthen your lower back muscles, can help.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Alaia, M. J. (2020, July). Hip Strains. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/hip-strains/

2. Johnson, R. (2021, June). Approach to hip and groin pain in the athlete and active adult. UpToDate. https://www.uptodate.com/contents/approach-to-hip-and-groin-pain-in-the-athlete-and-active-adult?search=Approach%20to%20Hip%20and%20Groin%20Pain%20in%20the%20Athlete%20and%20Active%20Adult&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

3. Paoloni, J. (2021, October). Approach to the adult with unspecified hip pain. UpToDate. https://www.uptodate.com/contents/approach-to-the-adult-with-unspecified-hip-pain

4. Robson, E. K., Hodder, R. K., Kamper, S. J., O’Brien, K. M., Williams, A., Lee, H., Wolfenden, L., Yoong, S., Wiggers, J., Barnett, C., & Williams, C. M. (2020). Effectiveness of Weight-Loss Interventions for Reducing Pain and Disability in People With Common Musculoskeletal Disorders: A Systematic Review With Meta-Analysis. The Journal of Orthopaedic and Sports Physical Therapy, 50(6), 319–333. doi:10.2519/jospt.2020.9041

5. Sheth, N. P., & Foran, J. R. H. (2022, February). Hip Bursitis. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/hip-bursitis/