Iliac Crest Pain: Causes, Treatments, & More

The Iliac crest - sounds like a national geographic-esque place with beautiful sunset views over a rocky cliff. In reality, the iliac crest lies along the upper margin of the pelvic bone. The iliac crest can fall victim to different conditions such as muscular strains or ligamentous injuries that can affect the lumbar and hip areas. 

If you are experiencing any aches or pains around the hip area (where your waistband typically sits) - it might be iliac crest pain. This questionable pain may emerge after doing an intense workout or anything hip mobility-related. Let's face it, it could be from anything - from running to improper squats or even leg raises. 

Where is the Iliac Crest?

The iliac crest makes up the prominent part of the ilium, the biggest of the three bones making up the hip bone. Indeed, it is curved at the upper part, hence the name crest. 

Pain in this area can also reach other body parts such as the back, groin, or abdomen. 

The importance of the iliac crest is attributed to the fact that it provides stability, strength, and support to the organs and spine. [2] 

Iliac Crest Pain Syndrome

Iliac crest pain syndrome (ICPS) is “defined by typical local tenderness over the medial part of the iliac crest” and can be found in a majority of individuals who exhibit chronic low back pain (LBP). [1] 

Symptoms of ICPS include:

• Localized pain
• Pain when moving:
• lumbar spine 
• leg raising
• heel-fall test [1]
• Pain that extends down the leg
• lower back pain 
• Pain when walking, twisting, or bending [2]

While ICPS isn’t technically a medical term, it’s used to describe the symptoms noted above - if you have discomfort in the iliac crest, you have ICPS. This is used as a generalized term - as the exact location of pain can vary. The most common associated symptom is lower back pain.

Iliac Crest Pain Muscles

The main muscles connected to the iliac crest include:

• Gluteus maximus 
• Quadratus Lumborum
• Main abdominal muscles
• Latissimus dorsi [2] 

Some Common Causes for Iliac Crest Pain

Without getting into too much detail, let’s briefly go over some common causes of iliac crest pain.

• Muscle strains: Overexertion and lack of recovery are no joke here!
• Ligament sprains 
• Hip bursitis
• Sciatica
• Herniated discs
• Osteoarthritis
• Pelvic inflammatory disease

Iliac Crest Pain Treatment

Of course, prolonged discomfort is a sign for you to go see your doctor. Since iliac crest pain can result from many things, diagnostic tests such as ultrasound and MRI are often used to get more definitive data. 

Oftentimes, diagnosing ICPS itself would require musculoskeletal ultrasound because most people start experiencing their discomfort as nonspecific lower back pain which eventually travels to the hip area. [4]

Depending on the underlying cause, some of the following interventions might help you with your pain.

• Rest and recovery
• Activity modification
• Ice or heat therapy
• Pain meds: over-the-counter pain relievers (such as acetaminophen or NSAIDs may help with temporary relief)
• Chiropractor visit
• Deep tissue massage

Iliac Crest Pain When Running

 

Some runners may complain of (top side) hip soreness after a run. Maybe after your attempts to fix it with new shoes, persistent icing and stretching, and modified runs/distances the stubborn pain just won’t go away. 

The hip flexor muscles, iliotibial band (IT band - AKA tensor fascia latae or TFL in this upper area), and other abdominal and back muscles attach to the iliac crest. Pain on the sides can be due to the tensor fascia latae and therefore strengthening your core and hips should help. Any lack of strength here can cause abnormal movements and undue stress. 

Speaking of the IT band, if there is tightness or inflammation present it can also be Iliotibial Band Syndrome (ITBS - yes another syndrome!). Check out our article focused on the IT Band pain in hip. There is useful information about where to do deep tissue massage with the QL Claw to relieve your IT hip band pain.

For even more information regarding the two main muscles used when running (gluteus medius and TFL), check out our page about hip pain after running.

Iliac Crest Pain When Lying On Your Side

You may experience more hip pain when lying or sleeping on your side due to several reasons.

Some examples include (but are not limited to)

• Pressure points
• Muscle strain
• Hip bursitis

Some interventions you can try include

• Adjusting your position to relieve pressure from the hip area
• Sleeping on your back is probably your best bet. Try it with a pillow under the knees for added support and less stress on hip flexors. 
• Evaluate mattress and pillow quality
• You may need a higher level of firmness and added contour for body alignment.

 

Iliac Crest Pain and the Quadratus Lumborum

You may be wondering at this point, what do the quadratus lumborum (QL) muscle and the iliac crest have in common? Well, the QL has some pretty gnarly trigger point patterns that can affect areas in the lower back, along the tailbone, the glutes, and yes - your hips. 

Anatomically speaking, the QL has a solid attachment to the iliac crest, so long story short, if you have knots or tension in the QL, it may manifest as hip pain. 

It has been expressed in several articles at Back Muscle Solutions that trigger points are often overlooked (especially in the medical field) as sources of ongoing pain. So if you have the curiosity and the time, do yourself a favor and read on Quadratus Lumborum Trigger Points and QL Pain!

Iliac Crest Pain: Key Takeaways

Hopefully, this post has shed some light on what may have brought on your hip pain and how to fix it! Any muscle strain or overexertion can be an easy culprit to detect but trigger points or other underlying causes can be trickier to diagnose. If you’re able to find true relief, remember to incorporate actions into your wellness routine that stretch and strengthen muscles. 

It is indeed possible to prevent unnecessary pain if you are able to simultaneously keep your muscles strong and release any trigger points! Whether you’re also doing physical therapy, resting more, or doing other medical interventions, remember that addressing iliac crest pain is truly an individualized approach. Here’s to you, restoring your functional mobility! 

Now that you've read about iliac crest pain, check out our pages on anterior pelvic tilt exercises, hip hinge exercises and 3 Tests to Tell You If Your Back Pain is Caused By SI!

 

Sources:

[1] Collee, G., Dikkmans, B., Vandenbroucke, J., Cats, A. Iliac crest pain syndrome in low back pain: frequency and features. Journal of Rheumatology, 1991. 

[2] About iliac crest pain (pelvic pain). Southern California Hip Institute. www.socalhip.com/about-iliac-crest-pain-pelvic-pain

[3] Ask the coaches: hip ache - iliac crest pain. runnersworld.com, 2007.  

[4] Todorov, P., Nestorova, R., Kalcheva, M., Batalov, A. Lower back pain due to enthesopathy of erector spine muscle: a comparative ultrasound and MRI study in patients with iliac crest pain syndrome. European Medical Journal, 2018.