Iliac crest pain is not that common in the general population, but it is frequent in older individuals, runners (and athletes in general), lower back pain sufferers… But that doesn`t mean “regular” people like you and me can`t experience it from time to time!
The pain is usually sudden, sharp and varies in intensity; it can be felt along the iliac crest, but it can also extend all the way to the spine, along the sciatic nerve path, through the hip and all the way to the groin area.
Pinpointing the exact cause and location of the pain is crucial, it will set you on the right track and speed up your recovery. For this reason, we decided to really go in-depth, cover the anatomy of the Iliac crest, causes of pain, diagnosis and treatment.
Iliac Crest Anatomy And Location
The Hip Bone
The hip bone is a large, irregular bone which forms the bony front and side wall of the pelvis. It consists of three parts1:
- Ischium and
Ilium is the largest part of the hip bone and it`s commonly divided into two parts – the body and the ala (Latin for a wing). We could go into great many details, exploring the ilium bone, but there is no need; all we are interested in is the part stretching between anterior superior and posterior superior iliac spine – the iliac crest. You can see these, along with some other, structures on the image below (you will notice we outlined these three structures with red):
Causes Of Iliac Crest Pain
Some of the most common causes of iliac crest pain are:
Sacroiliac Joint Dysfunction2
A sacroiliac joint is a place where the sacrum and iliac bone join together, in the forming of the pelvis. Since this is one of the most important supportive joints of our body, it does not allow a lot of movement.
Some of the main reasons for SI joint problems are:
- Muscle tightness
- Different leg length
Sacroiliac joint dysfunction usually manifests itself in the form of:
- Pain in the lower back
- Pain and discomfort when sitting or standing for longer periods of time
- Hip pain and
- Pain along the iliac crest
This is a condition which causes inflammation and pain along the iliac crest. The Iliac crest is a place where abdominal muscle attaches and regular strenuous activity can lead to temporary muscle weakness and inflammation.
Common symptoms of iliac apophysitis are:
- Pain which gets worse during exercise, sports sessions or any similar physical activity
- Tenderness and
- Increased temperature in the iliac crest area
Gluteus Muscle Problems
Since gluteal muscle group attaches in this region (along the iliac bone), tightness and aggravation in the muscle can cause pain and discomfort just below the iliac crest. Pain and discomfort in this area can interfere with walking, reduce the range of motion and limit flexibility in the hip joint.
Trauma – Hip Pointer
Hip pointer, also called iliac crest contusion, is an injury caused by a direct blow to the pelvis, a bad fall at an iliac crest, or a collision (when playing a sport). The injury damages the blood vessels, which bleed into the surrounding tissue and cause bruises (skin gets that black and blue look).
Most common symptoms of hip pointer are:
- Pain, swelling and tenderness along the iliac crest region
- Bruising under the skin
- Difficulty walking – intensifying pain when walking or running
- Muscle spasms
This is usually not a severe condition and it will go away in a couple weeks, with proper treatment.
Iliolumbar syndrome involves an inflammation or injury of the iliolumbar ligament, a ligament which stretches from the spine to the iliac crest.
It is generally caused by repetitive bending and twisting motion, which irritates this ligament and causes inflammation. Telltale signs of this syndrome are:
- Pain in the pelvis, hip and along the iliac crest area
- Referred pain in the groin and/or rectal area
- Lower back pain
- Pain after longer periods of sitting
Iliac Crest Burning Pain
The pain will usually worsen on hip flexion or when walking or running, and may even radiate to knee level.
The symptoms of this condition are usually kept under control with medication, but in some rare cases patients may require surgery to relieve the pressure and eliminate the pain.
What Can You Do For Iliac Crest Pain?
Some people will head straight to the doctor`s office at the first sign of pain while others might look for ways to treat their condition at home. There is no right or wrong here, you can try and access your general condition and decide whether you need professional help, or you want to try at-home treatment.
Here are some of the things you can do yourself:
- Stop the activity which is causing pain – this pretty much goes without saying, but there are cases where people force themselves to push through pain (like runners trying to finish a race), which is not a very good idea.
- Rest – resting will give you some time to evaluate your condition, see if the pain is becoming more intense or going away. If it does not go away on its own, call your doctor. It will also give your body time to heal itself.
- Icing – icing the affected area will calm the inflammation down, relieve pain and reduce swelling. Make sure you don`t apply ice directly onto your skin, wrap it in a piece of cloth and then apply; around 15 minutes, couple times a day.
- Stretching – approach stretching with caution, depending on the cause of pain. Gently stretch the muscles of your leg and core, and if you feel pain, stop before making it worse.
Best Iliac Crest Pain Exercises And Stretches – Iliopsoas Muscle
Iliac crest pain can also be induced by problems with the Iliopsoas muscle. Watch the video below for more information on the muscle itself, its anatomy, and some good exercise and stretching exercises aimed to release the tension and the pain:
If the pain does not go away after couple days, or it starts to intensify, you should turn to your GP for help. Common medical treatment for iliac crest pain are:
- Anti-inflammatory medication
- Injections to the affected area
- Physical therapy
- Electrical stimulation
- Range of motion exercises or
Iliac Crest Pain Prevention
Taking good care of yourself and your body might prevent iliac crest pain in the first place, sadly, most people don`t put a lot of emphasis on prevention and end up in pain. If you want to avoid this discomfort, you should:
- Make sure you are wearing appropriate footwear – feet are the foundation of our body, which is why taking care of them is a must; and good foot care starts with well-fitting shoes. You should pay extra attention to your shoes especially if are a runner or play sports on a regular basis
- Use tracks for running – of course, many of us don`t have the luxury of running on good quality running tracks, but at least make sure you find a nice, even stretch of road… You should also avoid running uphill or downhill, at least until you heal completely
- Warm-up properly – this is where most people get it wrong, they just take off and start running without warming up their muscles, joints, stretching, or getting the blood flowing. This is a huge mistake and can have severe consequences, even muscle rupture. Also, you need to cool down and stretch after you are done with physical activity
- (1912.) Gray H. The Bones Of The Lower Extremity, Anatomy Of The Human Body, Page 231.
- (August 25. 2012.) Sacroiliac Joint Pain – Aftercare, MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000610.htm
- Image retrieved from: http://biology.clc.uc.edu/courses/bio105/bone.htm
- Image:1 By BruceBlaus – Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=29987033
- Image retrieved from: (2010) Moore KL, Clinically Oriented Anatomy 7th edition, p 515