Hip Pain at Night: What It Means When It Wakes You Up

When a patient tells me their hip wakes them up at night, I take it seriously. Night pain usually means the symptoms are pretty severe. Most of the time, it’s arthritis that has become bone-on-bone.

What hip pain at night usually means

Arthritis that wakes people up is usually arthritis that has become extremely severe. In my experience, that tends to happen when:

• It’s been put off for too long. The hip has been getting worse for months or years.
• Treatment has been skipped or stopped. The exercises, injections, or follow-up visits fell by the wayside.
• There’s a really bad flare-up. An arthritic hip can flare badly enough to wake you up.

During the day you’re moving and distracted. At night, lying still lets an arthritic hip stiffen, and the pain is harder to ignore. If you want to know where your hip stands, see bone-on-bone hip: do you need surgery?

Steps, every day, and at night

Many of my patients describe the same three things:

When I hear all three, it usually means it’s time to talk about hip replacement. That doesn’t mean surgery is decided in the first visit. It means we need to look into it, with an exam and X-rays, and find the right treatment. If your pain is that severe, the answer may be surgical. For the rest of my list, see signs you need a hip replacement.

Why people wait so long

Hip replacement is an elective surgery, so the timing is up to you. And most patients who tell me their hip is waking them up at night are, honestly, well past the point when they could have come in.

What patients tell me

Pain on the side of the hip at night

Pain deep in the groin usually comes from the hip joint itself. Pain on the side of the hip is usually bursitis, and bursitis can have a few sources:

• The back. Back problems can show up as pain on the side of the hip.
• The hip joint. When the joint is arthritic, the muscles on the side of the hip work overtime to protect it and become inflamed.
• Bursitis on its own. Sometimes it’s just the bursa.

Which one it is changes the treatment. When an injection makes sense, I do one at a time, either on the side of the hip or inside the joint, so we can tell which one helps. I explain both in hip injections: inside the joint vs. the side of the hip.

The hip and the back

Most people with severe hip arthritis have some kind of back problem too. The two are closely related. When the hip gets stiff, the back takes on much of the force, and that extra pressure leads to back problems over time. That’s part of why I look at the whole picture, not just the hip.

How to sleep with hip pain tonight

• There’s no right side. No studies show one side is better than the other. Some of my patients with severe arthritis sleep with the bad hip down, and some with it up. With the bad hip up, the way the muscles pull on the hip can hurt. With it down, pressure on the bursa can hurt. Sleep however it hurts least.
• A medium-firm mattress is what most of my patients find most comfortable.
• A pillow between your knees helps most people.

These can help you get through the night, but they don’t fix the cause.

What to do next

If your hip is waking you up at night, come in. An exam and X-rays tell us whether it’s the joint, the bursa, or the back, and what will help. That might be physical therapy and other nonsurgical care, an injection with cortisone or PRP, or, when arthritis is severe, direct anterior hip replacement.