You’re finally ready to hit the hay, but your hip pain won’t let you sleep. You can approach this problem from a couple of new angles: comfortably positioning your body in bed, and understanding the root cause of the problem to address the root cause of the pain.

In this article, I will detail a little known reason you may be experiencing hip pain when sleeping (or rather a little known muscle that may be the culprit), a few ways to alleviate your hip pain at night, and how you can begin to address the root cause of your hip pain.

Although this article is filled with helpful resources and information, it is not meant to diagnose the cause of your specific hip pain. Consulting a physical therapist or medical practitioner is the best way to get a full picture of your situation, understand your treatment options, and establish a supervised treatment plan.

Let’s help you get some ZZZZs!

What causes hip pain when sleeping?

Numerous ailments can affect your hips and cause you pain. Many people who experience hip pain when sleeping may not have much pain during other activities - or even during other parts of their day.

In the evening, when your body has had a chance to rest and relax a little, your pain may be triggered by inflammation due to lack of movement. Or, you may just finally have had the time to notice your pain.

For athletes, sore muscles may cause hip pain while sleeping or even a more chronic pain like tendonitis or bursitis. As you age, hip pain may be caused by arthritis or osteoarthritis. Even certain cancers, injuries, or pregnancy can all contribute to hip pain.

One of the most common (yet often overlooked) reasons why so many of my patients have hip pain when sleeping is tight hip flexor muscles. That is: their hip flexor muscles are so tight that they are pulling their hips out of alignment (which can be the cause of pain for hip bursitis or SI joint pain). And this is only exacerbated by sleeping positions that cause an unnatural curvature in your neck and back for prolonged periods of time.

But what are your hip flexor muscles, and why do they hold so much sway over your hip pain while sleeping? I mean, you’re just laying there!

Tight iliacus muscles and tight psoas muscles can create hip pain while sleeping

Your hip flexor muscles are also known as the iliopsoas muscles. The iliopsoas are made up of two separate muscles: the iliacus and psoas.

These two muscles are essential to everyday movements like sitting, walking up stairs, running, jumping, and rotating your hips.

Because of the extensive overuse of your iliopsoas muscles in the various movements you make during your day, they tighten over time. This is especially true for athletes that tend to engage their iliopsoas muscles more and put additional strain on them during training.

Not surprisingly though, tight hip flexor muscles are equally common in people who tend to sit for most of their day.

These muscles like balance. So, both inactivity/under-stretching and overactivity/over-stretching can cause pain and tightness.

What’s more, the location of the iliopsoas muscles on the inside of your pelvis bone makes them hard to access and easy to overlook. In fact, many of my patients had never even heard of the iliacus before! So, unlike your hamstrings or calf muscles, you can’t easily use a massage roller to relieve your muscle tension after a workout or a long day on your feet.

The iliacus muscle attaches to the inside of your pelvis and comes down the front of the hip, where it connects to the front of your thigh bone. The iliacus muscle, in particular, is very close to the hip joint.

The psoas muscle blends with your diaphragm via connective tissue and attaches to the lower spine. As you move down the psoas muscle, it attaches to the same spot on the front of the hip as your iliacus muscle.

While there is a myriad of reasons while your hips could hurt, tight iliopsoas muscles are often a major culprit in hip pain when sleeping. So, it’s important to not only know about the issue of tight iliopsoas muscles, but how to prevent it.  

Best sleeping positions for hip pain

If you have hip pain while sleeping, it is extremely helpful to understand the root cause. Still, once you’ve determined what is causing your pain, it will take some time to treat, even if your issue is simply tight iliopsoas muscles.

That’s why I’ve compiled a list of some of the best sleeping positions for hip pain. These positions will help you lower your pain while you are working to get to the source of that pesky symptom.

Try a few of these out and see how they work. Finding comfortable sleeping positions may help you alleviate hip pain while sleeping and allow you to finally get a good night’s rest.

If you have hip pain when sleeping on your side

Many of us enjoy sleeping on one side, and in fact, you may even favor one side over the other.

If you have outer hip pain, such as hip bursitis, you may feel pain either on the hip you’re laying on, or the hip you’re not laying on.

If you have pain in the hip you’re laying on, pain caused by direct pressure on the joint, then pay attention to your mattress surface. You may find relief by adding a memory foam pad or mattress topper to your mattress to help distribute your weight more evenly and provide extra cushion for that hip joint.

If you have pain on the hip you’re not laying on, try sleeping with a pillow between your knees and ankles. It may take some time to find a position that works with your pillow, and you may even have to try out pillows of different densities. The goal is to have your legs rest parallel to each other, so your knee is not lower than your hip. This can be accomplished by using a fat pillow, resting lengthwise from knees to ankles.

Sleeping with a pillow between your knees and ankles is a good way to relieve SI joint pain while sleeping on your side, as it reduces the strain on muscles attaching to the top of the thigh bone (greater trochanter). This strain on the hip is directly related to a tight iliacus muscle, which causes an anterior rotation on the pelvis, and pulls on the lower back and hip joint.

Whatever the pillow position you choose, the main purpose of sleeping with the pillow is to alleviate the pull on your hip’s soft tissues and keep your pelvis in a natural alignment.

When you allow your leg to rest naturally while lying down, there is a slight dip that enables your legs to connect and rest. When this happens, your leg's natural pull adds more pressure to the muscles around your hip joint, which can then cause hip pain when sleeping.

If you have hip pain when sleeping on your back

If you have hip pain when sleeping on your back, it can make almost any other sleeping position uncomfortable. This pain is often caused by tension in the hip flexors which then tug on your lower back, hips, and legs.

For alleviating your hip pain when sleeping on your back, try placing a pillow or rolled-up blanket under your knees. Depending on the degree of muscular tension, you may need two pillows positioned under your knees. This places your hip flexors in a relaxed state, easing tension on your lower back and hips.

If you feel a pinch on your groin while laying in this position, allow your legs to spread and rotate outward. You can even use pillows on the outside of your knees to keep them comfortable and supported in this position.

If you have hip pain while sleeping on your stomach

Although sleeping on your back is likely the best sleeping position for someone with hip pain, there are those of us who prefer sleeping on our stomachs. If that is the case for you, and you want to prevent hip pain when sleeping, then grab a pillow and try this sleeping position out tonight.

When sleeping on your stomach, you might bend one leg out to the side. If you do, you should place a pillow under your knee to elevate it slightly. This will relieve some of the pressure on your hip.

If this is too dramatic of a position for you, then try a folded blanket or a thinner pillow that makes you more comfortable.

Iliacus release: Discover the root cause of your hip pain for a better night’s sleep

While getting enough sleep is crucial for your physical, mental, and emotional wellbeing, the ultimate answer is not extra pillows and smooshy mattresses, but addressing the root cause of the problem.

All of these issues tie back into tension in the iliacus muscle, one of your primary hip flexors. This tension in your core is likely putting strain on your lower back and hip joints.

Stretching may help some, but if tight muscles are the true cause of your hip pain when sleeping, then you’ll need to fully release those muscles to alleviate the pain for good.

The iliopsoas muscles (comprised of the psoas and iliacus) are very interconnected to the structure of your hip, and because of their positioning on the inside of your pelvis bone, they are difficult to access. Repeated sessions to a physical therapist or other practitioner who specializes in releasing the hip flexors may not be possible.

This is why I invented the Hip Hook: after decades of clinical practice and seeing this pattern of tight hip flexors creating hip pain, back pain, and even knee pain, I looked around to find any tool that could mimic the angled pressure I apply with my hands in therapy sessions. When I discovered that no psoas and iliacus release tool existed, I got to work inventing one!

If you want to address the root causes of hip pain at night, I highly recommend the Hip Hook. The Hip Hook is still the only muscle release tool designed for targeted pressure on the hard-to-reach iliacus muscle.

With just a few minutes added to your bedtime routine each night, or even once every few nights, the Hip Hook can help you be on your way to a life free from hip pain when sleeping.

3 simple steps to realign your pelvis before bed

Release your hip flexors as a part of your bedtime routine. Taking ten minutes and following these 3 simple steps can realign your body and stop your muscles from pulling on your joints, so you’ll never need an article like this again!

Step 1: Release the front of your hip using the Hip Hook or the Hip Release Ball. You can also add to a bedtime routine a slow, soothing yoga flow, or a few hip flexor stretches for tight hips.

If you have sciatica pain while sleeping, these self-massage techniques for sciatica can be helpful.

Step 2: Use a massage ball to release the muscles in the back of your hip.

Step 3: Realign your rotated pelvis with this simple 2-minute exercise.

Other ways to manage hip pain when sleeping

I’ve already given you a few good options, but there are even more ways that you can ease your hip pain while sleeping, and some of them happen before you go to bed.

Get the right mattress

First, make sure you have a decent mattress. In general, a firmer mattress is ideal for preventing hip pain when sleeping. If the mattress is too soft, your body will not be aligned properly and your hips, in particular, will not be given the support they need.  

A mattress can also be too firm and will be equally poor when it comes to giving your body the support it needs.

That is why it can help talk to an orthopedic specialist when choosing a mattress that’s right for your body.

You can also add a foam pad or mattress topper to your mattress to help distribute your weight more evenly and add more support, especially if you’re a side sleeper who experiences pain in the hip you lay on. Try not to get a mattress with inner metal springs, especially if you sleep on your side. A memory foam mattress is better for weight distribution and support.

Follow a bedtime routine

Although this may seem like a strange addition to the list, if you are already losing some sleep to hip pain, you need to try and get as much good sleep as you can.

One of the best ways to optimize your sleep is to put your body into a natural rhythm. To do this, you need good morning and evening routines (ideally including hip flexor release!).

Going to bed and waking up at the same time each day is ideal, especially if you can get 7-9 hours of sleep each night.

It also helps to eliminate distractions and to keep your bedroom clutter-free and reserved for sleep only. Create a peaceful environment so your mind and body can relax each night.

Before deciding to do hip flexor stretches, it is helpful to know the root cause of your hip pain. Although some stretching can be great, overstretching is possible and can cause more harm than good.

It’s important to visit a physical therapist to determine the cause of your hip pain when sleeping once and for all. Then, and only then, will you gain the tools to get rid of your hip pain.

FAQs about hip pain when sleeping

How do I stop my hip from hurting when I sleep?

One way is by using pillows to adjust the positioning of your body, allowing for more natural alignment. However, addressing any underlying muscle tension during the day may address the root cause of hip pain at night and lead to longer lasting results.

What can cause hip pain at night?

Common causes of hip pain at night include:

• Tendonitis
• Bursitis
• Arthritis
• Injury
• Tight hip flexors
• Pregnancy

What causes hip pain when lying on your side?

If your hip touching the mattress is hurting, it could be from the compression on that joint from a variety of causes, from bursitis to arthritis. If your top hip is hurting, it could be muscular tension from the angled weight of your top leg tugging the muscles around your hip joint.