Hip Bursitis: Why Lying on Your Side Hurts
You lie down at night and the outside of your hip starts to throb. You roll over and it hurts on the other side too. By 2 a.m. you're stacking pillows in positions that don't work. Hip bursitis is a common reason why people can't sleep on their side, and it usually improves with the right treatment and a few changes to how you sleep and move.
What's actually hurting
The bony point on the outside of your hip is called the greater trochanter. A fluid-filled cushion called a bursa sits on top of it, and the tendons of your gluteal muscles attach right beside it. When this area gets sore, most people call it hip bursitis. Doctors and researchers more often call it greater trochanteric pain syndrome now, because the bursa isn't always the problem. In many people the main trouble is in the gluteal tendons, which get irritated and weak in much the same way a tennis elbow tendon does. The bursa can be inflamed too, but treating only the bursa often misses the point.
The usual picture is pain on the outside of the hip, sometimes running down the outer thigh, with a spot you can press on that is very tender. It hurts when you lie on that side, climb stairs, get up from a low chair, or stand on that leg while you put on your pants.
Why lying on your side hurts
Two things are going on. The first is increased pressure. Lying on your side puts the weight of your upper body onto that bony point, and the sore tissue over it has nowhere to go.
The second explains why the other side hurts too. When you lie on your good side, your top leg tends to drop forward and across your body. That position pulls the sore tendons tight over the bone and squeezes them against it, so the hip on top gets compressed in a different way and aches by morning anyway. Keeping the top leg from falling across matters as much as staying off the sore side.
Who gets it, and why
It's most common in women over 40, and it also turns up in runners and walkers who have recently added mileage or hills. Low back, knee, or other hip trouble raises the risk, because those problems change how you load your leg when you walk and stand. A sudden change in activity is a common trigger. A new walking routine, or a few days of extra steps on a trip, can be enough.
Habits that keep it irritated
A few common habits make it worse without anyone noticing. Crossing your legs, or sitting with one knee tucked across your body, pulls on those tendons for hours. Standing with your weight shifted onto one hip, letting the other hip hang out to the side, does the same. Low, soft couches put your hips deeper than your knees, which stretches the tendons across the bone.
Some of the usual advice backfires too. Stretches that pull your knee across your body, like the figure-four or pigeon pose, squeeze the sore tendons against the bone. Foam rolling the outside of your hip and thigh, which is what many people try first, presses directly on the tender spot and rarely helps. Side-lying leg lifts can flare it up as well, at least early on. None of these will do lasting harm, but if your pain is getting worse, back off them.
Other things that cause outer hip pain
Not every sore outer hip is bursitis. Pain from the lower back can refer to the buttock and outer hip, and so can an irritated nerve. A hip joint with arthritis or a structural problem like hip impingement more often hurts in the groin or the front of the hip, and it can show up as stiffness or catching when you turn the leg inward. A burning, tingling, or numb patch on the outer thigh points to a skin nerve being squeezed rather than to bursitis. A stress injury in the hip bone hurts with every step and is usually felt in the groin. Telling these apart is a big part of what an exam is for.
When to get it checked
See someone if the pain has lasted more than a couple of weeks, if it's waking you up most nights, or if walking and stairs are getting harder. Go to the emergency room if you've had a fall or injury and can't put weight on the leg, or if the area is red, hot, and swollen, especially with a fever. Infected bursitis is rare but serious. Get medical care soon if you have unexplained weight loss, a history of cancer, or constant pain that doesn't change with position.
How we Treat it
The first visit is mostly an exam. We test the area to find the tender spot, test how strongly you can push your leg out to the side, and have you stand on the sore leg for 30 seconds, which brings on the pain in many people with this problem. We also check how your hip, low back, pelvis, and knee move, and we watch you walk, because the cause often sits above or below the hip. When something doesn't fit, we send you for an ultrasound or MRI before going further.
Treatment usually has three parts. Soft tissue work on the glutes and the muscles around the hip, done without grinding directly on the sore bone, chiropractic joint work on the low back, pelvis, or hip, and a graded strengthening program.
Additionally cortisone injections are a common option that provide temporary relief for this problem. In studies comparing the two approaches, injections gave quicker short-term relief, but a program of education and exercise did as well or better over the following year. If you already see a pain management doctor, we'll coordinate your care with them.
Another option we can add to your treatment plan is class IV laser therapy which sends focused light energy into the tissue around the hip, with the goal of calming inflammation, reducing pain, and supporting healing in the irritated tendon. Most people feel a gentle warmth, and sessions are short and typically painless.
How to fix your sleeping position
If you can sleep on your back, put a pillow under your knees. If you're a side sleeper, lie on the pain-free side and put a thick pillow between your knees and ankles, thick enough to keep your knees level with your hips so the top leg can't drop across. Hugging a second pillow to your chest keeps you from rolling forward. If you have to lie on the sore side, a two- or three-inch memory foam topper on the mattress spreads out the pressure.
During the day, keep walking, but pick flat routes, shorten your stride, and skip stairs where you can for a few weeks. Sit in firmer chairs with your knees at or below hip level, and uncross your legs. If it flares, heat or ice is mostly a matter of preference, and our post on ice versus heat explains how to choose.
How long it takes
Tendons heal slowly. Sleep often gets better within a few weeks of changing positions and starting exercises, but getting back to full activity can take two or three months, and a problem that has dragged on for a year may take longer. A flare after a long day doesn't mean you're starting over.
Hip and joint care in North Las Vegas
Modern Care Chiropractic is in the Hidden Canyon neighborhood of North Las Vegas, at 3925 N. Martin Luther King Blvd., Suite 120. If your hip has been keeping you up, call (702) 900-2709 or schedule an appointment online.
This article is for general information and is not a substitute for medical advice, diagnosis, or treatment. If you are having a medical emergency, call 911.
