If you have uneven hips, getting comfortable in bed can feel like an endurance event. You may find one side too painful to lie on, only for your lower back to ache when you roll onto the other. Even after finding a bearable position, the discomfort can return as soon as you move.
If this sounds familiar, you are not imagining the effect it can have on your rest. One study involving 2,225 older women found that hip pain while sitting or lying down was strongly linked to broken sleep. Other research found that younger and middle-aged adults with hip pain slept less and experienced more insomnia than people without it.
If you have been told that your hips are uneven, or have noticed that one hip appears higher than the other, adjusting your sleeping position may make nights more comfortable. First, though, it helps to understand what uneven hips actually mean and why one side of your pelvis may sit higher than the other.
What are uneven hips?
Uneven hips usually describes a pelvis that does not appear level when viewed from the front or back. One side of the pelvis may sit higher than the other, making the waistline, hips or legs look asymmetrical.
The pelvis is the bony structure connecting the spine to the legs. What people commonly call their hip bones are the upper edges of the pelvis. If one side sits higher, healthcare professionals may describe this as pelvic obliquity or a lateral pelvic tilt.
This is different from:
-
Anterior pelvic tilt, where the pelvis tips forward
-
Posterior pelvic tilt, where it rotates backward
-
Hip arthritis, which affects the joint itself
-
Hip dysplasia, where the hip socket does not fully cover the top of the thighbone
Bodies are not perfectly symmetrical, and a small difference does not necessarily mean anything is wrong. Uneven hips only become a concern when the difference is persistent, affects the way you stand or walk, or is accompanied by pain and other symptoms.
Why might one hip sit higher than the other?
There is no single cause of uneven hips. The difference may be functional, meaning it is related to how the muscles and joints are working, or structural, meaning it comes from the shape or length of the bones.
Possible causes include:
-
A genuine difference in leg length
-
Scoliosis or another spinal curvature
-
Weakness in the muscles that stabilize the pelvis
-
Muscle tightness or reduced movement around one hip
-
An injury that changes how you stand or walk
-
Hip or knee pain that causes you to shift your weight
-
Differences in foot position or walking pattern
-
Previous hip, leg or spinal surgery
Cleveland Clinic notes that weak hip abductor muscles can allow the pelvis to dip to one side while walking or standing on one leg. Scoliosis can also make one hip appear higher.
Because the causes differ, exercises or shoe lifts that help one person may be inappropriate for another. A physical therapist, primary care physician, physiatrist or orthopedic specialist can assess whether the apparent difference is structural or related to movement.
Can uneven hips cause pain at night?
Uneven pelvic positioning may contribute to strain in the muscles and joints around the hips and lower back. However, uneven-looking hips do not always cause pain, and nighttime hip pain can have other explanations.
Pain around the outside of the hip may be associated with greater trochanteric pain syndrome, which can involve the gluteal tendons and nearby bursa. The American Academy of Orthopaedic Surgeons notes that pain from hip bursitis is often worse at night and when lying on the affected side.
Other possible causes of nighttime hip pain include:
-
Osteoarthritis
-
Gluteal tendinopathy
-
Hip bursitis
-
Femoroacetabular impingement
-
Hip dysplasia
-
Muscle or tendon injuries
-
Pain referred from the lower back
-
Sciatica
-
Recovery from an injury or operation
Pain on the outside of the hip, deep in the groin and across the buttock or lower back may have different origins.
Uneven hips can be one cause of pain, but other hip issues can also cause pain, discomfort and restless nights.
What is the best sleeping position for uneven hips?
If you struggle to sleep because of hip pain, what you’re looking to do is reduce pressure on painful areas and limit twisting through the pelvis and lower back. The way to do this differs depending on the misalignment that’s at the root of your pain.
Sleeping on your back
Back sleeping distributes your weight more evenly across the mattress and removes direct pressure from the sides of the hips.
Try placing a pillow like the Groove adjustable 3-in-1 knee pillow beneath both knees rather than supporting only one leg. Slightly bending the knees can help some people relax their hip flexors and reduce the pull on the lower back.
The support should feel comfortable rather than forcing your legs into a sharply bent position. If raising the knees increases your pain, remove the pillow and speak to a healthcare professional.
Sleeping on your side
If only one hip hurts, avoid lying directly on the painful side where possible. Both the Mayo Clinic and AAOS recommend avoiding direct pressure on an affected hip when symptoms are aggravated by side sleeping.
Lie on the more comfortable side and place a pillow between your thighs, knees and ideally your ankles. Supporting only the knees can still allow the top foot to drop toward the mattress and rotate the upper leg.
The pillow should be thick enough to prevent the top knee from falling forward or downward. Your knees, hips and shoulders should remain comfortably stacked rather than the upper half of your body twisting toward the bed. The Groove 3-in-1 knee pillow is a popular option for people with hip pain.
Hospital for Special Surgery specifically recommends supporting both the legs and ankles for side sleepers with gluteal tendinopathy because side sleeping can compress the bottom hip and stretch the tissues around the upper one.
Using a semi-reclined position
Some people find that lying completely flat increases pain around the hip or lower back. A gently reclined position may feel more manageable, particularly during a flare-up or while recovering from certain procedures.
Use an adjustable bed or supportive wedge rather than stacking several loose pillows behind your head. If you have recently undergone hip surgery, follow your surgeon’s sleeping instructions rather than experimenting with positions.
Can pillows help with uneven hips?
A pillow cannot correct or treat the underlying cause of uneven hips. However, if you’d appreciate some help sleeping with uneven hips, a pillow can help support a more comfortable sleeping position and reduce the tendency for one leg or the torso to rotate.
Support between the legs
A regular bed pillow can work if it is firm enough to keep the legs separated without collapsing. A dedicated knee pillow is smaller and may be easier to keep in place.
The Groove Adjustable 3-in-1 Knee Pillow is one option. It has removable foam panels, allowing its thickness to be adjusted, and a strap intended to stop it from slipping away from the legs. Side sleepers can position it between the knees or thighs, while back sleepers can open it and place it beneath both knees.
Its adjustability may help people find a comfortable degree of separation between the legs.
Support for the head and neck
Your head pillow does not directly change the position of your hips, but it can affect your overall sleeping posture. If a side-sleeper pillow is too high or too low, the upper body may lean or rotate, creating additional twisting through the torso.
The Groove Adjustable Pillow contains removable memory foam panels so users can alter its height. This may be useful for side sleepers whose ideal pillow height depends on their shoulder width and mattress firmness.
It will not suit everyone. Some sleepers prefer softer fiber or down, while others find latex more responsive. The important point is that your head feels supported without being pushed toward or away from the mattress.
Does your mattress affect hip pain?
Yes. A very firm mattress can create concentrated pressure around the hip and shoulder, particularly when side sleeping. A mattress that is too soft may allow the pelvis to sink more deeply than the upper body, which can also feel uncomfortable.
There is no universally correct firmness for uneven hips. Body weight, sleep position, mattress construction and the cause of the pain will all affect what feels supportive.
Before replacing your mattress, try changing your position and pillow placement. A mattress topper may soften a bed that creates too much pressure, although it will not correct an underlying hip condition.
Should you exercise to correct uneven hips?
In some cases, exercise can help with uneven hips but not always. If one hip appears higher because of scoliosis, a structural leg-length difference or pain-related compensation, generic exercises may not address the cause.
Following an assessment, a physical therapist may recommend exercises targeting the glutes, hip abductors, core or surrounding muscles. The exact program should reflect your strength, mobility, walking pattern and diagnosis.
Exercises sometimes used in rehabilitation include:
-
Glute bridges
-
Side-lying hip abduction
-
Clamshells
-
Controlled step-downs
-
Core stability exercises
-
Hip mobility work
If you experience sharp pain, stop immediately. Always consult a medical professional before trying a new exercise routine.
The Verdict
If uneven hips and pain are disturbing your sleep, changing your position and adding support in the right places may help you feel more comfortable. Back sleepers can try placing a pillow beneath both knees, while side sleepers may benefit from supporting the upper leg to prevent it from dropping forward and twisting the pelvis.
The Groove Adjustable 3-in-1 Knee Pillow is a practical option for both positions. Its removable foam panels allow you to adjust the thickness, while the strap helps keep it between your legs if you move during the night. Back sleepers can also open it out and place it beneath both knees.
Although a knee pillow cannot correct uneven hips or treat the condition causing your pain, it may help you maintain a more supported position. If your discomfort continues, speak to a physician or physical therapist to find out what is causing it.
FAQs
Which side should I sleep on if one hip is higher?
The higher side is not automatically the side you should avoid. Sleep on whichever side is less painful and use a pillow between your thighs, knees and ankles to limit rotation. If both sides hurt, try sleeping on your back with support beneath both knees.
Can sleeping on one side make your hips permanently uneven?
There is not good evidence that simply favoring one side during sleep permanently changes a healthy adult pelvis. However, side sleeping can increase pressure on an already painful hip or aggravate certain conditions. Persistent asymmetry should be assessed rather than attributed to sleeping position alone.
Should I use a shoe lift if my hips are uneven?
Do not add a shoe lift without being assessed. An apparent leg-length difference can come from pelvic position, muscle tension or spinal alignment rather than a genuine difference in bone length. Using the wrong lift could alter your gait and increase discomfort.
References
-
American Academy of Orthopaedic Surgeons. Hip Bursitis.
-
Cleveland Clinic. Pelvic Tilt: Types, Causes and Symptoms.
-
Cleveland Clinic. Scoliosis: Symptoms and Signs.
-
Cleveland Clinic. Trendelenburg Gait.
-
Hospital for Special Surgery. What Is Gluteal Tendinopathy and Why Is It Common in Women?.
-
Parmelee, P.A. et al. (2012). Hip pain while using lower extremity joints is associated with sleep disturbances in elderly women.
-
Prather, H. et al. (2018). Anxiety and insomnia in young- and middle-aged adults with hip pain.
-
Jacobs, C.A. et al. (2020). Sleep quality and nocturnal pain in patients with femoroacetabular impingement and acetabular dysplasia.