Hip Pain in the Morning: Why It Hurts When You Wake Up

Waking up with hip pain or stiffness can make getting out of bed, putting on your shoes or taking your first few steps uncomfortable.

Sometimes the discomfort eases after moving around, while in other cases it continues throughout the day or returns every morning.

Morning hip pain can be associated with sleeping position, hip osteoarthritis, gluteal tendinopathy, muscle irritation, inflammatory arthritis or referred pain from the lower back.

The location of the pain, how long the stiffness lasts and how symptoms respond to movement can help guide an assessment.

From a physiotherapy perspective, the aim is to identify what is limiting comfortable movement, address contributing factors and restore strength and activity tolerance.

However, persistent morning stiffness or worsening pain should not automatically be attributed to ageing or an uncomfortable sleeping position.

Why Does Your Hip Hurt After Sleeping?

Your hip remains relatively still for several hours while you sleep.

If the joint or surrounding tissues are sensitive, prolonged inactivity or sustained pressure may make movement uncomfortable when you first get up.

Several factors can contribute to morning hip pain:

• Joint stiffness: Hip osteoarthritis and other joint conditions can cause discomfort after prolonged rest.
• Pressure during sleep: Lying directly on a painful outer hip can aggravate sensitive tendons and surrounding tissues.
• Muscle or tendon irritation: A recent increase in walking, exercise or stair climbing may leave tissues sensitive.
• Inflammatory conditions: Some joint disorders cause stiffness that is particularly noticeable in the morning.
• Referred pain: Problems involving the lower back may produce discomfort around the hip or buttock.

The pattern of symptoms matters.

Brief stiffness that eases with gentle movement may have a different explanation from prolonged stiffness affecting several joints.

Morning hip pain is a symptom rather than a diagnosis.

A clinical assessment may be needed to distinguish between possible causes.

Common Causes of Hip Pain in the Morning

1. Hip Osteoarthritis

Hip osteoarthritis involves changes in the joint that can affect cartilage, underlying bone and other joint tissues.

It can lead to pain, stiffness and difficulty moving the hip comfortably.

Common symptoms include:

• Stiffness when getting out of bed.
• A deep ache in the groin or front of the hip.
• Discomfort when putting on socks or shoes.
• Difficulty taking the first few steps after resting.
• Reduced hip movement or pain when turning in bed.

Morning stiffness may ease after several minutes of movement, although discomfort can return after prolonged walking or other demanding activities.

Hip osteoarthritis becomes more common with age, but age alone cannot confirm the diagnosis.

Other conditions can produce similar symptoms.

Physiotherapy can help through progressive strengthening, mobility exercises, walking advice and activity modification.

A systematic review and cumulative meta-analysis found that exercise therapy can improve pain and physical function in people with hip osteoarthritis, although individual results vary. (Teirlinck et al., 2023)

2. Greater Trochanteric Pain Syndrome and Gluteal Tendinopathy

If your pain is mainly on the outside of your hip, particularly after sleeping on that side, the gluteal tendons may be involved.

Greater trochanteric pain syndrome (GTPS) describes pain around the outer hip.

It commonly involves gluteal tendinopathy, although other nearby tissues may also contribute.

You may notice:

• Pain when lying on the affected side.
• Tenderness over the bony prominence on the outer hip.
• Discomfort when climbing stairs or walking uphill.
• Pain when standing on one leg.
• Soreness after activities that repeatedly load the hip.

Sleeping directly on the painful side can compress sensitive tissues and make the area uncomfortable when you wake up.

Physiotherapy usually focuses on managing tendon load, reducing aggravating positions and gradually rebuilding hip strength.

Aggressive stretching is not always appropriate because certain positions may increase compression around the gluteal tendons.

A randomized clinical trial found that education about tendon load management combined with exercise improved outcomes in people with persistent gluteal tendinopathy compared with a wait-and-see approach. (Mellor et al., 2018)

3. Sleeping Position and Prolonged Pressure

Morning discomfort may sometimes be aggravated by your sleeping position, particularly if the pain is mild and settles soon after you change position or move around.

Side-sleeping can place pressure on the outer hip.

Keeping the upper leg pulled forward or maintaining an uncomfortable hip position may also aggravate existing sensitivity.

However, sleeping position should not automatically be blamed for persistent pain.

It may be aggravating an underlying joint or tendon problem rather than causing it in the first place.

You can experiment with the following adjustments:

• Sleep on your back with a pillow under your knees if comfortable.
• If sleeping on your side, try lying on the unaffected side with a pillow between your knees.
• Avoid putting direct pressure on a painful outer hip.
• Choose a position that feels comfortable instead of forcing your hips into a particular alignment.

If the pain repeatedly wakes you, becomes more severe or persists despite changing positions, arrange an assessment.

4. Hip Flexor or Muscle Irritation

The hip flexors help lift your thigh and support activities such as walking, climbing stairs and getting into a car.

Irritation around these muscles or tendons can cause discomfort at the front of the hip or in the groin.

Morning symptoms may appear after unfamiliar exercise, prolonged sitting or repeated movements involving the hip.

You might notice discomfort when lifting your knee, extending your leg behind you or getting out of bed.

A muscle-related problem becomes more plausible when symptoms follow a clear increase in activity, but pain location alone cannot confirm the cause.

Management may involve temporarily reducing aggravating activities, restoring comfortable movement and gradually rebuilding strength.

Persistent groin pain should be assessed because joint-related and other conditions can produce similar symptoms.

5. Inflammatory Arthritis

Inflammatory conditions, including rheumatoid arthritis and axial spondylarthritis, can cause stiffness after periods of rest.

Hip symptoms may occur alongside discomfort in other joints or the back.

Features worth discussing with a healthcare professional include:

• Morning stiffness lasting around 30 minutes or longer.
• Recurrent pain or stiffness affecting several joints.
• Joint swelling or tenderness.
• Back or buttock pain that improves with movement rather than rest.
• Unusual fatigue or other symptoms suggesting a broader inflammatory condition.

These features do not establish a diagnosis.

Morning stiffness is not specific to inflammatory arthritis, and its duration alone cannot reliably distinguish one condition from another.

However, repeated prolonged stiffness deserves medical assessment.

A clinician can determine whether further investigation or referral to a rheumatology specialist is appropriate.

Physiotherapy may support mobility, strength and everyday function once the condition and appropriate medical management have been established.

6. Referred Pain From the Lower Back

Pain felt around the hip does not always originate in the hip joint.

The lumbar spine and nearby nerves can refer discomfort into the buttock, outer hip or thigh.

You may notice morning hip pain alongside lower-back stiffness after sleeping in one position for several hours.

Other clues include:

• Pain that changes when bending or straightening the back.
• Discomfort spreading down the thigh or leg.
• Tingling, numbness or burning sensations.
• Symptoms that vary with posture rather than hip movement alone.

A physiotherapist can assess both the hip and lower back to determine which structures may be contributing to the symptoms.

Treatment may involve improving comfortable spinal movement, gradually increasing activity and addressing relevant strength or movement limitations.

New or progressive leg weakness, significant numbness or changes in bladder or bowel control require urgent medical evaluation. (Chamberlain et al., 2021)

7. Overuse and Delayed-Onset Muscle Soreness

If you recently increased your walking distance, started a new workout or spent more time climbing stairs, the muscles around your hip may feel sore the following morning.

Delayed-onset muscle soreness typically develops after unfamiliar or demanding exercise.

It can cause tenderness, stiffness and discomfort when moving the affected muscles.

This soreness usually improves over several days.

Sharp pain, significant swelling, difficulty bearing weight or symptoms that continue to worsen should not be assumed to be ordinary muscle soreness.

When a serious injury has been excluded, recovery may involve temporarily reducing exercise intensity, maintaining comfortable movement and returning to activity gradually.

Why Does Hip Pain Improve After Walking?

If your hip feels stiff when you first get out of bed but becomes more comfortable after several minutes of walking, stiffness after rest or reduced movement tolerance may be contributing.

Gentle movement allows you to transition from rest to activity and assess how comfortably the hip moves under everyday loads.

However, improvement after walking does not automatically mean the problem is harmless.

Osteoarthritis and some inflammatory conditions can both cause symptoms that change with movement.

Pay attention to the overall pattern:

• Stiffness that settles quickly: Can occur with several musculoskeletal conditions and does not identify a specific diagnosis.
• Stiffness lasting 30 minutes or longer: Warrants medical assessment when recurrent, particularly if accompanied by other symptoms.
• Pain that increases while walking: May indicate that the hip is struggling to tolerate the activity or that another problem is present.
• Pain that persists at rest or progressively worsens: Should not be managed with exercises alone without appropriate assessment.

The NHS advises seeking medical advice if hip stiffness lasts more than 30 minutes after waking, if pain repeatedly returns or worsens, or if it affects sleep or normal activities. (NHS)

Where Do You Feel the Pain?

The location of your pain can help guide an assessment, although several conditions can produce similar symptoms.

Pain location	Possible causes	Other clues
Groin or front of the hip	Hip osteoarthritis, joint-related problems or hip flexor irritation	Pain with hip movement or putting on shoes
Outer hip	GTPS or gluteal tendinopathy	Pain when lying on the affected side
Buttock or back of the hip	Lower-back referral or gluteal problems	Symptoms may change with spinal movement
Hip and thigh	Hip joint problems, soft-tissue irritation or nerve-related pain	Radiating pain, stiffness or altered sensation
Several joints with prolonged stiffness	Possible inflammatory joint condition	Swelling, fatigue or symptoms elsewhere

Use these patterns as clues rather than a self-diagnosis.

A healthcare professional can interpret them alongside your medical history and examination findings.

How Physiotherapy Can Help Morning Hip Pain

Physiotherapy aims to identify what contributes to your symptoms and help you regain comfortable movement.

The treatment plan should reflect the underlying problem rather than rely on the same exercises for everyone.

1. Assess Hip Movement and Muscle Function

A physiotherapist may examine hip range of motion, muscle strength, walking pattern and your ability to perform everyday activities.

The assessment may include standing from a chair, climbing a step or lifting the knee.

The lower back and relevant neurological function may also be assessed if your symptoms suggest referred pain.

This helps guide exercise selection and determine whether further medical evaluation is needed before rehabilitation begins.

Evidence-based physiotherapy guidance for hip pain emphasizes assessing mobility, strength, movement coordination and functional limitations, then selecting interventions according to the findings. (Enseki et al., 2023)

2. Begin With Gentle Morning Movement

If the symptoms are mild, movement is safe and no warning signs are present, a short period of gentle activity may help you feel more comfortable before starting your day.

Options may include:

• Ankle pumps: Move your feet up and down while lying in bed before standing.
• Gentle heel slides: Slowly slide one heel towards your body and then straighten the leg within a comfortable range.
• Easy walking: Walk a short distance around your home if you can bear weight comfortably.

These movements are examples of gentle mobility, not a universal treatment for hip pain.

Stop if they cause sharp pain or significantly worsen your symptoms.

3. Progress to Strengthening Exercises

If an assessment identifies weakness or reduced load tolerance, a physiotherapist may introduce exercises such as controlled sit-to-stand movements, supported hip strengthening or functional balance training.

For hip osteoarthritis, strengthening may improve everyday function.

For gluteal tendinopathy, exercises should improve load tolerance without repeatedly aggravating the affected tendons.

Exercise selection, resistance and progression should reflect your symptoms and functional ability.

Avoid starting a demanding strengthening program before severe or unexplained pain has been assessed.

4. Modify Daily Activities

Your physiotherapist may recommend changing how you manage prolonged sitting, walking, stair climbing or exercise.

The goal is to reduce repeated aggravation while maintaining comfortable activity.

Complete inactivity is not usually necessary for routine musculoskeletal problems, although some injuries require specific restrictions.

As symptoms improve, activity can be increased gradually according to how well you tolerate it.

What Can You Do at Home?

If your pain is mild and there are no warning signs, the following steps may help manage morning discomfort.

• Adjust your sleeping position: Avoid direct pressure on a painful outer hip.
• Move gently before standing: Try comfortable ankle movements or heel slides if they do not aggravate symptoms.
• Start the day gradually: Allow a few minutes for comfortable movement before strenuous activity.
• Avoid sudden increases in exercise: Increase walking distance and exercise intensity progressively.
• Take breaks from prolonged sitting: Brief movement breaks may help if stiffness also develops during the day.
• Track your symptoms: Record where the pain occurs, how long stiffness lasts and whether movement improves it.
• Seek assessment if symptoms persist: Recurrent pain affecting sleep, walking or everyday activities warrants professional advice.

Do not force stretches or push through worsening pain in an attempt to loosen the hip.

The appropriate treatment depends on the underlying cause.

When Should You See a Healthcare Professional?

Arrange a medical assessment if your hip pain keeps returning, interferes with sleep or daily activities, worsens over time or does not improve after about two weeks of appropriate self-care.

Seek assessment sooner if morning stiffness repeatedly lasts 30 minutes or longer, particularly if you also have symptoms in other joints or your back.

Seek urgent medical care if you experience:

• Sudden, severe hip pain without an obvious explanation.
• A hot or swollen hip, especially with fever or feeling seriously unwell.
• Severe pain after a fall or injury.
• Inability to walk or put weight on the affected leg.
• New or progressive leg weakness or significant neurological symptoms.

Severe pain after an injury or inability to bear weight may indicate a fracture.

A hot, swollen joint accompanied by fever can indicate a joint infection, which requires urgent treatment.

A Lesser-Known Fact About Morning Hip Pain

The duration of morning stiffness is useful information, but it cannot diagnose the cause by itself.

For example, brief stiffness after rest may occur with osteoarthritis or other musculoskeletal problems.

Prolonged stiffness affecting several joints may raise suspicion of an inflammatory condition.

However, there is overlap between these patterns.

The location of pain, severity, associated symptoms and response to movement all matter.

Keeping a short symptom diary can help you explain the pattern to your physiotherapist or doctor.

Record how long the stiffness lasts, whether it improves with movement and whether anything else makes it worse.

Conclusion

Hip pain when you wake up in the morning can result from sleeping position, hip osteoarthritis, gluteal tendinopathy, muscle irritation, inflammatory arthritis or referred pain from the lower back.

The duration of stiffness, pain location and response to movement provide useful clues, but they cannot establish the cause on their own.

Gentle movement, comfortable sleeping positions and an individualised physiotherapy programme may help when the problem is musculoskeletal.

Persistent, prolonged or worsening morning stiffness should be assessed rather than repeatedly treated with stretches or exercises without a diagnosis.

The best approach is to identify the underlying cause, manage aggravating factors and restore movement and strength safely.

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