Hip pain is more common in women than men and is most prevalent in women aged 40–60 years. It is mainly caused by injury or overuse, although there are some other causes.
In this article, we take a look at these causes, along with available treatment options and tips for preventing hip pain at night.
Common causes of hip pain at night
Hip pain at night can be caused by a variety of different conditions affecting the hip joint, connected muscles, or surrounding tissue.
Greater trochanteric pain syndrome
Hip pain may be caused by conditions affecting the joint, muscles, or surrounding tissue.
The muscles around the buttock are called the gluteal muscles. Poor strength in the gluteal muscles can cause the front of the hip to overcompensate to stabilize and support the rest of the joint.
This causes the tendons attaching the gluteal muscles to the hip and pelvis to become squeezed, leading to pain at the hip known as greater trochanteric pain syndrome (GTPS).
GTPS specifically involves the tendons and fluid-filled sacs surrounding the greater trochanter, which is the prominent bony part of a hip. An injury to either the tendons or sacs can cause pain and tenderness to the hip, particularly at night.
Bursae are small fluid-filled sacs that act as cushions, helping to reduce friction at the hip joint. Bursitis occurs when the bursae become inflamed.
Inflammation of the bursae causes pain from the hip that spreads down the side of the thigh. This sharp, intense pain may worsen at night.
Tendinopathy refers to any disease of the tendons. Tendons in the hip attach the gluteal muscles to the hip and pelvis. Together, they work to stabilize the pelvis and support hip mobility during day-to-day tasks, such as walking and going up the stairs.
Tendons in the hip may become inflamed or break down due to compression or overloading without having time to recover. This can cause hip pain at night.
Frequently sitting with legs crossed, or standing with all the weight on one hip can also cause tendinopathy and hip pain.
Osteoarthritis of the hip joint is another common cause of hip pain at night. Osteoarthritis is a result of age-related "wear and tear" of the tissue known as cartilage that surrounds the ends of bones.
As the cartilage at the hip wears away, the bones at the hip rub against each other, which leads to inflammation, swelling, and pain.
Osteoarthritis can present as stiffness and soreness of the hip, which can make everyday tasks difficult and painful over time. Hip pain can move around to the buttocks or down the leg, affecting mobility, and can be painful at night.
Strenuous exercise — such as soccer, running, or dancing — has been linked to increased risk of hip pain. This could be due to a range of conditions, including bursitis, tendinopathy, or injury to the iliotibial band, a band of tissue connecting the pelvis and the shin bone.
A recent change to the frequency of exercise may also be a trigger for injury or pain in the hip.
Several other factors could lead to hip pain occurring at night:
- Age: Both osteoarthritis and trochanteric bursitis are more common in older adults. People transitioning to menopause and post-menopausal women are also at greater risk of hip pain at night.
- Overweight and obesity: People who are overweight or obese are more likely to get osteoarthritis as their joints have to deal with more pressure from increased body weight.
- Accident or injury: Hip pain at night can be brought on by an injury that dislocates the hip joint or an accident, such as falling over.
- Pain from the knee, pelvis, or back: A person may feel pain from other areas of the body in the hip. For example, pain in the back caused by pressure on a nerve there can also occur in the hip.
Swimming may be an effective exercise for treating hip pain.
A person might be able to treat hip pain at night by making changes to exercise and sleep routines, alongside other lifestyle changes.
If these do not work, several pain management options are available.
To improve hip pain at night, people should do the following:
- Strengthen the hip, thigh, pelvis, and gluteal muscles with exercises that involve moving these areas from side to side.
- Rest from activities and exercises that might be aggravating the hip and tendons, such as running or hill walking.
- Choose a lower-impact activity, such as swimming or cycling, instead of high-impact exercise, such as running or step aerobics.
- Always warm up and cool down properly when exercising.
- Wear appropriate footwear when running.
A physio can recommend specific exercises to increase hip strength and flexibility.
Changing a regular sleeping position can help improve hip pain. People may want to try the following:
- Lying flat on the back. This position leads to less compression between the hips.
- When lying on one side, place a pillow between legs to keep legs parallel and support the hips, pelvis, and spine.
People may also wish to consider a new mattress or foam topper mattress. This can improve support and distribute weight more evenly to minimize pressure on hips.
Some simple lifestyle changes may help reduce hip pain at night:
- avoiding long periods of sitting with legs crossed
- trying not to stand with weight on one hip pushed out to one side
- maintaining a healthy weight
People can relieve and control hip pain in several different ways:
- Taking over-the-counter anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or aspirin, may help reduce pain and control inflammation.
- Applying ice to the hip after exercise to prevent pain and swelling.
- Using a heat pad or hot water bottle on the affected area after a couple of days.
- Having a corticosteroid injection may provide temporary relief but may not address the cause of the hip pain.
- Having a massage can relax the muscles in the back and hips.
Hip pain at night during pregnancy
During pregnancy, it is quite common for individuals to experience changes in their body and hormone levels. One potential change is a pain in the hip or pelvis as muscles and ligaments relax and stretch before giving birth.
When pregnant, the best sleeping position is on the side. Experts recommend putting a pillow between the legs, which can help support the hips and lower back and prevent rolling over.
Other less common causes of hip pain during pregnancy are:
- A tear in the ring of cartilage that cushions the hip joint and holds the ball and socket joint together. Mending this tear might require surgery.
- A hernia, where an organ or tissue pushes through a weak spot in the surrounding muscle or tissue. Added pressure on the abdomen during pregnancy could cause a hernia.
Anyone who is concerned about hip pain during pregnancy should tell a doctor or midwife, or make an appointment to see a physio.
Wearing appropriate footwear during exercise may help.
Here are some steps that people can take to reduce the risk of experiencing hip pain at night:
- avoid repetitive activities that put a strain on the hips
- lose weight if overweight or obese
- maintain strength and flexibility at the hip joint by exercising safely
- make sure to wear appropriate footwear when exercising
When to see a doctor
People should seek medical attention if hip pain at night is persistent, gets worse, or spreads to knees, pelvis, or lower back.
If someone is taking NSAIDs long-term, but the drugs no longer help ease the hip pain, the person should make an appointment to talk with a doctor about alternative medication options.
For a thorough diagnosis of hip pain, it is likely that the doctor will order an imaging test, such as an X-ray, to look more closely at the hip.
In some instances, hip pain is unpreventable and a natural part of aging.
Moderate exercise with appropriate footwear and maintaining a healthy weight helps to protect bones and joints. Doing both of these things will hopefully prevent hip pain from getting worse.
Anyone who is experiencing hip pain at night should see if they can improve their sleeping position and mattress. Adding a foam topper, which can be purchased online, may make a difference.
If the pain does not improve, the person should make an appointment to see their doctor.