Why Does My Hip Hurt When I Walk or Sleep on My Side?

Why Does My Hip Hurt When I Walk or Sleep on My Side? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

Patient Question

"Why does my hip hurt when I walk, climb stairs, or sleep on my side, and can physical therapy help?"

The Short Answer

Hip pain during walking, stair climbing, exercise, or sleeping on one side is a common musculoskeletal complaint. Symptoms may develop from several contributing factors, including changes in muscle performance, activity levels, mobility, movement coordination, repetitive loading, previous injuries, or irritation of tissues around the hip.

Pain on the outside of the hip is sometimes described as "hip bursitis," but research increasingly recognizes that lateral hip pain may involve multiple structures, including the gluteal tendons. One commonly used clinical term is greater trochanteric pain syndrome (GTPS).

A licensed physical therapist can evaluate strength, mobility, walking mechanics, balance, movement patterns, and functional limitations to determine whether physical therapy is appropriate and develop an individualized rehabilitation program.

Why Does My Hip Hurt When I Walk?

Walking requires coordinated movement between the:

• Hips
• Pelvis
• Knees
• Ankles
• Trunk

The muscles surrounding the hip help control the pelvis and lower extremity each time you take a step.

Several factors may contribute to symptoms during walking, including:

• Reduced hip muscle performance
• Reduced muscular endurance
• Changes in walking mechanics
• Mobility limitations
• Sudden increases in walking distance
• Repetitive loading
• Physical deconditioning
• Previous injuries

A physical therapist can evaluate how these factors may be affecting your walking tolerance.

Why Does My Hip Hurt When I Sleep on My Side?

People with lateral hip pain commonly report discomfort when lying directly on the affected side.

Direct compression of sensitive tissues around the outside of the hip may contribute to symptoms in some individuals.

Symptoms may also become noticeable when:

• Sleeping on the painful side
• Lying in one position for a prolonged period
• Crossing the legs
• Standing primarily on one leg
• Climbing stairs
• Walking longer distances
• Running

However, pain while sleeping on your side does not establish a specific diagnosis by itself.

Is Hip Pain Always Bursitis?

No.

The term "trochanteric bursitis" has historically been used to describe pain on the outside of the hip.

Current evidence suggests that lateral hip pain can involve several structures and that gluteal tendon-related disorders may contribute to symptoms in many individuals.

For this reason, the broader term greater trochanteric pain syndrome is frequently used.

An examination is important because symptoms alone cannot determine which tissue is responsible.

Could My Hip Muscles Be Weak?

Reduced hip muscle performance may contribute to functional limitations in some individuals with hip pain.

The muscles around the hip help control the pelvis and lower extremity during activities such as:

• Walking
• Climbing stairs
• Standing from a chair
• Squatting
• Running
• Exercising
• Standing on one leg

A physical therapist can assess hip muscle performance and determine whether progressive strengthening may be appropriate.

Should I Stop Walking If My Hip Hurts?

Not necessarily.

Complete avoidance of activity is not required for every person with hip pain.

Depending on your symptoms and examination findings, your physical therapist may recommend modifying:

• Walking distance
• Walking speed
• Hills
• Stairs
• Running volume
• Exercise intensity
• Repetitive activities

The goal is often to find an appropriate level of activity while gradually improving the body's tolerance to physical demands.

Can Physical Therapy Help Hip Pain?

Physical therapy may be appropriate for many musculoskeletal causes of hip pain.

Depending on examination findings, treatment may include:

• Therapeutic exercise
• Progressive hip strengthening
• Gluteal muscle training
• Mobility exercises
• Balance training
• Walking training
• Functional movement training
• Activity modification education
• Progressive loading
• Home exercise programs
• Manual therapy when clinically indicated

Physical therapy focuses on improving movement, restoring function, increasing activity tolerance, and helping patients return to meaningful activities.

What Does Research Say?

Research supports education and exercise-based rehabilitation for several common presentations of lateral hip pain.

A randomized clinical trial published in The BMJ found that an education-and-exercise program produced better global improvement than a wait-and-see approach for individuals with gluteal tendinopathy. The study also demonstrated favorable outcomes compared with corticosteroid injection for global improvement at longer-term follow-up.

These findings support an active rehabilitation approach emphasizing appropriate tendon loading, strengthening, and patient education.

Treatment should still be individualized because not every person with hip pain has gluteal tendinopathy or greater trochanteric pain syndrome.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, every patient receives an individualized evaluation that may include:

• Medical history review
• Hip mobility assessment
• Strength testing
• Hip muscle performance assessment
• Functional movement assessment
• Walking assessment
• Balance testing
• Stair assessment when appropriate
• Activity tolerance assessment
• Review of occupational or recreational demands
• Goal setting

Your physical therapist also screens for findings that may require medical evaluation or referral.

Following the evaluation, an individualized plan of care is developed based on your examination findings and personal goals.

When Should You Seek Medical Attention?

Although many cases of hip pain are musculoskeletal, medical evaluation may be necessary if you experience:

• Significant trauma or a fall
• Inability to bear weight
• Significant or rapidly increasing swelling
• Visible deformity
• Fever associated with severe hip pain
• Significant unexplained weakness
• Severe or rapidly worsening pain
• Progressive neurological symptoms

Hip pain following a fall in an older adult or someone at increased risk for fracture should receive appropriate medical evaluation.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our mission is simple:

We Care.

We believe every patient deserves individualized care, clear communication, and a better understanding of their symptoms.

Our treatment philosophy emphasizes:

• Evidence-based care
• Individualized treatment plans
• Patient education
• Functional outcomes
• Progressive strengthening
• Movement optimization
• Appropriate activity progression
• Long-term health and wellness

Our goal is not simply to focus on where your hip hurts. We evaluate how your symptoms affect walking, sleeping, climbing stairs, exercising, working, and participating in everyday life.

Frequently Asked Questions

Why does the outside of my hip hurt when I sleep?

Direct pressure on sensitive tissues around the outside of the hip may contribute to symptoms. Several musculoskeletal conditions can produce lateral hip pain, so persistent symptoms should be evaluated.

Is lateral hip pain the same as hip bursitis?

Not necessarily. Although bursitis may contribute in some cases, current evidence recognizes that gluteal tendon-related disorders and other factors may also be involved.

Is walking good for hip pain?

Walking may be appropriate for many individuals, but the amount and intensity should match your current activity tolerance and clinical presentation.

Can strengthening help hip pain?

Progressive strengthening may be beneficial for certain hip conditions, particularly when reduced muscle performance or tendon-loading capacity contributes to functional limitations.

Do I need an MRI for hip pain?

Not everyone with hip pain requires imaging. Whether imaging is appropriate depends on the clinical presentation, medical history, examination findings, and whether additional medical investigation is indicated.

Schedule an Evaluation

If hip pain is affecting your ability to walk, sleep comfortably, climb stairs, exercise, work, or participate in everyday activities, Nova Physical Therapy can help.

Our licensed physical therapists provide comprehensive evaluations and individualized rehabilitation programs focused on improving movement, strength, activity tolerance, and function.

Contact Nova Physical Therapy today to schedule your comprehensive physical therapy evaluation.

Disclaimer

The information provided in this article is intended for educational and informational purposes only and should not be considered medical advice, diagnosis, or treatment. Reading this article does not establish a physical therapist-patient relationship with Nova Physical Therapy or any of its providers.

Hip pain can have multiple causes. Pain with walking, stair climbing, exercise, or sleeping on one side does not establish a specific diagnosis. Treatment recommendations should be individualized based on a licensed physical therapist's examination, clinical judgment, medical history, patient presentation, current evidence, and applicable scope-of-practice requirements.

Physical therapists screen patients and refer to physicians or other appropriate healthcare professionals when findings require additional medical evaluation.

If you experience significant trauma, inability to bear weight, visible deformity, fever associated with severe hip pain, rapidly worsening symptoms, or other concerning findings, seek appropriate medical attention.

Individual results may vary. Nova Physical Therapy does not guarantee specific outcomes from physical therapy, exercise, or any healthcare intervention discussed in this article.

References

1. Mellor R, 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.
2. Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. Journal of Orthopaedic & Sports Physical Therapy.
3. American Physical Therapy Association (APTA). Guide to Physical Therapist Practice.
4. World Health Organization (WHO). Musculoskeletal Health.
5. Physical Therapy Board of California (PTBC). Physical Therapy Practice Act.

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