Can’t Sleep on Your Side? Outer-Hip Pain, Gluteal Tendons, and Pillow Tricks

If the bony point on the outside of your hip (the greater trochanter) aches or burns when you lie on your side, you are describing a classic pattern of gluteal tendinopathy—often labeled greater trochanteric pain syndrome. In this condition, the gluteus medius and gluteus minimus tendons and the tissues over the greater trochanter become sensitive to compression and load, especially when you lie directly on them or let the top leg sag across the midline. ^[1-3]

Night aggravation has two main drivers:

• Compression: Side-lying puts sustained pressure on the greater trochanter and compresses the tendons under the iliotibial band. If the top knee drifts across your body, the tension in the band shears the painful area. ^[1-4]
• Irritable tendons hate surprise load after rest: Like many tendons, gluteal tendons are stiffer and more pain-sensitive after being still for hours. The first minutes in bed—or the turn in the night—can sting. ^[2,5]

Outer hip pain at night can also occur with hip osteoarthritis, but the mechanism is different. In hip osteoarthritis, deep joint pain (groin and buttock more than the side) limits motion and can wake you when you roll over or after a long day on your feet. People often point to the groin crease or the deep buttock, not just the trochanter. ^[6-9]

Knowing which pattern you have matters. The sleep hacks and exercises that help a sensitive tendon are different from the strategies that soothe an arthritic hip.

Use these pattern clues while you seek a proper diagnosis if pain persists.

• Focal tenderness directly over the bony outside of the hip (greater trochanter). A single finger can often land on “the spot.” ^{[1- 3]}
• Side-lying pain when lying on the sore side or when the top knee falls across the body (even if you are lying on the other side). ^[1-4]
• Pain with single-leg stance or after a day of stairs, hills, prolonged standing, or walking on cambered surfaces.
• Resisted hip abduction (pushing the leg outward against resistance) or adduction stretch (letting the knee drop across the midline) provokes symptoms. ^{[1, 2]}

• Deep groin pain that may radiate to the buttock, thigh, or knee; often described as “deep ache” rather than a sharp pinpoint burn. ^[6-9]
• Morning stiffness that eases with movement; pain after prolonged walking or after sitting then standing.
• Reduced hip rotation (especially internal rotation) and flexion with a stiff or “blocked” end-feel.
• Crepitus or catching after activity; X-rays may show joint-space narrowing and osteophytes (though symptoms can precede imaging changes). ^[6-9]

Quick memory hook: Trochanter hurts? Tendon first. Groin/buttock deep ache with stiff motion? Think joint. Many people have elements of both, but one pattern usually dominates.

Lying on the painful side compresses the tender region under your body weight. Even lying on the non-painful side can hurt the painful hip if the top knee hangs across, tensioning the iliotibial band and pressing the tendons into the bone. ^{[1, 2, 3, 4]}

• If you must lie on the sore side, place a thick, firm pillow (or folded blanket) from just below your waist to mid-thigh to widen the base so the trochanter floats off the mattress edge rather than being the highest point.
• If you lie on the other side, use a between-knees pillow thick enough to keep the top thigh parallel to the mattress, not dropping across your body. The pillow should reach from knee to ankle; a too-short pillow lets the lower leg hang and still twists the hip.

A long body pillow or a knee-to-ankle foam wedge is ideal because it prevents the “midnight slide” where the top leg slowly crosses midline. ^{[1, 2, 3, 4]}

Adduction (top knee dropping inward) increases compressive load. People often sleep slightly curled, which squeezes the sore side. ^[1-3]

• Hug a body pillow so your top knee and shin rest on it.
• If you prefer a smaller pillow, slide a rolled towel into the pillowcase near the knees so the top thigh cannot drift down.
• Side sleepers who also have low-back pain usually like a pillow that is thick enough to maintain a level pelvis.

Isometrics (tension without movement) lower pain sensitivity in many tendons and can be done in bed before sleep. For outer hip pain at night, the goal is to turn on the gluteus medius/minimus gently without shear.

1. Lie on your non-painful side with knees bent 30–40°.
2. Place a small pillow or folded towel between the knees.
3. Gently press the top knee downward into the pillow (as if trying to lift the top ankle toward the ceiling without moving). You should feel the side hip working, not the front of the hip.
4. Hold 20–30 seconds, 5 reps, breathing slowly. Pain should stay ≤3/10 and often eases by the third hold.

Follow with the pillow positioning described above and settle in to sleep.

Why it works: low-load isometrics recruit the lateral hip without compressing the tendon under the iliotibial band, reducing nociceptive drive so you can fall asleep. ^{[2, 5, 10]}

• Avoid prolonged one-leg standing (hip jutted out while chatting or washing dishes). Balance your weight over both legs; think “zipper tall, belt buckle forward.” ^{[1, 2, 3]}
• Change sitting angles: very low couches place the hip in high flexion and internal rotation, which can irritate a sensitive lateral hip. Use a higher seat or a small wedge to sit taller.
• Walk hills later in recovery: steep downhills lengthen the lateral hip under load. Start with flat walks and short, frequent bouts.
• Shoes with worn outer edges tilt the pelvis and can load the trochanter. Replace uneven soles.

Week 1–2: Calm and activate

• Isometric abduction (bedside routine) as above.
• Side-lying hip abduction (short-arc): Small lift with the top leg only a hand’s width off the lower leg, knee slightly bent, no drop across midline on the way down. 2–3 sets × 8–12, every other day.
• Standing wall-press: Stand sideways 20–30 cm from a wall, press the outside knee gently into the wall for 20–30 seconds, 5 reps.
• Rule: Pain during or after should be ≤3/10 and back to baseline by morning. If not, reduce the volume.

Week 3–6: Build capacity and control

• Progress side-lying abduction to longer holds or light ankle weights (0.5–1 kg).
• Add step-ups to a low step (focus on pelvis staying level).
• Hip hitch on a step: Stand on the painful side; use the side hip to raise and lower the opposite pelvis a few centimeters in control. 2–3 sets × 8–12.
• Maintain sleep positioning and isometric pre-bed routine during this phase. ^{[1-3, 10-12 ]}

Week 1–2: Motion is lotion + pain-tolerant strength

• Hip pendulum / gentle range in standing: circles and small arcs within comfort for 2–3 minutes twice daily.
• Glute bridge (feet hip-width, squeeze buttocks, lift pelvis) 2–3 sets × 8–12 every other day.
• Sit-to-stand from a higher chair, 2–3 sets × 6–10.
• Optional: stationary cycling low resistance 10–15 minutes to lubricate the joint before bed.

Week 3–6: Progress endurance and function

• Increase cycling or walking time by 10–15% per week if next-day stiffness settles in 24 hours.
• Add hip external rotation with a light band (seated, knees apart).
• Keep pillow positioning to prevent night twists that jam the joint. ^{[6-9, 12-14]}

Many people have both: an irritable lateral tendon over an arthritic joint. In that case, follow the tendinopathy night routine and build hip-friendly strength for osteoarthritis during the day.

• Topical non-steroidal anti-inflammatory gel on the sore trochanter for flares can help with minimal systemic exposure. ^{[13, 15]}
• Oral non-steroidal anti-inflammatory drugs may reduce night pain short-term if safe for you (not for those with ulcers, kidney disease, or anticoagulants—talk to your clinician). ^[13]
• Corticosteroid injection over the greater trochanter can provide short-term relief in greater trochanteric pain syndrome (weeks to a few months). Use it to enable a loading and positioning plan, not as a stand-alone fix. ^{[1-3, 11]}
• For hip osteoarthritis, injections (corticosteroid; hyaluronic acid in selected regions) can help short term for some patients; long-term benefit is variable. Exercise and weight management carry the strongest evidence. ^{[8, 9, 14]}

• Fever, redness, warmth, or feeling unwell (concern for infection).
• Night pain that does not change with position, unintended weight loss, or history of cancer.
• Sharp groin pain after a fall or inability to bear weight (possible fracture).
• Severe low-back pain with neurological signs (numbness in the groin, weakness in the leg).

Seek prompt medical assessment if any of these are present. ^[9]

How long until night pain improves?

With consistent pillow positioning and isometric holds before bed, many people with gluteal tendinopathy notice better sleep within 1–2 weeks, with steadier gains over 6–12 weeks as strength builds. Hip osteoarthritis improvements track with daily motion and strength and may be more gradual—aim for weeks to months. ^{[2, 8, 10, 11, 12]}

Should I stretch the iliotibial band?

Aggressive iliotibial band stretching often compresses the sore area more and can aggravate symptoms. Prioritize strength and positioning; use only gentle mobility that does not pull the thigh across the midline. ^[1-3]

Is foam rolling helpful?

Rolling the outer thigh can give short-term relief for some, but it does not change tendon capacity. If you roll, keep pressure light and follow it with your isometric or strength routine. ^[10-12]

Do I need imaging to diagnose greater trochanteric pain syndrome?

Usually not. Diagnosis is clinical—location, provocation, and function. Ultrasound or magnetic resonance imaging is reserved for atypical cases, suspected full-thickness gluteal tear, or lack of progress after good rehab. ^{[1-3, 11]}

What Mattress is best?

A medium-firm mattress with sufficient top-layer compliance to contour the pelvis reduces pressure points. Regardless of mattress, the between-knees pillow is usually the game-changer. ^[4]

• Did I do 5 isometric holds for the outer hip (20–30 seconds each)?
• Is my between-knees pillow thick enough (knee to ankle supported, thigh parallel to mattress)?
• If lying on the sore side, is my trochanter floating (pillow/blanket stack under waist-thigh)?
• Did I avoid curling the top knee across my body?

If pain spikes overnight, switch sides, reset the pillow, and do 2–3 light isometric holds.

• Outer hip pain at night is most often gluteal tendinopathy—a tendon and compression problem at the greater trochanter—not just “bursitis.” Hip osteoarthritis can also cause night pain, but it tends to be deeper (groin/buttock) with stiff motion. ^{[1-3, 6-9]}
• The fastest sleep relief for greater trochanteric pain syndrome blends pillow positioning that prevents compression with isometric abductor holds that calm the tendon. ^{[2, 5, 10-12]}
• Build daytime capacity with graded strengthening; consider short-term medications or injections only to enable your program. ^{[8-9, 11, 13-15]}

Red flags or stalled progress deserve a clinician review. Small, consistent changes—not heroic stretches—win the night.

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