Side sleeping places the body’s entire weight onto the outer hip, specifically over the greater trochanter. This mechanical compression of the soft tissues can cause discomfort or worsen existing conditions throughout the night. This pressure is the direct reason why side sleepers often find their sleep disrupted by hip pain. Understanding the underlying causes and how to adjust the sleep environment is necessary for relief.
Common Causes of Hip Pain When Side Sleeping
The primary reason for hip pain often traces back to trochanteric bursitis, the inflammation of a fluid-filled sac. Bursae cushion tendons, muscles, and bone; the trochanteric bursa is located over the greater trochanter. Prolonged pressure from lying on the affected side irritates this sac, causing pain and tenderness that disrupts sleep. This pain is typically felt on the outside of the hip and may radiate down the thigh.
Poor spinal alignment is another significant factor, occurring when the spine and pelvis are not kept straight. Without proper support, the top leg can drop forward, causing the hip joint to rotate internally and the spine to twist. This misalignment strains the hip abductor muscles (gluteus medius and minimus). If these tendons become damaged, gluteal tendinopathy can develop, which is a major source of outer hip pain worsened by side sleeping.
The age and firmness of the mattress can also contribute to the problem. A mattress that is too firm will not allow the hip to sink in enough, increasing the pressure on the greater trochanter. Conversely, an old or overly soft mattress that sags can fail to support the spine, allowing the body to fall into poor alignment and increasing muscle tension in the hip. Underlying muscle tightness, particularly in the iliotibial (IT) band, can pull on the hip structures and increase friction, making the area more sensitive to the pressure of side sleeping.
Positional Adjustments for Relief Tonight
Immediate relief can often be found by modifying your sleeping position. Placing a supportive pillow between the knees is one of the most effective adjustments for side sleepers. This action prevents the upper leg from crossing over the body, maintaining neutral alignment of the hips and spine. The pillow acts as a spacer, reducing the inward movement of the top leg and keeping tension off irritated gluteal tendons and bursa.
The quality of the sleeping surface also plays a role in pressure distribution and pain management. A mattress that provides a medium level of firmness is often recommended, as it offers enough give to cushion the hip bone while still providing necessary support to keep the body level. If a new mattress is not an option, using a mattress topper can add a layer of cushioning to alleviate direct pressure on the hip joint.
If the pain is acute, temporarily switching to back sleeping can eliminate the direct compression on the outer hip. When sleeping on your back, placing a pillow underneath the knees can help maintain the natural curve of the lower back and further reduce pressure on the hips. For side sleepers who cannot easily change position, it is important to avoid sleeping on the side with the painful hip to allow the inflamed structures a chance to recover.
When to Seek Professional Help and Long-Term Management
While many cases of hip pain improve with positional changes and rest, certain symptoms warrant a medical evaluation. You should consult a healthcare provider if the pain is intense, occurs suddenly without a clear cause, or if you experience any of the following:
- Fever, chills, or significant swelling.
- Pain that radiates sharply down the leg.
- Numbness or tingling.
- Inability to bear weight on the affected leg.
For persistent hip pain that interferes with daily activities for more than a few weeks, a physical therapist can provide effective long-term management. The long-term prevention of hip pain often involves strengthening the hip-stabilizing muscles, particularly the gluteal muscles. Simple exercises like glute bridges or banded hip abductions help to improve the tendons’ ability to tolerate load and reduce the recurrence of tendinopathy.
Incorporating gentle stretching of the hip flexors and surrounding muscles can reduce overall tension and improve joint stability. Maintaining a regular stretching and strengthening program ensures the hip joint is supported and less susceptible to strain from daily activities and sleeping positions. Early intervention with a physical therapist helps address muscle imbalances before they become chronic issues.