How To Sleep With Hip Pain
There are many different causes for hip pain that can affect you both during the day and especially at night. The majority of cases of hip pain at night occur as a result of lying directly on the painful soft tissue structures to the side or back of the hip. Alternatively, when lying on the opposite side, these same soft tissue structures may be placed in a stretched position, causing hip pain when lying down. This is often referred to by physiotherapists as ‘lying on your hips’ – something we should all avoid doing if possible!
When lying on one’s side, the pelvis will tilt forward slightly, which places pressure on the sciatic nerve (which runs from the lower back through the buttock and down each leg) between the greater and lesser trochanters. If this movement continues too long, it will cause irritation and inflammation of the sciatic nerve. When lying on one’s back, the sacrum (the bone at the base of the spine) tilts backwards, putting pressure on the L4-L5 discs and also irritating the sciatic nerve.
Other factors that contribute to hip pain include tight muscles, muscle imbalance, poor core stability and low back flexibility. Tight hip flexors, hamstrings and gluteus maximus muscles limit range of motion in the hip joint itself, making it much more difficult to move around comfortably. Muscle imbalances in the torso, such as weak abdominal muscles, can lead to increased lordosis in the lumbar region of the spine, resulting in an increase in pelvic incidence when standing upright. Pelvic incidence refers to how straight the pelvis is while standing; higher values indicate less natural alignment. A high value may put extra stress on the intervertebral disks and joints, leading to degeneration over time. Low back flexibility reduces spinal mobility, allowing excessive backward curvature of the lumbar spine. Increased lordosis of the lumbar spine results in compression of the cauda equine nerves that exit the upper back through the neck, creating neurological symptoms including pins and needles sensations, numbness, tingling or weakness.
Painful conditions of the hip include osteoarthritis, rheumatoid arthritis, bursitis, trauma, infection, tumours, fracture/dislocation and inflammatory bowel disease. In addition to sciatica, some common problems include:
sciatic neuralgia
piriformis syndrome
impingement of the femoral head onto the acetabular rim
snapping scapula syndrome
postural deformities
If your hip pain is severe enough, you should see your doctor immediately, even if you have been experiencing discomfort for only a short period of time. Your doctor will perform tests to assess whether there has been damage to any surrounding tissues, such as ligaments, tendons or cartilage. They will then discuss treatment options with you, depending upon the severity of your condition. Treatment methods include rest, ice packs, physical therapy, medication and injections. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celebrex, are used to reduce swelling and relieve pain. Acetaminophen, such as Tylenol® and FeverAll™, is another option to treat mild to moderate pain. Ibuprofen should not be taken within two hours before or after taking oral anticoagulants, such as warfarin, aspirin, clopidogrel, Coumadin®, Plavix® and Pradaxa®, due to potential interaction. Patients who take blood thinners must use caution when using NSAIDS. Always consult your physician first before starting any new medications or supplements.
Hip exercises may help ease pain, but they do nothing to improve underlying structural issues. For example, strengthening the hip abductor muscles helps correct abnormal movements, but does little else to address the problem. Exercises that target specific areas of the hip are key to improving functional strength and reducing overall pain. These exercises will strengthen the core stabilising muscles of the hip and ensure that no part of the body is left unsupported. There are several important core muscles that support the pelvis, lower back and legs that need to be strengthened. Exercises that focus on the following areas are particularly effective:
pelvic floor muscles (puboccocygeus)
transverse abdominis
multifidi
external rotators
internal rotators
erector spinae
obliques
rectus abdominus
Strengthening these muscles improves core stability and prevents further injury. Improving core stability requires proper breathing technique. It is important to exhale fully and keep the chest open when performing abdominal exercises. Breathing improperly leads to shallow breaths and hyperventilation, which increases carbon dioxide levels in the bloodstream and can constrict the arteries. Hyperventilation causes the heart rate to rise, increasing the work cycle and thus strain on the cardiovascular system. Shallow breathing affects posture because the diaphragm goes up into the ribcage instead of staying below it, so the chest closes off the lungs and makes them smaller. This restricts oxygen flow and therefore slows metabolism.
Proper sleep is essential for good health. Lack of sleep can disrupt hormonal regulation and immune function, impair judgement and cause mood changes. Many people experience difficulty sleeping well, particularly those suffering from chronic pain, depression or anxiety. Treatments such as acupuncture, massage therapy, meditation, yoga and biofeedback have helped patients deal with their pain and sleep better. Biofeedback training involves learning about the relationship between bodily functions and emotional states. By becoming aware of what is happening inside your own body, you become empowered to make healthier choices.
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