Side hip pain at night is often a tendon you are squeezing
In a trial of 204 people, 77 in 100 felt better after eight weeks of habit lessons and exercise. Here are the habits, starting with a pillow.
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Live well At about three in the morning last March, Carol rolled onto her right side and woke up with a sharp ache on the outside of her hip. She did not think much of it. A turn onto her back, and she was asleep again. But it came back the next night, and the next. By April she could only sleep on her left side. She woke each time she drifted over. The stairs up to our bedroom made it ache too. She was sure it was arthritis in the hip joint. So was I. The hip joint sits deep in the groin, not on the side. Pain you can put one finger on, right over the bony knob on the outside of your hip, is often something else… and it has its own fix. That knob has a name. It is the greater trochanter, the top outer corner of the thigh bone. Two of your buttock muscles end in tendons that wrap over it. A tendon is the tough cord that ties a muscle to a bone. When those tendons get worn and sore, doctors call it gluteal tendinopathy. You may also hear the old name, trochanteric bursitis.
Why the night is the hard part Here is the odd thing about these tendons. Use does not bother them much. Squeezing does. Picture a rope laid over the edge of a table. Pull it straight along the edge. It slides. Push it sideways into the edge and it pinches. The tendon on your hip works the same way. When your top leg drops across your body, the tendon is pressed into the bone. And it stays pressed for as long as you lie there. Now think about how you sleep on your side. Your top knee falls forward and down onto the bed. That pulls the top hip across. Lie on the sore side and you add your own weight on top of the knob. Either way, you can spend six hours squeezing a sore tendon. In other words, the ache at three in the morning may be set up by how you lay down at eleven. What the best trial found The best test of this idea is a trial from Australia, called LEAP. It came out in the BMJ, a top British medical journal, in 2018. It took 204 people aged 35 to 70 with this kind of hip pain. Most of them, 167, were women. That fits. Cleveland Clinic says women over 40 get it more, most of all after menopause. The people were split into three groups by chance. One group had 14 visits over eight weeks with a physical therapist. Each visit paired exercise with lessons on how not to squeeze the tendon. A second group got one cortisone shot… that is, a steroid the doctor injects to calm the swelling. The third group was told to wait and see. At eight weeks, 77 in 100 people in the lessons group said they were better. With the shot, it was 58 in 100. For those who waited, it was 29. At a year, the lessons group was still at 79 in 100. The shot group sat at 58, and the wait group had climbed to 52. Bear in mind what this trial cannot tell you. The habit lessons came bundled with the exercise. So no one can say how much of the gain came from the pillow and how much from the leg work. Also, by a year, pain scores were about the same for the lessons group and the shot group. The lessons group just said more often that they felt better overall. It is one good trial. Not ten. The habits, one by one The advice below comes from the LEAP lessons, from Cleveland Clinic, and from healthdirect, the health advice site of the Australian government. They all say much the same thing. It costs nothing. I can't see how any of it could hurt you.
Carol's first night with a pillow was clumsy. It slid out by two in the morning, and she found it on the floor at dawn. So she tried a long one, the kind sold as a body pillow, and hugged it with her knees. That one stayed put. The hard habit for her was the leg crossing. She has crossed her right leg over her left since grade school. I caught her at it four times in one evening of the news. Now she keeps both feet flat on the floor… and when she forgets, I cough. By the way, stairs and hills load these tendons too. Cleveland Clinic lists both as things that set the pain off. You do not need to stop. Just take them a bit slower for a while. Walk on flat ground when you can. How it went for Carol Her hip took about two months to settle. I can't tell you it was the pillow. It may have been time. It may have been the side leg raise from Monday, which she now does while the kettle boils. I have no idea which. But she sleeps through most nights now… and some nights on her right side again. If you have this kind of pain, start tonight with the pillow. Give the habits two weeks… that is long enough to tell. If the ache does not ease, or it gets worse, see your doctor or a physical therapist. They can check that it is the tendon and not the joint. And they can set you up with the right exercise, which was half of the LEAP plan. A pillow between the knees is not a cure. But it stops you from doing the harm for six hours a night. That is a good place to start.
Here is to a full night on your good side, The Health Brief is for education only. It is not medical advice. Always check with your own doctor about your own situation. |