The iliac crest is the most prominent part of the ilium, the largest of the three bones that make up the bony pelvis or hip bone.

It is the curved part at the top of the hop that sits close to the skin and forms the wing-like part of the pelvis on which a person will sometimes rest their hands.

Pain in the iliac crest can also radiate to other areas of the body, including the back, abdomen, and groin. The location where it is felt depends on what is causing the pain.

What is the iliac crest?

The hip bone or bony pelvis provides strength, stability, and support for the spine and organs. It is made up of three bones, including the ilium, ischium, and pubis.

The iliac crest is the most prominent part of the ilium, the largest of the three big bones.

As well as dividing the pelvis and the abdomen, the iliac crest is connected to many important muscles. These muscles include:

  • the gluteus maximus of the hip itself
  • the main abdominals
  • the latissimus dorsi or largest muscle in the back

How does iliac crest pain feel?

Iliac crest pain tends to make normal movement difficult. The type of pain experienced can vary.

Pain may also be felt in areas other than the hip, as so many muscles and nerves are connected to the pelvis.

Exactly where the pain is felt will depend on its underlying cause, but the most common symptom is lower back pain.

The pain may spread down the leg, through the buttocks, and into the groin. In some people, it can lead to dull aches in the back or buttocks or sharp muscle spams. Others may experience pain when walking, while bending or twisting may make it worse.

Tenderness and swelling can also be signs of iliac crest problems, particularly if caused by trauma

Causes

Potential causes of iliac crest pain include trauma and sacroiliac joint dysfunction, which may be caused by jogging.

There are a number of causes of iliac crest pain. These can include:

Weak muscles

Strong core muscles are needed to support the joints and to move properly. If the abdominal muscles or lower back muscles are weak, hip pain can occur.

Trauma

The iliac crest can be damaged during a trauma, such as a fall or a car accident. This can result in tenderness and pain in the hip area, and sometimes in the lower back.

If a serious fall occurs, and the person lands on the front and upper part of the iliac crest, it is called a hip pointer.

Sacroiliac joint dysfunction

Pain in the lower back, abdomen, or groin may be caused by damage to or inflammation of the sacroiliac joint.

This joint, which is in the pelvis and connects the iliac to the lower part of the spine, can be damaged by arthritis, aging, or exercise, such as jogging.

The pain usually starts in one side of the lower back and buttocks and can reach up to the lower hip, groin, and upper thigh.

People may also feel numbness, tingling, or weakness in their leg. The symptoms may get worse when sitting, sleeping, or walking up and down stairs.

Treatment

The first step to managing most types of iliac crest pain is RICE, an acronym standing for:

  • rest
  • ice
  • compression
  • elevation

If someone experiences iliac crest pain, they should ensure they rest after activities that put a strain on their lower back or hipbone.

After resting, they should apply ice to the affected area as a compress to reduce inflammation and pain. Ice should be wrapped in a towel and applied for 15 minutes about three times per day.

If possible, wrapping the area in a compression bandage can reduce swelling, as can elevating the injured area above the heart.

Over-the-counter pain medications, such as acetaminophen and ibuprofen, may also help reduce pain and inflammation

In most cases of iliolumbar syndrome, the best remedy is resting the back. Ice and over-the-counter pain medications can be used to manage pain and swelling. Steroid injections may also be used if the pain is particularly bad.

In cases of ilium apophysitis, if RICE does not ease the pain, a doctor may recommend anti-inflammatory medication.

Some people also find that physical therapy can help with the pain and discomfort from iliac crest pain.

Exercises and stretches

A number of exercises and stretches have been shown to both treat and prevent iliac crest pain.

Hip flexor stretch

  1. Kneel on one knee with the other bent in front of you and your hands on your hips.
  2. Keeping your back straight, thrust your hips forward.
  3. Hold for up to 30 seconds before switching legs.

Hip abduction stretch

  1. Stand up straight with your hips, knees, and feet pointing forward.
  2. Lift your left leg out to the side and hold for a few seconds.
  3. Repeat on the other side.

Hip extensions

  1. Hold on to something at waist height, such as the back of a chair.
  2. Extend one leg out behind you, keeping your back straight, and hold.
  3. Repeat on both sides.
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