The Hip Pain That Wakes You at Night: Making Sense of Pain on the Outside of Your Hip

If you have ever been woken by an ache on the outside of your hip after rolling onto that side, felt it standing at the kitchen counter with your weight sunk onto one leg, or getting out of a low car seat, you already know the particular nuisance of outside hip pain.

Outside hip pain at night is more common than most people realize, and far more common in women. In a study of just over 3,000 adults aged 50 to 79, 15 percent of women had it on one side and 8.5 percent on both, against 6.6 and 1.9 percent of men—odds more than three times higher.

The good news? Outside hip pain responds to the right kind of loading better than to almost anything else on offer. In a trial of 204 adults whose diagnosis was confirmed on MRI, 51 of 66 people given education about managing load plus exercise rated themselves improved at eight weeks, against 20 of 68 left to wait and see.

At Rooted Motion Physical Therapy, we believe that understanding what irritates a tendon is what lets you stop irritating it. Here is what outside hip pain really is, why it is worst at night, and how physical therapy helps.

What Is Causing Pain on the Outside of Your Hip?

Outside hip pain usually comes from the tendons of the gluteus medius and gluteus minimus—two muscles at the side of your pelvis whose tendons anchor onto the bony bump at the top of your thigh. Name them once and you can forget them: from here they are simply the side-hip tendons.

The tendons run over the bony bump at the top of the thigh.

Tendinopathy means a tendon has become irritated and less tolerant of load than it used to be. It builds over weeks rather than arriving in a single moment, and it announces itself in the same few places:

• Pain right on the bony point at the side of the hip, sometimes spreading down the outer thigh.

• Waking when you roll onto that side.

• Discomfort standing on one leg, or with your weight sunk onto one hip.

• Pain climbing stairs or hills, or rising from a low seat.

• Soreness after a long walk that felt fine at the time.

So It Is Not Bursitis?

Probably not, or at least not mainly. For years this was called trochanteric bursitis, a name that describes inflammation of a small fluid-filled cushion beside the bone. The current view places the tendons at the center instead, with the bursa often irritated alongside them rather than being the origin.

There is a number behind that shift. When 877 patients scanned for pain at the side of the hip were reviewed, about 80 percent had no bursitis at all on ultrasound. Around half showed changes in the gluteal tendons, and bursitis appeared in only about one in five.

Note the other half: tendon changes were absent in half the sample too. More than one contributor.

That matters more than a name usually does. A bursa suggests something to calm down and wait out. A tendon suggests something whose load needs managing and whose capacity needs rebuilding—a different plan, and a more hopeful one.

Why Does It Hurt Most at Night?

Because tendons object to being squeezed as much as they object to being worked. Where the side-hip tendons pass over that bony bump, certain positions press them into the bone underneath, and pressure on an already-irritated tendon is thought to be what turns a quiet ache into a sharp one.

Imagine a Cable Pressed Into the Corner of a Desk

Picture a cable running over the corner of a desk. Left to drape, it is fine. Push it hard into the corner and hold it there, and all the strain lands in one place.

Your side-hip tendons behave the same way. Whenever the thigh travels toward the midline of your body—lying on your side, crossing your legs, letting one hip drop as you stand—the tendon is pressed harder into the bone beneath it. Lying on the painful side does this directly. Lying on the other side does it too, because the top leg falls across.

Pressure, not effort, is what makes the night the worst part.

What Does the Research Show About Outside Hip Pain?

The strongest evidence comes from a 2018 trial published in the BMJ, which compared three approaches in 204 adults: education about load management combined with exercise, a single corticosteroid injection, or waiting. The education and exercise group did best at eight weeks, on reported pain and on how people rated their own improvement.

Education and exercise against an injection, and against waiting.

Two things are worth knowing before you take that as a promise. The program ran to fourteen sessions across eight weeks, so it is not what two appointments buy. And participants knew which group they were in, which flatters a self-rated result.

One more thing from that trial, because the answer is not the obvious one. When the researchers went back to ask why education and exercise worked, the improvement did not track with gains in hip strength or range of movement. It tracked with how people were managing the activities that mattered to them, how confident they felt about their pain, and how constant that pain was. The strengthening is still the vehicle. What seems to change is your relationship with the load, not only the size of the muscle.

What About a Cortisone Shot?

A fair question, and the same trial answers part of it directly. The injection did beat doing nothing at eight weeks. It did not beat education and exercise. By twelve months the education and exercise group were still rating themselves better off, although by then the two groups’ pain scores had converged. The wait-and-see group improved considerably on their own across the year too. Time helps. It just helps less, and more slowly.

But that trial compared the injection against waiting, not against a dummy injection, and those are different questions. A smaller trial did the harder one: forty-six adults received either a steroid injection or an injection of salt water, with neither they nor the person assessing them knowing which. There was no clear difference at four weeks, and none at three or six months.

Forty-six people is small enough that a modest real effect could hide inside it, so this is not proof that the steroid does nothing. It does mean the case for it is weaker than the first trial on its own suggests.

A reasonable reading: an injection may buy relief and is worth discussing with your physician, but it works better as something that makes rehabilitation possible than as a replacement for it.

How Much Discomfort Is Acceptable?

Some is usually expected. A review of thirty tendon-loading trials—gluteal tendinopathy among them—found that most programs use pain as the guide for when to progress, while noting plainly that this common practice is not backed by strong evidence. It also found clinicians split between two opposite philosophies: one that advances load only when the exercise is essentially pain-free, and one that permits controlled discomfort so long as it stays tolerable and does not build. No trial has yet run the same program both ways. So mild discomfort that settles is generally treated as acceptable and sharp or escalating pain is not, but the precise number is judgment rather than rule.

What You Can Change Tonight

None of this needs equipment, and it was part of the education program that beat both the injection and waiting in the trial. What has not been done is a study testing these positions on their own—so treat it as load management that follows from the mechanism, not as a cure in itself:

The top leg is the one that matters.

• Put a pillow between your knees and ankles when you sleep on your side, so the top leg does not fall across.

• Where you can, sleep on the less painful side, or on your back with a pillow under your knees.

• Uncross your legs when you sit.

• Stand with your weight even rather than sinking onto one hip.

• Go easy on stretches that pull your knee across your body—they compress the tendon where it already hurts.

• Keep walking, but end the walk before it becomes the walk that flares you.

How Long Should This Take?

The trial measured its main result at eight weeks and then followed people for a year, which is a fair picture of the timescale: meaningful change over a couple of months, with the rest of the year telling you whether it held.

If several weeks of sensible changes have made no difference, that is worth a proper look rather than more patience. Pain here can also come from the back, the hip joint itself, or less commonly a tear in the tendon.

The Rooted Motion Difference

Care here is one-on-one, in your own home, and built around your day:

• An evaluation of the hip, the back, and how you load the leg—not only the sore point.

• A look at the positions you actually spend your nights and days in.

• A progressive strengthening plan for the muscles at the side of the hip.

• Straight talk about injections, imaging, and what the evidence does and does not support.

• Regular reassessment, so the plan moves as your symptoms move.

• Convenient concierge mobile physical therapy delivered where you are.

Because recovery is not just about settling a sore hip—it is about sleeping through the night again.

Ready to Sleep Through the Night Again?

If this has been going on for months, that is unfortunately typical, and it is not a sign that nothing can be done. Tendons are slow, but they are responsive, and the evidence here points clearly toward loading them well rather than waiting them out.

Ready to move better and live rooted? Contact Rooted Motion Physical Therapy to schedule a one-on-one evaluation and begin a personalized loading plan for the tendons at the side of your hip.

Research Used for This Article

1. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. DOI

2. Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy. 2015;45(11):910-922. DOI

3. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine. 2015;45(8):1107-1119. DOI

4. Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation. 2007;88(8):988-992. DOI

5. Escriche-Escuder A, Casaña J, Cuesta-Vargas AI. Load progression criteria in exercise programmes in lower limb tendinopathy: a systematic review. BMJ Open. 2020;10(11):e041433. DOI

6. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR American Journal of Roentgenology. 2013;201(5):1083-1086. DOI

7. Nissen MJ, Brulhart L, Faundez A, et al. Glucocorticoid injections for greater trochanteric pain syndrome: a randomised double-blind placebo-controlled (GLUTEAL) trial. Clinical Rheumatology. 2019;38(3):647-655. DOI

Educational disclaimer: This article is for general education and is not a substitute for an individualized evaluation. Seek prompt medical care for hip pain that follows a fall or other injury; inability to bear weight; sudden severe pain or visible deformity; a hot, swollen joint with fever; or new numbness, tingling, or weakness in the leg.