.avif)
By Mr Oni MBChB BSC PGDip FRCS (Tr &Orth), Consultant Hip and Knee Surgeon
Written: August 19th, 2026
Hip pain that appears during the day is one thing. Hip pain that wakes you at two in the morning is another, and patients are right to treat it differently. Night pain is one of the most useful pieces of information you can bring to a consultation, because when it happens, and exactly where it hurts, says a great deal about what is going on.
The most common pattern I see is pain over the outer hip that flares when you lie on that side. This is usually greater trochanteric pain syndrome, often called hip bursitis, rather than hip arthritis. It comes from irritation of the tendons and soft tissues over the bony point of the hip, which is exactly the spot that takes your weight when you lie on your side. It is particularly common in women in their fifties and sixties. The reassuring news is that it is very treatable, and it does not mean the joint itself is wearing out.
The second pattern is different. A deep groin ache that wakes you as you turn over points more towards hip arthritis. The joint is stiff, the movement of turning drags it through its worn range, and the ache is enough to pull you out of sleep. If this is happening alongside daytime stiffness and a groin ache when you twist or put on socks and shoes, the hip joint is the likely culprit.
Pain that regularly wakes you is worth taking seriously. With arthritis it often marks the point where the joint has worn enough to be worth discussing treatment properly, rather than simply adding another pillow and hoping. That does not automatically mean surgery. It means the conversation about your options, from targeted physiotherapy and injections through to hip replacement, is now worth having with someone who can examine you and look at an X-ray.
A few simple things can make nights more manageable in the meantime:
• A pillow between the knees takes the strain off the outer hip and keeps the pelvis level.
• Staying off the painful side, where you can train yourself to, gives irritated tissue a chance to settle.
• Have a look at whether the mattress is part of the problem. A mattress that has softened with age lets the hip sink and load awkwardly, and sometimes the mattress, not the hip, is the real offender.
This is one of the most searched questions about night pain, so let me answer it directly. For the great majority of people, hip pain at night means bursitis or arthritis, both of which are common and treatable. The signs that need prompt review rather than watchful waiting are night pain alongside fever, unexplained weight loss, or a past history of cancer. If any of those apply to you, do not wait. See a doctor promptly so the right checks can be done.
If hip pain is waking you regularly, that on its own is a good enough reason to get it looked at. An examination and an X-ray usually give a clear answer quickly, and both bursitis and arthritis respond much better when they are treated properly rather than endured. You can book a consultation at one of my clinics in Kent and East Sussex.