Pain on the bony point of the hip, worst when you lie on that side at night, is one of the most commonly mislabelled complaints we see. People arrive having been told it is arthritis, or sciatica, or bursitis.
It is usually a tendon problem, and that changes what helps.
Working out what it actually is
Hip pain gets treated as one thing. It is at least four, and where it hurts is the best clue.
| Where the pain is | Likely cause | Typical giveaway |
|---|---|---|
| Bony point on the outside | Gluteal tendinopathy | Worst lying on it at night |
| Groin, deep in front | Hip joint — often osteoarthritis | Stiff turning the leg; worse putting socks on |
| Buttock, running down the leg | Referred from the back or nerve | See sciatica |
| Front of the hip on flexing | Hip flexor or joint impingement | Worse on deep squatting |
| All over, with fever or swelling | Needs medical assessment | See a doctor |
The Arthritis Foundation and the American College of Rheumatology’s patient resources both cover the joint-related causes if the pattern above points at the groin instead.
Why lying down is the worst part
This is the detail that makes the condition recognisable, and it has a mechanical explanation worth knowing because it suggests the fix.
Lying on the painful side compresses the tendon straight against the bone. But lying on the other side is often just as bad, because the top leg drops across the body and stretches the tendon over that same bony point.
A pillow between the knees keeps the top hip in line and removes the second problem entirely. It is free, and for a fair number of people it is the single most effective thing they do.
What the evidence supports
Targeted physiotherapy has the best long-term results. One study found around 60% of patients reporting symptom resolution at fifteen months, outperforming both shockwave therapy and corticosteroid injection over that period.
Steroid injection gives good short-term relief and worse long-term outcomes when used alone — a pattern that repeats across tendon problems. Combined with rehabilitation it does better.
There is no good trial evidence for acupuncture in this condition specifically. What applies is the general musculoskeletal pain literature, which makes it a reasonable adjunct rather than an evidenced treatment for the tendon itself.
How the options compare
| Option | Short term | At 12-15 months | Note |
|---|---|---|---|
| Targeted physiotherapy | Slower | Best — around 60% report resolution | The treatment; everything else supports it |
| Load and posture changes | Gradual | Substantial | Free, and prevents recurrence |
| Corticosteroid injection | Good | Worse than physiotherapy alone | Better combined with rehabilitation |
| Shockwave therapy | Moderate | Below physiotherapy | Promising, limited evidence |
| Acupuncture and massage | Symptom relief | No specific trial evidence | Adjunct while you do the loading work |
| Rest | Feels better | Worse | Tendons weaken without load |
What makes it worse
Almost all of these involve compressing the tendon against the bone, and most are habits rather than activities.
- Standing with your weight hitched onto one hip. Extremely common, and directly compressive.
- Sitting cross-legged, or with knees together and feet apart.
- Figure-four and cross-body stretches. These feel like they should help and usually make it worse.
- Hills and stairs, which load the tendons heavily.
- Sleeping without a pillow between the knees.
Why it is so often called bursitis
For decades this was labelled trochanteric bursitis, and the name persists. Current understanding is that the primary problem is usually the tendon, with bursal inflammation secondary or absent altogether.
That matters practically. If the problem is inflammation of a fluid sac, an anti-inflammatory injection is the obvious answer. If it is a degenerative tendon that has lost its capacity to take load, the answer is graded loading, and repeated injections may weaken it further.
It is the same reframing that happened with tennis elbow, and it points in the same direction: load the tendon rather than calm it down.
Where treatment fits
Needling addresses the gluteal muscles and the lateral hip, along with the low back, which is frequently involved. Hands-on work helps the surrounding muscular tension.
But we would say the same thing here as for tennis elbow: the loading programme is the treatment, and what we do is make it easier to get on with. If a practice tells you otherwise about a tendon, be sceptical.
When to see a doctor
Seek assessment for hip pain following a fall, particularly if you cannot weight-bear; for a hip that is hot, swollen or accompanied by fever; for night pain that is constant rather than positional; or for pain with unexplained weight loss.
That third one is the distinction worth holding onto. Tendon pain is positional — it hurts because of how you are lying. Pain that is there regardless of position, and wakes you from sleep on its own, is a different question.
Booking a session in Beverly
Acupuncture is $75 a session and massage is $45 for 30 minutes, $75 for 60 and $105 for 90 — all on our rates page.
Browse all our articles, see acupuncture for knee and joint pain if the pain is in the groin rather than the side, or get in touch to book an appointment.
Frequently asked questions
What causes pain on the outside of the hip?
Most often gluteal tendinopathy — irritation of the tendons attaching at the bony point of the hip — sometimes with bursitis alongside. Together these are called greater trochanteric pain syndrome. It accounts for up to a fifth of hip presentations and affects women over 40 around four times as often as men.
Is it arthritis?
Usually not. Hip osteoarthritis typically causes pain in the groin and stiffness turning the leg, not pain on the bony point of the hip. The distinction matters because the treatment is different.
Why does it hurt so much at night?
Lying on the affected side compresses the tendon directly against the bone. Lying on the other side is often just as bad, because the top leg drops across and stretches the tendon over the bone. A pillow between the knees fixes the second problem.
What helps most?
Progressive gluteal strengthening. Targeted physiotherapy outperforms both shockwave therapy and corticosteroid injection at longer follow-up, with around 60% reporting resolution at fifteen months. Everything else supports that.
Should I stretch it?
Careful with the classic figure-four and cross-body stretches — they compress the tendon against the bone and often make this worse. Strengthening is more useful than stretching here.
This article is general information, not medical advice. Acupuncture is intended to work alongside the care of your doctor, not to replace it. Please speak to a clinician about any new, severe or changing symptom.