How to sleep on your side without hip pain

Side sleeping hip pain usually comes from the top knee dropping toward the mattress, which twists the pelvis and loads the outside of the hip. Keeping your knees stacked with a pillow between them, and letting the lower hip sink slightly into the mattress, often helps. The NHS advises seeing a GP if hip pain affects your sleep².

Why your hip hurts on your side

Two hips, two different problems. The lower hip carries weight, so a mattress that is too firm presses on the bony point at the outside of the hip. The top hip has the opposite problem: nothing holds it up, so the leg falls forward and down, twisting the pelvis and stretching the tissues at the outside of the hip.

The NHS lists several causes of hip pain in adults, including bursitis, a common cause of pain at the outside of the hip that can be worse when lying on that side². Positioning will not fix every cause. It does remove one common source of strain that repeats for 7 or 8 hours every night.

Step 1: stack your knees

Lie on your side with both knees bent about 30 to 45 degrees, one directly on top of the other. Then put a pillow between them. The Sleep Foundation says a small pillow between the knees may take additional strain off the lower back¹, and the same alignment keeps the top hip from rolling forward.

The pillow should hold the top knee at the same height as the top hip. If your knee still slopes down, the pillow is too thin. If the knee is pushed up higher than the hip, it is too thick.

Our guide to sleeping with a pillow between your knees compares a rolled towel, a small knee pillow and a body pillow.

Step 2: support the whole top leg

A small cushion between the knees supports the knee but leaves the ankle hanging. That lets the shin rotate inward, which can still twist the hip slightly. A longer pillow that runs from the knee down toward the ankle supports the whole leg.

This is also where small knee pillows tend to fail. They slip out when you shift, and the knee drops again at 3 a.m. A body pillow that runs from your chest down to your knees is harder to lose.

Step 3: check your mattress

The lower hip needs to sink a little. On a very firm mattress the hip and shoulder take all the pressure. On a mattress that sags in the middle, the pelvis drops lower than the shoulders, which bends the spine sideways.

• Lie on your side and slide a flat hand under your waist. A small gap is normal.
• If you cannot fit your hand at all, the mattress may be sagging or too soft.
• If the gap is large and your hip feels pressed, the mattress may be too firm.

A topper can add give to a firm mattress. Nothing fixes a sag except a new mattress or a firmer base.

Step 4: take care of the other side

If one hip is sore, lie on the other side where you can, with a pillow between the knees so the sore top hip is supported. If you keep rolling onto the sore side during the night, a pillow behind your back makes that roll harder.

If both hips hurt, alternate sides through the night and use support between the knees on both. Our complete guide to sleeping on your side shows the full setup, including head and arm support.

Setups compared

What to do during the day

What you do in the day can affect how the hip feels at night. Long periods sitting in one position, or standing with your weight on one leg, load the same tissues you lie on at night. The NHS hip pain page lists the self-care steps it suggests trying for 2 weeks before seeing a GP².

For general back and hip stiffness, the NHS suggests a heat pack wrapped in a tea towel can relieve stiffness or muscle spasms⁴. Do not sleep with a hot water bottle against your skin.

When to see a GP

The NHS suggests seeing a GP if hip pain is stopping you from doing normal activities or affecting your sleep, if the pain is getting worse or keeps coming back, if it has not improved after treating it at home for 2 weeks, or if you have hip stiffness for more than 30 minutes after waking up². Severe pain, pain after a fall or injury, or pain with a fever needs urgent care rather than a new pillow.

A physiotherapist can also look at how you move and suggest exercises. Bring a note of which side you sleep on and what you have tried.

Choosing one pillow for the job

If you keep losing a knee pillow, a crescent body pillow solves the slipping problem. The Cove Classic is 52 inches tip to tip, which suits most adults from about 5 ft to 6 ft 4 in, so one end sits between the knees while the curve supports your chest and arm. The shredded memory foam fill adjusts through an inner zip if the knee end feels too thick or too thin.

It comes with a 100 night trial, which is about the time it takes to know whether a change in setup is working for you. See what size body pillow you need if you are shorter or taller.

A one week plan

1. Nights 1 to 3: knees stacked, pillow between them, lying on the side that hurts least. 2. Nights 4 to 5: lengthen the support so it reaches the ankle. 3. Nights 6 to 7: add a pillow behind your back if you are still rolling. 4. Day 8: note what changed. If nothing has, or the pain is worse, book a GP appointment.

Changing one thing at a time tells you what actually helps. Side sleeping is a good position for many people³, and most hip pain from position responds to small changes.

Keep reading

• Why your shoulder hurts when you sleep on your side
• Side sleeping and lower back pain