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

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

By Nova Physical Therapy | North Hollywood, CA

Looking for physical therapy in North Hollywood? Explore our rehabilitation services at Nova Physical Therapy Services.

You go to bed feeling reasonably comfortable.

Then you roll onto one side.

Within a few minutes, you notice an ache or tenderness along the outside of your hip. You roll onto the other side, but sometimes that isn't comfortable either.

The next morning you may feel it again when you:

walk → climb stairs → stand on one leg → get out of the car.

A common assumption is:

“I probably have hip bursitis.”

But lateral hip pain is more complicated than that.

One possible musculoskeletal presentation is greater trochanteric pain syndrome (GTPS), an umbrella term commonly associated with structures around the outside of the hip, including the gluteal tendons. Gluteal tendinopathy is an important presentation within this group. However, lateral hip pain can have several causes, so the location of pain alone should not be used to establish a diagnosis. 

And this distinction matters because the rehabilitation strategy may involve much more than trying to “reduce inflammation in the bursa.”

Patient Question

“The outside of my hip hurts when I sleep on that side. Sometimes it also hurts when I walk, climb stairs, or stand on one leg. I was told it might be bursitis. Should I stretch it, stop walking, or try to strengthen my hip?”

The Short Answer

Pain over the outside of the hip—particularly when lying on that side, walking, climbing stairs, or performing other weight-bearing activities—can occur with several musculoskeletal presentations.

One commonly recognized presentation is greater trochanteric pain syndrome.

Despite the familiar term “trochanteric bursitis,” research and contemporary clinical practice recognize that the gluteal tendons may be important contributors in many people with lateral hip pain. 

Physical therapy may therefore focus on more than simply trying to calm the painful area.

Depending on the individual evaluation, rehabilitation may address:

• Hip muscle performance
• Progressive loading
• Walking tolerance
• Single-leg control
• Stair tolerance
• Activity modification
• Positions that aggravate symptoms
• Functional strength
• Return to exercise or recreation

A 2025 systematic review identified evidence supporting several approaches for clinically diagnosed gluteal tendinopathy, including education plus exercise. 

And a newly published September 2026 study examining expert clinical reasoning found that experts emphasized individualized education, load management and progressive exercise while recognizing that treatment needs to account for the patient's specific presentation. 

Key Takeaways

1. Outside-of-the-hip pain isn't automatically “bursitis.”

Several structures and conditions can contribute to lateral hip pain.

2. Sleeping directly on the painful hip can aggravate symptoms.

That does not necessarily mean sleeping on the hip is causing new tissue damage.

3. Stretching everything isn't necessarily the answer.

Certain positions can increase compression around sensitive lateral hip structures.

4. Strengthening may be important—but dosage matters.

Rehabilitation may progressively improve the ability of the hip to tolerate walking, stairs, exercise and single-leg activities.

5. The goal isn't simply to avoid using the hip.

When appropriate, the goal is to rebuild capacity for the activities that matter to you.

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

This is where understanding the mechanics becomes useful.

When you lie directly on one side, your body weight creates pressure around the outside of the hip.

If tissues in that area are already sensitive, prolonged compression may provoke symptoms.

That's why someone might say:

“I feel okay when I go to bed, but after 20 minutes on that side, my hip starts aching.”

That symptom provides useful information.

But it does not, by itself, tell us exactly which tissue is responsible.

PT Insight

Think of the painful hip as having a current tolerance level.

Walking, stairs, standing on one leg, exercise and sleeping positions all place different demands on that region.

Physical therapy isn't necessarily about removing every demand.

Often, it is about identifying which demands are currently aggravating symptoms and progressively improving the hip's ability to tolerate the activities you need.

Is This Hip Bursitis?

Possibly—but the term can be misleading when used as an automatic explanation for every case of lateral hip pain.

A bursa is a fluid-containing structure that helps reduce friction between tissues.

Historically, pain over the greater trochanter—the bony area on the outside of the hip—was commonly labeled:

trochanteric bursitis.

Today, clinicians often use the broader term:

greater trochanteric pain syndrome.

This recognizes that lateral hip pain can involve more than one structure and that the gluteal tendons may play an important role. 

For the patient, the practical message is simple:

Don't assume every painful outer hip is just an inflamed bursa that needs to be “calmed down.”

Why Does My Hip Hurt When I Walk?

Walking repeatedly loads the muscles and tendons around the hip.

Every step requires the hip musculature to help control the pelvis and lower extremity.

One step may feel fine.

But:

100 steps

is different from:

2,000 steps

which is different from:

10,000 steps.

This is why some patients say:

“It doesn't hurt when I start walking. It hurts after 15 or 20 minutes.”

That information can be clinically useful because it tells us something about activity tolerance.

Why Does My Hip Hurt Going Up Stairs?

Stairs increase the muscular demand placed on the lower extremity.

The hip muscles have to contribute to moving and controlling your body against gravity.

Someone whose lateral hip is sensitive to loading may therefore notice symptoms with:

• Stairs
• Hills
• Step-ups
• Hiking
• Repeated sit-to-stand activities

Again, the activity isn't automatically harmful.

The current demand may simply exceed the person's present capacity.

Why Does Standing on One Leg Hurt?

Standing on one leg seems simple.

Biomechanically, however, it places substantial demand on the muscles that help control the pelvis.

You perform versions of single-leg loading constantly:

walking

stairs

putting on pants

stepping into a bathtub

getting into a car

running

and

sports.

If these activities provoke symptoms, rehabilitation may need to progressively restore tolerance to single-leg loading rather than permanently avoiding it.

Why Does My Hip Hurt When I Get Out of the Car?

Getting out of a car combines several movements:

hip flexion + rotation + weight transfer + standing.

If the hip is sensitive, that combination can be uncomfortable.

The same may occur when:

• Getting out of a low chair
• Rising from a couch
• Stepping sideways
• Turning while standing

A useful physical therapy evaluation looks beyond:

“Does your hip hurt?”

and asks:

“Which activities reproduce the problem?”

That difference helps make rehabilitation functional.

Should I Stop Walking?

Not automatically.

There is an important difference between:

load management

and

complete avoidance.

Imagine someone currently walks 45 minutes every evening.

Symptoms begin around minute 20 and become progressively worse for the remainder of the walk.

One possible rehabilitation strategy might involve temporarily adjusting the walking dose and then gradually progressing it.

That does not mean everyone should walk exactly 20 minutes.

The example simply demonstrates the concept:

find tolerable load → build capacity → progressively increase demand.

Should I Stretch My Hip?

This is where lateral hip pain becomes particularly interesting.

People frequently assume:

“It hurts, so it must be tight. I should stretch it.”

But a sensation of tightness does not automatically mean a tissue needs aggressive stretching.

Some hip positions can increase compression around the lateral hip.

For example, repeatedly pulling the leg strongly across the body may not feel good for some people with a compression-sensitive lateral hip presentation.

That does not mean:

“Never stretch your hip.”

It means exercise selection should be based on the patient's presentation rather than the assumption that every painful body part needs more stretching.

Should I Use a Massage Gun on the Painful Spot?

This is another extremely common modern question.

A patient feels a tender area and thinks:

“If I loosen this knot, maybe the problem will go away.”

A massage gun or other self-massage strategy may temporarily feel comfortable for some people.

But repeatedly applying aggressive pressure directly over a highly sensitive lateral hip may also aggravate symptoms.

More importantly, passive treatment alone does not necessarily improve the hip's capacity to tolerate:

walking

stairs

single-leg loading

or

exercise.

If those activities are the problem, rehabilitation ultimately needs to address those demands.

Should I Foam Roll My IT Band?

Foam rolling may temporarily change how an area feels.

But the common idea that you can simply:

“break up” or “lengthen” the IT band

with a foam roller is an oversimplification.

And if direct pressure over the outside of the hip substantially aggravates symptoms, repeatedly rolling aggressively over the painful region may not be helpful.

The more useful question is:

What functional limitation are we trying to improve?

Should I Strengthen My Glutes?

Potentially, yes.

Progressive strengthening is an important component of contemporary rehabilitation for gluteal tendinopathy presentations. 

But saying:

“Your glutes are weak—do clamshells.”

isn't enough.

The hip musculature works during many activities:

walking → stairs → squatting → single-leg stance → running → jumping.

Rehabilitation may therefore progress from lower-demand exercises toward increasingly functional loading.

The appropriate progression depends on the patient.

Are Clamshells the Best Exercise?

No single exercise is universally best.

Clamshells may be useful in certain programs.

But someone whose goal is:

walking three miles

or

returning to hiking

eventually needs rehabilitation that prepares the hip for those demands.

A rehabilitation program should not become:

“Do the same three exercises forever.”

Exercise should progress as capacity improves.

Can I Still Do Squats?

Possibly.

Squatting uses the hips, knees and ankles and can be a useful strengthening activity.

If squatting aggravates symptoms, variables can sometimes be adjusted:

depth

resistance

stance

volume

frequency

or

exercise selection.

The objective isn't automatically:

“Squats are bad for your hip.”

It may be:

“How can we appropriately build back toward the squat?”

Can I Run With Lateral Hip Pain?

This depends on the presentation.

Running substantially increases repeated loading compared with normal walking.

A runner may need to consider:

• Recent mileage changes
• Running frequency
• Speed work
• Hills
• Recovery
• Other training
• Symptom response

Sometimes running volume may temporarily need adjustment while strength and load tolerance improve.

That is different from telling every runner:

“Stop running until you have zero pain.”

Should I Put a Pillow Between My Knees?

Some people find this more comfortable when sleeping on the opposite side.

Why might it help?

Without support, the upper leg can fall across the body.

A pillow can change that position and may reduce uncomfortable compression for some individuals.

But this should be presented accurately:

A pillow is a comfort and positioning strategy—not a treatment that heals the underlying condition.

Do I Need an MRI?

Not necessarily.

Lateral hip pain is often evaluated initially using history and physical examination.

Imaging may become appropriate depending on:

• Significant trauma
• Unusual symptoms
• Significant weakness
• Concern for another condition
• Failure to progress as expected
• Medical history
• Clinical findings

An MRI finding should also be interpreted in the context of the patient's symptoms and function.

Can Physical Therapy Help?

Yes, when the presentation and associated movement or functional limitations are appropriate for physical therapy.

A physical therapy program may address:

• Hip muscle performance
• Lower-extremity strength
• Progressive loading
• Walking tolerance
• Stair tolerance
• Single-leg control
• Balance when relevant
• Functional movement
• Exercise tolerance
• Return to work
• Return to hiking
• Return to running or sport
• Education about aggravating positions and activity

The goal should be bigger than:

“Make the painful spot less tender.”

If you want to walk three miles, your hip needs to tolerate walking.

If you want to hike, your hip needs to tolerate hills.

If you want to play pickleball, your hip needs to tolerate lateral movement.

Rehabilitation should eventually resemble the life you want to return to.

What Patients Sometimes Assume vs. What You Should Know

What Does Research Say?

September 2026: How Experts Actually Manage Gluteal Tendinopathy

A particularly relevant paper was published in the September 2026 issue of Physiotherapy.

Researchers interviewed international interdisciplinary experts specifically to explore clinical reasoning and best-practice management of gluteal tendinopathy.

This matters because rehabilitation is not simply a list of exercises.

Clinical management requires decisions about:

education → load management → exercise selection → progression → individual patient factors.

The study was designed specifically to investigate how experts make those decisions in practice. 

2025 Review of Physiotherapy Management

A 2025 article in the Journal of Physiotherapy specifically reviewed physiotherapy management of gluteal tendinopathy, reflecting the growing recognition of this presentation within rehabilitation practice. 

2025 Systematic Review of Treatments

A systematic review published in Clinical Rehabilitation evaluated randomized controlled trials of treatments for clinically diagnosed gluteal tendinopathy.

The investigators deliberately focused on medium- or high-quality randomized trials with low risk of bias.

Four interventions from four randomized trials demonstrated efficacy, including an approach involving education and exercise. 

This is important because it supports a broader rehabilitation strategy rather than simply treating lateral hip pain as:

“inflammation that needs rest.”

International Physiotherapy Consensus

An international consensus statement developed by 15 physiotherapists and eight orthopedic surgeons addressed assessment and both nonsurgical and surgical physiotherapy management of greater trochanteric pain syndrome.

The authors emphasized individualized assessment and acknowledged limitations in the available high-quality evidence—an important reminder that clinicians should not overstate certainty. 

What Does the Evidence Mean for a Patient?

It doesn't mean:

Everyone needs the same strengthening program.

It doesn't mean:

Never stretch.

And it doesn't mean:

Every outer-hip pain presentation is gluteal tendinopathy.

A more responsible interpretation is:

evaluate the presentation → identify functional limitations → manage aggravating loads when appropriate → progressively improve physical capacity → return toward meaningful activities.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, an evaluation for lateral hip pain may include, when appropriate:

• Detailed symptom history
• Medical and injury history
• Hip movement
• Hip muscle performance
• Lower-extremity muscle performance
• Walking
• Single-leg activities
• Balance
• Squatting
• Step-up or step-down tasks
• Functional movement
• Discussion of work, exercise and recreational demands

We may ask:

Where exactly does your hip hurt?

Can you sleep on that side?

Does walking aggravate it?

How long can you walk before symptoms begin?

Do stairs hurt?

Does standing on one leg hurt?

Did you recently increase your activity?

Do you have back pain?

Do you have numbness or tingling?

Was there an injury?

What activities do you want to return to?

This distinction is important for Nova's California content.

The Physical Therapy Board of California describes physical therapists as licensed professionals who evaluate physical status, establish a plan of care and goals, and provide treatment aimed at improving movement and function. 

California law also explicitly maintains the prohibition against a physical therapist diagnosing a disease. 

Therefore, Nova's role is not:

“Your outer hip hurts, therefore you have gluteal tendinopathy.”

It is to appropriately evaluate the movement and functional presentation, provide physical therapy when indicated, and refer when additional medical evaluation is warranted.

When Should You Seek Medical Attention?

Seek appropriate medical evaluation for hip pain associated with:

• Significant trauma
• Inability to bear weight following injury
• Suspected fracture or dislocation
• Rapidly increasing swelling
• Significant redness or warmth
• Fever or systemic illness
• Progressive neurological symptoms
• Significant numbness or weakness
• Severe or rapidly worsening symptoms
• Unexplained systemic symptoms
• Other concerning changes

Hip pain following a significant fall—particularly in an older adult—requires a different level of concern than gradually developing discomfort after an increase in walking.

Persistent symptoms that do not progress as expected should also be appropriately reassessed.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our philosophy is simple:

We Care.

But for us, “We Care” should mean more than being friendly.

It means we don't want to reduce every patient to a body part.

Someone doesn't walk into Nova simply with:

“a painful hip.”

Maybe that person used to walk every evening with their spouse.

Maybe they stopped hiking because hills became uncomfortable.

Maybe they're exhausted because rolling onto the hip wakes them several times every night.

Maybe they stopped exercising because they are afraid they're damaging something.

Those details matter.

So instead of beginning with:

“Here are three exercises for hip pain.”

we want to understand:

What changed?

What can you no longer do comfortably?

What does the physical therapy evaluation show?

What can your hip currently tolerate?

What do you want your hip to be able to tolerate again?

Then rehabilitation can be built around that person.

Our approach emphasizes:

• Individualized evaluation
• Evidence-informed physical therapy
• Progressive exercise
• Functional strengthening
• Load management when appropriate
• Patient education
• Return to meaningful activities
• Appropriate medical referral when indicated

Because the goal isn't simply to make someone better at physical therapy exercises.

The goal is to help improve the movement and function they need outside Nova.

That's what We Care should mean.

Frequently Asked Questions

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

Direct pressure and prolonged positioning may aggravate sensitive structures around the lateral hip. The symptom alone does not establish a diagnosis.

Is outer hip pain always bursitis?

No. Several musculoskeletal presentations can cause lateral hip pain, and contemporary research recognizes the potential importance of the gluteal tendons.

Should I sleep on the painful hip?

If direct pressure consistently aggravates symptoms, temporarily changing sleeping position may improve comfort.

Does putting a pillow between my knees help?

Some people find it more comfortable because it changes the position of the upper leg. It should be considered a positioning strategy rather than a cure.

Should I stretch lateral hip pain?

Not automatically. Certain positions may increase symptoms in some lateral-hip presentations. Exercise selection should be individualized.

Should I strengthen my glutes?

Progressive hip strengthening may be appropriate depending on the evaluation and is an important component of rehabilitation for many gluteal tendinopathy presentations. 

Are clamshells the best exercise for lateral hip pain?

No single exercise is best for everyone. Exercise should eventually prepare the patient for their specific functional demands.

Should I stop walking?

Not necessarily. Walking volume may sometimes need modification, followed by progressive increases according to tolerance and the clinical presentation.

Can I run with lateral hip pain?

That depends on the individual presentation, symptom response, training load and examination findings.

Can physical therapy help pain on the outside of my hip?

Physical therapy may address relevant movement, muscle-performance, load-tolerance and functional limitations associated with lateral hip pain when PT is appropriate.

Schedule an Evaluation

If pain on the outside of your hip is making it difficult to:

• Sleep
• Walk
• Climb stairs
• Stand on one leg
• Exercise
• Run
• Hike
• Work
• Get in or out of the car
• Participate in normal daily activities

Nova Physical Therapy can evaluate your movement and functional limitations and determine whether physical therapy is appropriate.

Our rehabilitation approach focuses on:

movement + strength + progressive loading + functional capacity + return to meaningful activity.

Ready to learn more? Visit Nova Physical Therapy Services to explore our services and learn more about care at our North Hollywood clinic.

Disclaimer

This article is for general educational and informational purposes only. It does not constitute medical advice, medical diagnosis, exercise clearance, or individualized physical therapy treatment.

Pain on the outside of the hip cannot independently establish greater trochanteric pain syndrome, gluteal tendinopathy, bursitis, arthritis, lumbar involvement, or another medical condition.

Physical therapists evaluate and treat movement and functional impairments within their regulated scope of practice. California law maintains the prohibition against physical therapists diagnosing disease. 

Physical therapy, exercise, activity modification, manual therapy and other interventions cannot guarantee symptom resolution or prevention of recurrence.

Research discussed in this article represents group-level findings and should not be interpreted as an individualized treatment recommendation.

Seek appropriate medical evaluation for significant trauma, inability to bear weight after injury, suspected fracture or dislocation, fever or systemic illness, progressive neurological symptoms, rapidly worsening symptoms, or other concerning findings.

Individual results vary.

References

1. Bremer T, Lack S, Fearon A, Morrissey D. Best Practice for Patients With Gluteal Tendinopathy: A Qualitative Exploration of Expert Clinical Reasoning and Management. Physiotherapy. September 2026;132:101871. 
2. Fearon AM. Physiotherapy Management of Gluteal Tendinopathy. Journal of Physiotherapy. 2025;71(2):81–90. 
3. The Efficacy of Gluteal Tendinopathy Treatments: A Systematic Review. Clinical Rehabilitation.2025;39(5):600–617. The review included medium- or high-quality randomized trials with low risk of bias evaluating pain and function in adults with clinically diagnosed gluteal tendinopathy. 
4. The 2022 International Society for Hip Preservation Physiotherapy Agreement on Assessment and Treatment of Greater Trochanteric Pain Syndrome: An International Consensus Statement. International expert consensus involving physiotherapists and orthopedic surgeons. 
5. Physical Therapy Board of California. Consumer Information and California Laws and Regulations Related to the Practice of Physical Therapy.
6. American Physical Therapy Association. Standards of Practice for Physical Therapy and Clinical Practice Guidelines Library. APTA describes CPGs as tools to assist clinical decision-making while emphasizing that they do not replace clinician judgment. 

Evidence resources: 2026 gluteal tendinopathy best-practice research · 2025 systematic review of gluteal tendinopathy treatments · Physical Therapy Board of California · APTA Clinical Practice Guidelines Library