Outer Hip Pain at Night: Is It Bursitis?
By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published October 2026
You lie down on your side to sleep, and within minutes there's a deep ache on the outside of your hip. You roll over, but then that side starts to hurt too. During the day it bothers you on stairs, getting out of the car, or standing for long periods.
Pain on the outside of the hip is very common, especially in adults over 40, and it's often called "hip bursitis." But research has changed how we understand it, and that change matters for what actually helps. This article explains what outer hip pain may be associated with, what makes it worse, what the research shows, and when to see a doctor.
The short answer
Pain on the outside of the hip that's worse when lying on that side is often associated with what clinicians call greater trochanteric pain syndrome. In many people, the tendons of the gluteal muscles are involved, not just the bursa. In a large clinical trial, people who received education plus a targeted exercise program did better than those who received a cortisone injection or simply waited and saw (Mellor et al., BMJ 2018). Only an evaluation can sort out the cause. In California, you can see a physical therapist without a referral.
Why does the outside of my hip hurt at night?
On the outside of each hip is a bony point called the greater trochanter. Several tendons from your gluteal muscles attach there, and a small fluid-filled sac (a bursa) sits nearby.
When you lie on your side, the weight of your body presses directly on that area. When you lie on the opposite side, your top leg often drops down and across your body, which stretches and squeezes the tendons against the bone. Either way, irritated tendons can complain, which is why night pain is one of the most common signs of this problem.
Other symptoms that are often reported include:
• Tenderness when you press on the outside of the hip
• Pain getting up after sitting, especially from low chairs or the car
• Pain climbing stairs or walking uphill
• Pain standing for long periods, especially when leaning onto one leg
• Pain that sometimes spreads down the outside of the thigh
Is it really bursitis?
Often, not exactly. For years, outer hip pain was labeled "trochanteric bursitis." Research using imaging has since shown that in many people, the gluteal tendons are irritated or overloaded, a problem called gluteal tendinopathy, with or without bursa involvement. That's why many clinicians now use the broader term greater trochanteric pain syndrome.
This isn't just a name change. Tendons respond to how they're loaded, so treatment that changes and gradually builds tendon load often makes more sense than treatment aimed only at calming a bursa.
Pain on the outside of the hip can also come from other sources, such as the lower back or the hip joint itself. Pain felt mainly in the groin is more often linked with the hip joint and should be evaluated.
What makes outer hip pain worse?
The gluteal tendons tend to get irritated when they're squeezed against the bone, especially when the leg crosses toward or past the middle of your body. Common culprits include:
• Lying on the painful side, or on the other side with your top knee dropped forward
• Crossing your legs when sitting
• Standing with your weight shifted onto one hip
• Sitting in low chairs where your knees are higher than your hips
• Sudden jumps in activity, like a lot more walking, hiking, or stair climbing
• Stretching the outer hip hard, which can squeeze the tendons further
Small changes that help many people:
• Sleep on your back, or on the non-painful side with a pillow between your knees
• Keep your knees uncrossed and apart when sitting
• Stand with your weight evenly on both feet
• Raise low seats with a cushion
• Build up walking, hiking, and stairs gradually
How can physical therapy help?
The LEAP trial, published in the BMJ, compared three approaches in 204 people with long-lasting outer hip pain (Mellor et al., BMJ 2018; ACP Journal Club summary):
• Education plus exercise (14 physical therapy sessions over 8 weeks)
• A single cortisone injection
• Wait and see (one session of general advice)
At 8 weeks, about 77% of the education-plus-exercise group reported success, compared with about 59% of the injection group and 29% of the wait-and-see group. At one year, the numbers were about 79%, 58%, and 52%. In other words, education and exercise did better than an injection or waiting, and the benefit lasted.
A physical therapy evaluation may include:
• When the pain started and what makes it better or worse
• Tests of hip strength, especially the side hip muscles
• How you stand, walk, climb stairs, and balance on one leg
• A check of your lower back and hip joint
• Screening for signs that need a physician's evaluation
A typical plan may include:
• Education on positions and habits that squeeze the tendons, and simple changes
• Strengthening for the hip and leg muscles, starting gently and progressing over time
• Balance and single-leg control exercises
• Guidance on returning to walking, hiking, stairs, and exercise
• A home program you can keep doing on your own
Tendons usually improve gradually, often over several weeks to a few months. Physical therapy doesn't guarantee a specific result or timeline. Questions about injections, imaging, or medication are best directed to your physician.
At Nova Physical Therapy in North Hollywood, every plan for hip pain starts with an evaluation so treatment fits what we find.
When should I see a doctor?
Get medical care right away if you have:
• Hip or groin pain after a fall, especially if you're older or have osteoporosis
• Inability to put weight on your leg
• A hip that is hot, red, or swollen, or pain with a fever or chills
• A leg that looks shortened or turned outward after an injury
See a physician promptly if you have:
• Pain mainly in the groin
• Night pain that doesn't change when you change positions
• A history of cancer, or unexplained weight loss
• Numbness, tingling, or weakness in the leg, or pain spreading from your back
• Pain that isn't improving or is getting worse despite care
We screen for these signs during every evaluation and refer you to a physician when findings call for medical assessment.
Do I need a referral for physical therapy in California?
Not to get started. California allows direct access to physical therapy. A physical therapist can evaluate and treat you without a referral for up to 45 calendar days or 12 visits, whichever comes first. After that, a physician or podiatrist needs to sign the plan of care for treatment to continue. Your insurance plan may have its own referral rules, so check your coverage.
Frequently asked questions
Why does my hip hurt when I lie on my side?
Lying on the painful side presses directly on the tendons at the outside of the hip. Lying on the other side can let your top leg drop across your body, which squeezes the same tendons. A pillow between your knees often helps.
Is hip bursitis the same as gluteal tendinopathy?
They're related but not the same. Research shows that in many people with outer hip pain, the gluteal tendons are involved, not just the bursa. Many clinicians now use the term greater trochanteric pain syndrome to cover both.
Should I stretch my outer hip?
Not hard. Aggressive stretching of the outer hip can squeeze the tendons further. Gentle movement and a gradual strengthening program are usually a better fit.
Will a cortisone shot fix it?
Some people get short-term relief from an injection, but in the LEAP trial, education plus exercise did better at both 8 weeks and one year. Injection decisions are made with your physician.
How long does outer hip pain take to get better?
Tendon pain usually improves gradually, often over several weeks to a few months with consistent changes and exercise.
Is walking bad for outer hip pain?
Usually not. Walking is generally fine, but you may need to reduce long walks, hills, or stairs for a while and build back up gradually.
Do I need a referral to see a physical therapist?
No, not to start. California allows direct access within the limits described above.
About Nova Physical Therapy
Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from sports injuries, back and neck pain, work injuries, auto accident injuries, knee pain, and shoulder problems, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.
Schedule an evaluation
If outer hip pain is keeping you up at night or making stairs and walks harder, an evaluation can help sort out what is driving it and which next steps fit you.
Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online
Disclaimer
This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Hip pain has many causes, and only an in-person evaluation can determine what is right for you. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.
References
1. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. Link
2. ACP Journal Club. In gluteal tendinopathy, education + exercise improved outcomes vs corticosteroid injection or wait strategy. Ann Intern Med. 2018. Link