Painful Hip at Night? Why Lying on Your Side Hurts (Gluteal Tendinopathy Explained)

Introduction:

It’s 2am. You’ve rolled onto your side for the fifth time, and there it is again – a deep, nagging ache on the outside of your hip that won’t let you settle. Switch sides and the other hip starts complaining too. Lie on your back and you can’t get comfortable. By morning, you’re tired before the day has even started.

If that sounds familiar, there’s a good chance the cause is gluteal tendinopathy – one of the most common reasons for hip pain at night, and one of the most misunderstood. Many people are told it’s “bursitis” or “just wear and tear” and given little more than a leaflet. The truth is, gluteal tendinopathy responds really well to the right approach, and you don’t have to accept broken sleep as your new normal.

In this guide, we explain what gluteal tendinopathy is, why lying on your side makes it worse, the everyday habits that keep it irritated and the exercises and treatment that genuinely help – including how physiotherapy at home can get you sleeping comfortably again.

What Is Gluteal Tendinopathy?

Your buttock muscles – especially gluteus medius and gluteus minimus – attach to a bony point on the outside of your hip called the greater trochanter. You can feel it as the hard bump at the side of your upper thigh. These muscles do a huge job: they keep your pelvis level every time you stand on one leg, which happens with every single step you take.

Gluteal tendinopathy happens when the tendons that attach these muscles to the bone become irritated and less able to cope with load. It isn’t usually caused by one injury. Instead, it builds up when the tendon is either overloaded or squashed (compressed) more than it can tolerate.

You may also hear it called greater trochanteric pain syndrome, or GTPS. For years, this pain was blamed on trochanteric bursitis, but we now know that the tendon is usually the main source of the problem. South Tees Hospitals NHS Foundation Trust has a clear patient guide on gluteal tendinopathy if you’d like to read more.

Why Does Gluteal Tendinopathy Hurt at Night?

This is the question we hear most. There are two main reasons why hip pain at night is such a hallmark of gluteal tendinopathy.

Lying on the painful side

When you lie on your sore side, your body weight presses the tendon directly against the bone. That pressure is enough to irritate an already sensitive tendon, and the ache builds the longer you stay there.

Lying on the other side

This one surprises people. When you lie on your good side, your top knee usually drops down towards the mattress. That pulls the painful hip across your body and stretches the tendon tightly over the bone – another form of compression. That’s why switching sides often doesn’t help.

Add in a firm mattress, hours without moving, and a tendon that’s already been busy all day, and it’s easy to see why so many people with gluteal tendinopathy dread bedtime.

Who Gets Gluteal Tendinopathy?

Anyone can develop it, but it’s particularly common in:

• Women aged roughly 40–60 – hormonal changes around menopause appear to affect tendon health. Our women’s health physiotherapy team sees this often.
• People who’ve recently increased activity – a new walking challenge, more running, hill walking or extra time on the stairs
• People who’ve recently become less active – weaker glutes are less able to protect the tendon
• Those who stand with their weight on one hip – often while carrying a child or standing at the kitchen worktop
• People with lower back problems – changes in how you move can shift load onto the hip

Common Symptoms of Gluteal Tendinopathy

• Pain on the outside of the hip, sometimes spreading down the outer thigh towards the knee
• Hip pain at night, especially when lying on either side
• Tenderness when pressing on the bony point at the side of the hip
• Pain when climbing stairs, walking uphill or getting out of the car
• Pain standing on one leg, for example when putting on trousers or socks
• Stiffness and pain when you first stand up after sitting
• Discomfort sitting with your legs crossed or in a low, soft chair

Hip pain can come from several places, and the NHS guide to hip pain in adults is a helpful overview. Pain in the groin is more often linked to the hip joint itself, while pain that travels down the back of the leg below the knee may come from the lower back. If that sounds like you, our sciatica physiotherapy and back pain physiotherapy pages explain how we help.

See your GP urgently if: your hip pain followed a fall, you can’t put weight on your leg, the hip is hot, red or swollen, you feel unwell with a fever, or you have unexplained weight loss or pain that is severe and constant day and night.

Everyday Habits That Make It Worse

One of the most useful things you can do for gluteal tendinopathy is reduce the compression on the tendon during the day as well as at night. Try to avoid:

• Crossing your legs – whether sitting or standing
• Hanging on one hip – stand evenly with your weight on both feet
• Low, deep chairs and sofas – where your knees end up higher than your hips; add a cushion to raise the seat
• Stretching the outside of the hip – those popular glute and ITB stretches often squeeze the tendon further and can make things worse
• Big jumps in activity – suddenly adding long walks, steep hills or lots of stairs

How to Sleep Better With Gluteal Tendinopathy

A few simple changes can make a big difference to hip pain at night:

• Put a pillow between your knees when lying on your good side, so your top leg stays level with your hip rather than dropping down
• Soften your mattress with a memory foam or egg-crate topper to reduce pressure on the painful side
• Lie on your back with a pillow under your knees if side-lying is too sore
• Try a partial roll – lie halfway between your back and your side, supported by a pillow behind you
• Avoid lying directly on the painful hip while it’s flared up

Best Exercises for Gluteal Tendinopathy

Tendons love the right kind of load. Research consistently shows that education plus a progressive strengthening programme is one of the most effective treatments for gluteal tendinopathy. A well-known Australian trial, the LEAP study published in the BMJ, found that this approach gave better long-term results than a steroid injection or a wait-and-see approach.

These are common starting exercises, but your physio will tailor them to you:

• Isometric hip holds: lying on your back with a belt around your knees, gently push your knees outwards into the belt and hold for 30–45 seconds. Repeat 5 times. These often ease pain quickly.
• Bridges: lying on your back with knees bent, squeeze your buttocks and lift your hips. Hold for a few seconds and lower slowly. 2–3 sets of 10.
• Sit-to-stands: from a firm chair, stand up and sit down slowly without using your hands, keeping your knees in line with your toes. Start with a higher chair if needed.
• Step-ups: step onto a low step with your painful leg, keeping your pelvis level. Progress the height gradually.

Expect some mild discomfort, but pain shouldn’t be worse the next morning. Tendons adapt slowly, so give it 8–12 weeks of steady work to see the full benefit.

How Physiotherapy Helps Gluteal Tendinopathy

Many people try a few exercises from the internet, find they flare things up and give up. The difference with physiotherapy is getting the right exercises at the right level, and progressing them at the right pace. Your physio will:

• Confirm the diagnosis and rule out other causes such as hip joint arthritis or referred back pain
• Explain which positions are compressing your tendon and how to change them
• Build a personalised strengthening programme that progresses safely
• Use hands-on techniques to ease pain and stiffness where appropriate
• Help you return to walking, stairs, running or the gym without flaring the tendon
• Give you a long-term plan so gluteal tendinopathy doesn’t keep coming back

Why Home Physio Works Well for Hip Pain

When getting in and out of the car hurts, a trip to the clinic isn’t appealing. With home visit physiotherapy, your physio comes to you. Better still, they can check the things that are keeping your tendon irritated – your bed, your sofa, the height of your chairs and how you get up from them – and give advice that fits your real life.

Why People Choose FlexAura Home Physio UK

FlexAura connects you with more than 230 physiotherapists across the UK, including musculoskeletal and women’s health specialists. Every physio on our platform is HCPC-registered, enhanced DBS-checked and fully insured, and many offer same-day or next-day appointments.

We cover cities including London, Manchester, Birmingham, Leeds, Bristol, Liverpool, Edinburgh and Glasgow. Prices are clear from the start: online consultations are £45, home visits are £110 for the first session and £99 for follow-ups, and a 5-session home visit package is £450 – ideal for a full tendon rehab programme with the same physio each time. See our pricing page for details. Many practitioners also accept private health insurance, including Bupa, AXA and Vitality.

Frequently Asked Questions

Is gluteal tendinopathy the same as hip bursitis?

They’re closely related and often occur together, but the tendon is usually the main source of pain. That’s why strengthening the tendon tends to work better than treating the bursa alone.

How long does gluteal tendinopathy take to heal?

With the right exercise and load management, many people notice improvement within a few weeks, but full recovery often takes three months or more.

Should I stretch my hip?

Usually not. Stretches that pull the leg across the body can compress the tendon and make symptoms worse. Strengthening is far more helpful.

Will a steroid injection fix it?

An injection may ease pain in the short term, but it doesn’t strengthen the tendon. Research suggests exercise-based physiotherapy gives better long-term results.

Get Back to Sleeping Through the Night

Hip pain at night is exhausting, but gluteal tendinopathy is very treatable. With a few changes to how you sit, stand and sleep, and a well-planned strengthening programme, most people get back to comfortable nights and pain-free days. The sooner you start, the sooner you can stop dreading bedtime.

Book a home physiotherapist today or call 07782 610 633 for a friendly chat about your hip.

This article is for general information and isn’t a substitute for personalised medical advice. If you’re concerned about your symptoms, speak to your GP or a qualified physiotherapist.

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