Hip pain can be frustrating, especially when it affects your sleep, makes getting out of bed uncomfortable or becomes worse after exercise. Some people notice stiffness first thing in the morning, while others feel fine until they have been walking, standing or exercising for a while.
The timing and location of the pain can offer clues about what might be causing it, although they cannot tell you for certain. Muscles, tendons, the hip joint and even the lower back can all contribute to hip pain.
The good news is that changing your sleeping position, adjusting activities and trying suitable gentle exercises may help. The right approach depends on the cause of the pain, so persistent or worsening symptoms should not be ignored.
Why Does Hip Pain Feel Worse in the Morning?
Hip pain that is worse when you first get out of bed can be linked to stiffness after a period of inactivity. When you have been lying still for several hours, the muscles and joints around your hips may feel tight or uncomfortable when you start moving again.
Possible causes include:
- Osteoarthritis: Wear and changes in the hip joint can cause pain during movement and stiffness after resting.
- Tendon problems: Irritation of the tendons around the hip can cause discomfort when you first move or put weight on your leg.
- Muscle tightness or strain: Muscles may feel sore after activity, particularly following unfamiliar exercise or overuse.
- Inflammatory joint conditions: Some conditions cause stiffness after rest, which may take a while to ease once you start moving.
If your stiffness lasts more than 30 minutes after waking, particularly if it happens regularly, speak to your GP. It is worth getting persistent morning stiffness assessed rather than assuming it is simply a sign of getting older.
Why Does Hip Pain Get Worse After Exercise?
Pain that develops or increases after exercise can mean that the muscles, tendons or joint have been put under more strain than they can currently tolerate.
This may happen after a long walk, running, climbing stairs, lifting weights or suddenly increasing your usual activity.
The location of the pain can sometimes provide a clue:
- Pain on the outside of the hip: This can be associated with irritation of the tendons around the hip or greater trochanteric pain syndrome, sometimes called hip bursitis.
- Pain in the groin or deep inside the hip: This can occur with hip joint problems, including osteoarthritis.
- Pain in the buttock or spreading down the leg: This can sometimes originate in the lower back or involve irritated nerves, rather than the hip joint itself.
- Soreness in the surrounding muscles: This may follow unfamiliar or strenuous exercise.
You do not necessarily need to stop exercising altogether. Gentle movement can help maintain strength and mobility, but you may need to reduce the intensity, shorten your walks or choose lower-impact activities such as swimming.
A useful guide is how you feel afterwards and the following morning. If an activity causes a substantial increase in pain, or you are noticeably worse the next day, reduce the amount and build up more gradually.
What Makes Hip Pain Worse at Night?
Hip pain at night can have several causes. One common reason is pressure on the outside of the hip when lying on your side. This can aggravate irritated tendons and surrounding tissues.
Other possible reasons include:
- Sleeping directly on the painful side.
- Keeping the hips in an uncomfortable or twisted position.
- Stiffness associated with arthritis.
- Pain from activity earlier in the day.
- Problems affecting the lower back that become more noticeable when lying down.
If your hip hurts when lying down but not when standing, pressure from your mattress or sleeping position could be contributing. However, pain that occurs only at night does not automatically mean that your mattress is to blame.
Persistent night pain, especially if it is getting worse, repeatedly wakes you or occurs alongside unexplained weight loss or feeling generally unwell, needs medical assessment. Night pain does not automatically mean cancer, but it should not be dismissed if it is persistent or unexplained.
What Is the Best Sleeping Position for Hip Pain?
There is no single sleeping position that suits everyone. The aim is to reduce pressure on the painful area and keep your hips in a comfortable, reasonably neutral position.
1. Sleep on your back with a pillow under your knees
If you find lying on your back comfortable, try placing a pillow under both knees. This can help support your legs and may reduce tension around your hips and lower back.
You do not need a special orthopaedic pillow. An ordinary pillow that feels comfortable may be enough.
2. Sleep on your side with a pillow between your knees
If you prefer sleeping on your side, try lying on the less painful side and placing a pillow between your knees.
The pillow helps support the upper leg and can prevent it from dropping forward and twisting your hips. Choose a pillow thick enough to keep your legs comfortable without forcing your knees too far apart.
Avoid lying directly on the painful hip if that increases your discomfort.
3. Try a different position if you keep waking in pain
If your usual position repeatedly causes pain, experiment with sleeping on your back or changing which side you lie on. A mattress that is sagging or uncomfortable may also make it harder to find a position that supports you properly.
You do not have to force yourself to sleep in a particular position. Comfort is the main guide.
Should You Sleep With a Pillow Under Your Hip?
Usually, it is more helpful to place a pillow under your knees when lying on your back, or between your knees when lying on your side, rather than directly under the painful hip.
A pillow directly beneath the hip may increase pressure or leave your body in an awkward position, depending on how you lie. If you are trying to support your hip, experiment carefully and stop if the position makes the pain worse.
If you are unsure which position is best for your particular symptoms, a physiotherapist can give you more individual advice.
How Can You Tell Whether Hip Pain Is Muscle or Joint Pain?
It is not always possible to distinguish muscle pain from joint pain by how it feels. The hip joint sits deep in the body, and problems in the surrounding muscles, tendons, nerves and lower back can produce similar symptoms.
However, there are some general patterns.
| Possible source | What the pain may feel like |
|---|---|
| Muscle strain | Soreness or tenderness after activity, sometimes worse when using or stretching the affected muscle. |
| Tendon irritation | Pain around the outside of the hip, sometimes worse when walking, climbing stairs or lying on that side. |
| Hip joint problem | Pain deep in the hip or groin, stiffness and discomfort when walking, bending or rotating the leg. |
| Lower back or nerve problem | Pain in the buttock that may spread down the leg, sometimes with tingling or numbness. |
These patterns are not a diagnosis. For example, osteoarthritis can cause pain in the groin, thigh or buttock, while tendon problems can make walking uncomfortable.
A GP or physiotherapist can assess your symptoms, movement and medical history to help identify the likely cause.
Gentle Exercises That May Help Hip Pain
Suitable exercises can help maintain movement and strengthen the muscles that support your hips. Start slowly, especially if you have been inactive because of pain.
The following are gentle options, but they may not be suitable for every hip problem. If you have had a recent injury, have severe pain or have been advised to restrict movement, seek professional advice before trying them.
1. Knee bends while lying down
This is a gentle way to move the hip and knee without standing.
- Lie on your back on a comfortable, firm surface.
- Keep your legs straight.
- Slowly slide one heel towards your bottom, bending the knee as far as feels comfortable.
- Slide your heel back until your leg is straight again.
- Repeat on the other side if comfortable.
Start with two or three repetitions on each leg. Move slowly and do not force your knee towards you.
2. Gentle standing hip movements
This exercise encourages controlled movement while giving you something to hold for balance.
- Stand behind a sturdy chair and hold its back.
- Keep your body upright.
- Slowly move one leg a short distance backwards without arching your back.
- Return to the starting position.
- Repeat on the other side if comfortable.
Start with two or three repetitions on each side. Keep the movement small and controlled.
3. Sit-to-stand practice
Getting up from a chair works the muscles around the hips and thighs.
- Sit on a firm, reasonably high chair with your feet flat on the floor.
- Lean forward slightly and use your legs to help you stand.
- Sit down slowly and with control.
- Use the arms of the chair for support if needed.
Begin with two or three repetitions. If standing up causes sharp pain or significantly increases your symptoms, stop and try a different exercise after seeking advice.
4. Short, gentle walks
If walking is comfortable, several short walks may be easier to manage than one long walk. Start with a distance that does not significantly increase your pain and build up gradually.
Swimming or exercising in water can also be useful for some people because the water supports part of your body weight.
How often should you exercise?
Start with just one or two exercises and a few repetitions. Increase gradually as they become easier.
Mild, short-lived discomfort can sometimes happen when starting a new movement, but exercise should not cause sharp pain or leave your hip substantially worse afterwards or the following morning. If it does, reduce the movement or stop and seek advice.
You can find further guidance and exercise demonstrations through NHS inform’s hip osteoarthritis exercise guide.
When Should You See a Doctor About Hip Pain?
Arrange a GP appointment if your hip pain:
- Affects your sleep or normal daily activities.
- Keeps returning or is gradually getting worse.
- Has not improved after around two weeks of self-care.
- Comes with stiffness lasting more than 30 minutes after waking.
Seek urgent medical advice through your GP or NHS 111 if you develop sudden, severe hip pain without an obvious injury, or your hip becomes hot or swollen, changes colour, or is painful alongside a fever or feeling generally unwell.
If you have severe hip pain after a fall or injury, or cannot walk or put weight on your leg, seek emergency medical help.
Products That May Help With Hip Pain
Small changes to your sleeping position and daily routine may help ease hip discomfort. Depending on your needs, products such as supportive pillows, heat pads and seat cushions may also help make resting and everyday activities more comfortable.
Here are some products to consider if you’re looking for extra support or ways to manage hip pain at home.
Always follow the product instructions, and remember that these products may help with comfort but won’t treat every cause of hip pain.
- Knee Pillow for Side Sleepers
- Deep Heat Heat Rub
- Nurofen Ibuprofen Caplets 256mg, 16 Pack – Joint, Back, Knee Pain Relief
- Sacroiliac SI Joint Hip Belt
- Motusol Max 2.32% w/w Gel 30g, Diclofenac gel for joints and muscles, suitable for sprains and strains
- Pain Relief Heat Patches for Hip & Back
To Conclude
Hip pain that is worse on waking may be related to stiffness after rest, while pain that increases after exercise can be linked to strain or irritation of the muscles, tendons or joint. Night-time discomfort may also be affected by pressure on the hip while sleeping.
Trying a pillow between your knees or under them, adjusting activities and starting gentle movement may help. However, the pattern of your pain cannot identify the cause on its own.
If the pain persists, disrupts your sleep or gets worse, arrange an assessment rather than relying on exercises and changes to your sleeping position alone.
This article provides general information and is not a substitute for medical advice or an individual assessment.
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