Overview of Hip Pain
Hip pain while sleeping can keep you up at night. You may have trouble falling asleep or staying asleep as the pain takes over. It can also carry over into the daytime and severely impair your activities of daily living (ADLs).
Unfortunately, night-time hip pain is a growing, silent epidemic among older adults!
One in five people over the age of 65 reports having chronic (long-term) hip pain and end up not getting enough sleep.
There are many reasons why you may be experiencing hip pain. Let’s explore some of these potential causes…
Common causes of hip pain when sleeping
Night-time hip pain can be caused by many medical problems. Here are some of the more common ones:
Hip Tendonitis (inflammation of the tendons in the hip)
The tendons in the hip play an important role in stabilizing the pelvis and maintaining hip mobility.
These functions are vital for the daily functions that most of us take for granted, such as walking, climbing stairs, and maintaining general body stability.
As we know, tendons attach muscles to bone. So, in the case of the hip structure, the hip tendons attach the gluteal muscles to the hip and pelvis.
When your hip tendons are subjected to stress or overload without having an opportunity to recover, they can become inflamed and weak.
This can be a cause of your hip pain.
Other things that can cause hip pain include standing with all your weight on one side of your hip or sitting with your legs crossed, both of which can cause strain and imbalance.
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Getting uninterrupted, good-quality sleep depends on your sleeping position.
If you sleep on your back, you should not have any sleeping difficulties. If you are having problems, something else might be responsible.
If you have gastroesophageal reflux disease (GERD), sleeping at an elevated angle might help. You can find a good selection of sleep wedges here.
If you want to learn more about GERD, my comprehensive article on GERD and its causes, diagnosis, and medication management discusses this in more detail.
If you are a side sleeper, try not sleeping on the affected side, and place a knee pillow between your knees to keep your hips aligned.
If you sleep on your back, try placing your pillow under your knees to relieve lower back pain and a sore hip.
You can find a great selection of these pillows here.
Joints in our bodies typically contain small fluid-filled sacs called bursae.
There are over 150 bursa sacs throughout our bodies, primarily in our arms, legs, back, and hips.
These bursae help to cushion our joints and help them move smoothly.
These sacs can become inflamed and irritated from overuse, certain forms of strenuous exercise, playing sports, running, or heavy lifting that requires the hips to provide stability and force. This form of inflammation is called bursitis.
Inflamed hip bursae can cause severe hip pain.
Symptoms of bursitis include:
- Pain that starts when you stand up after sitting for a long time, and worsens when you take a long walk, climb stairs, or when you squat
- Pain that gets worse at night while sleeping on the affected hip or when you lie down
- Pain that starts off as a sharp pain, especially when touched, which then develops into an ache or persistent pain later
- Pain that is on the outside of your hip and the upper thigh
If you do not experience hip pain while standing, then it is most likely not bursitis. Regardless, you should always see your doctor to be properly evaluated.
Fortunately, bursitis often improves with rest and proper treatment.
Hip osteoarthritis and other types of arthritis
The most common type of arthritis affecting the hips is osteoarthritis (OA).
However, other types of arthritis can also cause hip pain while sleeping. These are:
- Rheumatoid arthritis (RA) – An autoimmune disease that attacks the joints and causes inflammation, damage, and pain; not due to the effects of normal aging like in OA
- Psoriatic arthritis – associated with psoriasis; affects the joints as well and causes inflammation and pain
- Septic arthritis – a bacterial or viral infection in the joint causing pain and inflammation
If you experience the following, you should have your doctor examine you for possible hip arthritis:
- Pain in the groin area
- Pain in your buttocks, thigh, or knee
- Pain that gets worse during rainy weather, in the morning hours, or after you have rested or sat for a period of time
- Pain that keeps you awake at night
- Pain when taking a walk, getting up from a seated position, or when bending over
- Your hip locks or “sticks,” or if you hear grinding sounds in your hips when you move
Greater trochanteric pain syndrome
Greater trochanteric pain syndrome (GTPS) is a common cause of side hip pain. It is more commonly seen in women between the ages of 40 and 60.
GTPS is so common that 10-20% of people presenting with hip pain to their primary care doctors are diagnosed with it.
It is caused by weak buttock muscles, which cause strain in the front of the hip bone as it attempts to compensate for the weakness.
Pain is located on the side of the hip closer to the upper thigh bone.
Symptoms of GTPS are:
- Worsening or severe pain when lying on your side
- Pain in the upper thigh/buttocks
- Worsening pain when walking long distances, running, or when standing
- Pain in more noticeable when walking quickly
- Pain when sitting with your legs crossed
- Tender to touch
- Walking pattern is altered due to discomfort and pain, and your body attempts to guard against it
How to manage hip pain at night
Your treatment for hip pain will depend on the type and cause of your discomfort.
Once your doctor has identified the source of your pain, its treatment will most likely involve some or a combination of lifestyle changes, alternative and alternative therapies, physical therapy, non-medication, and medication management.
Although it may sound counterintuitive, maintaining an active lifestyle with low-impact exercise will actually strengthen the muscles and soft tissues surrounding and supporting the hip joint and prevent recurrent episodes.
You can try pilates or Yoga to improve strength and flexibility.
Strength training and aerobic exercises such as walking and jogging or using the elliptical machine or treadmill can really help you avoid back and hip injuries. When engaging in physical activity, please make sure that you are wearing supportive shoes to prevent further stress on your joints.
Gentle stretching can help ease tension on your hip flexors and gluteal (buttock) muscles, maintain flexibility, and prevent injury.
The key point here is only to do what you can comfortably do and then gradually work your way up in exercise intensity as you gain strength and endurance.
Some clinical evidence also suggests that consuming food with anti-inflammatory properties may help to reduce the inflammation in your joints.
Examples are turmeric, lemon water, antioxidants, and omega-3 fatty acids.
BUT…a word of caution…these should not replace a proper evaluation, diagnosis, and treatment plan by a qualified healthcare provider. These foods can be a great complement to a clinically sound management plan grounded in science-based medicine.
Non-medication and medication management
Using a warm or ice pack on the affected hip may also bring some relief. But, please ensure not to burn yourself when using the warm compress!
Over-the-counter (OTC) drugs such as acetaminophen (Tylenol) and anti-inflammatory medications such as ibuprofen (Advil/Motrin) can help alleviate inflammation and pain.
If you are using NSAIDs such as ibuprofen, ALWAYS consult your doctor first.
Using these medications improperly can cause kidney damage, increased blood pressure, worsening of heart failure, cause gastrointestinal bleeding, and cardiac events!
Using a topical NSAID such as diclofenac gel (Voltaren) may be a better option, as these agents have less systemic absorption than their orally taken counterparts.
Complementary and Alternative Therapies
Acupuncture, massage, cupping therapy, Yoga, Pilates, and Tai Chi are good management options that can complement your doctor-prescribed treatment plan.
Another area that is gaining momentum through its positive clinical and research outcomes is CBD supplementation. (Use code GA20 for 20% off your order!) I write extensively about CBD use in older adults in my post here.
As the name suggests, these therapies are not meant to replace science-based, clinically validated medical treatment of your hip pain.
As always, consult your healthcare provider before trying any alternative therapies to plan which approach works best for you.
Summary and Helpful Tips
- Night-time hip pain can be incredibly frustrating, painful, and exhausting as it robs you of a good night’s sleep
- Proper diagnosis by a qualified healthcare provider is key to establishing the correct management plan for you
- Effective management of your hip pain can be managed with a combination of lifestyle changes, complementary/alternative therapies, and medication management
- Side sleepers and back sleepers, using a pillow between and under your knees respectively can help align your hips
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- Ahuja V, Thapa D, Patial S, Chander A, Ahuja A. Chronic hip pain in adults: Current knowledge and future prospective. J Anaesthesiol Clin Pharmacol. 2020 Oct-Dec;36(4):450-457. doi: 10.4103/joacp.JOACP_170_19. Epub 2020 Sep 26. PMID: 33840922; PMCID: PMC8022067.
- Barratt PA, Brookes N, Newson A. Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med. 2017 Jan;51(2):97-104. doi: 10.1136/bjsports-2015-095858. Epub 2016 Nov 10. PMID: 27834675.
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