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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. Pain can occur due to wear, tear, trauma, and exercise.

The iliac crest is the curved part at the top of the hip. It forms the wing-like part of the pelvis on which a person will sometimes rest their hands.

Muscles, ligaments, and fascia (a thin casing of connective tissue) attach to the iliac crest, and pain is caused when these are pulled or strained. The pain can also radiate to other body areas, including the back, abdomen, and groin.

This article explores the causes of iliac crest pain, what it feels like, treatments, and exercises that may help to prevent and relieve pain.

A female doing lunge exercises that can help with hip pain.Share on Pinterest
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The hip bone or bony pelvis provides strength, stability, and support for the spine and organs. It comprises 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.

In addition to dividing the pelvis and the abdomen, the iliac crest connects to many important muscles. These muscles include:

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

Weak muscles

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

Learn more about exercises to strengthen the core muscles here.

Trauma

Trauma can damage the iliac crest, such as a fall or car accident. This can result in muscle pulling away from the bone, causing tenderness and pain in the hip area and sometimes in the lower back.

This type of injury may be called a hip pointer, as a person will point with one finger to the location of the pain (in this case the hip).

Sacroiliac joint dysfunction

Damage or inflammation of the sacroiliac joint can cause pain in the lower back, abdomen, or groin.

This joint sits in the pelvis and connects the iliac to the lower part of the spine. Arthritis, aging, or exercise, such as jogging, can all damage the sacroiliac joint.

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 legs. The symptoms may worsen when sitting, sleeping, or walking up and downstairs.

Ilium apophysitis

An apophysis is a growth plate and the point on a bone where muscles are attached. It is the area of bone that the rest of the bone grows from, and so is the last area of bone to fully harden. As such, it is relatively soft in children and teenagers.

If the muscles are repeatedly pulled from the growth plate, during sports, for example, this can cause it to become irritated and inflamed, or it may even be pulled off the bone. The condition will resolve itself once growth has finished and the bone has fully hardened.

Ilium apophysitis occurs in children and adolescents. Overuse causes the condition and results in a dull pain in the front of the hip. The area can sometimes swell and is usually tender, and the pain tends to worsen with activity.

Iliolumbar syndrome

Iliac crest pain syndrome, also known as iliolumbar syndrome, occurs when the iliolumbar ligament tears. This can happen if it undergoes repeated twisting or bending motions and actions.

It can also result from repetitive microtrauma at a person’s work, acute strain, and poor posture.

Common symptoms of iliolumbar syndrome include persistent bouts of severe pain in the lower back that can spread to the hip and groin. This pain may get worse when a person bends or twists.

Gluteus medius pain

A problem with the gluteus medius muscle, a muscle lying between the gluteus maximus and gluteus minimus, can lead to pain near the iliac crest.

This can mean reduced blood flow, flexibility, range of motion, and less nerve and muscle function.

Bone cancer

In rare cases, bone cancer causes iliac crest pain.

However, in most cases of iliac crest pain, the cause will be one of the other conditions listed above.

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

Pain can also be felt in other body areas, as many muscles and nerves are connected to the pelvis. The location of the pain depends on its underlying cause, but the most common symptom is lower back pain.

The pain may spread down the leg, through the buttocks, and groin. It can lead to dull aches in the back or buttocks or sharp muscle spasms in some people.

Others may experience pain when walking, while bending or twisting may make it worse.

Tenderness and swelling can also indicate iliac crest problems, particularly if caused by trauma.

A person with iliac crest pain will be asked to provide their medical history. If the pain is a result of injury, then details of how the trauma occurred must be specified.

A healthcare professional will then examine the hip area for signs of bruising, swelling, tenderness, and pain.

If a fracture is suspected, then an X-ray may be performed. A CT scan or MRI may be recommended if a person has continued pain or if the pain is severe.

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.

A person can use a cold compress instead of ice. Cold compresses are available for purchase online.

Wrapping the area in a compression bandage and elevating the injured area above the heart can also reduce swelling. Compression bandages are available online.

Pain medications available over-the-counter or online, 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 (OTC) pain medications can be used to manage pain and swelling. A healthcare professional may recommend steroid injections may if the pain is particularly bad.

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

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

An orthopedic surgeon may be consulted on rare occasions where a fracture occurs or the pain is continuous and severe.

Although some causes of iliac crest pain cannot be avoided, such as during pregnancy, there are some things a person can do to try and prevent hip pain.

The UK’s National Health Service (NHS) advises people to try the following:

  • Maintaining a moderate weight: Keeping a healthy weight will help reduce pressure on the hips.
  • Wearing good shoes: Wearing comfortable, shock-absorbing shoes with a soft sole.
  • Avoiding strain: Trying to avoid putting too much strain on the hip, it’s always good to keep moving but a person should avoid overdoing it.
  • Exercising: Trying gentle hip stretching exercises.

Some risk factors for iliac crest pain include:

  • running
  • sitting for long periods
  • aging
  • arthritis

Several exercises and stretches may help to 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.

People trying these stretches and exercises should only do them as many times as they feel comfortable. Trying to do more than is comfortable can lead to further injury.

Talk with your doctor before starting a new exercise regime.

Wearing good-quality shoes while exercising and increasing muscle strength can help prevent iliac crest pain.

Exercises may also help, including lunges, hip extensions, hip flexor exercises, and hip abductions. These exercises all strengthen the muscles in the iliac crest area.

Most causes of iliac crest pain are treatable by following the RICE procedure and taking over-the-counter pain medications.

If iliac crest pain does not go away with these home treatments, a person should speak to a doctor about other ways to manage the pain.