The hip bone is made up of three bones of which the largest one is the ilium. In this structure the most prominent part is the iliac crest. So, it can be said that the iliac crest is one of the most important structures of the hip bone. In layman’s terms, iliac crest can be explained as the part of the body that is present in the top of the hip and is close to the skin surface where sometimes people rest their hands on.[1,2,3]
The primary function of the hip bone is to provide support, stability, and strength to the spine. The other bones aside from the ilium that constitute the hip bone are the ischium and pubis. There are many important muscles that are connected to the iliac crest. These muscles include the gluteus maximus, the abdominal muscles, and the latissimus dorsi muscles. All these muscles are extremely important for a person to carry out activities of daily living, walking, running, and posture.[1,2,3]
A person with Iliac Crest Pain will have difficulty with any type of movement or activities like sitting, walking, and running due to pain and discomfort. The extent and severity of the pain may be variable depending on the cause. Some people with Iliac Crest Pain also may experience discomfort in areas other than the hip as a result of the Iliac Crest being connected to many other muscles and nerves as well.[1,2,3]
The pain experienced in the iliac crest may radiate down the hips and buttocks into the thighs and down the groin and legs. Some people also have muscle spasms as well. In case if an injury or trauma to the iliac crest is the cause of Iliac Crest Pain then the area will have palpable tenderness and swelling as well.[1,2,3] This article highlights some of the causes of Iliac Crest Pain and ways to manage the symptoms.
7 Causes of Iliac Crest Pain
The primary causes of Iliac Crest Pain include
- Muscle Weakness: It is vital for the core muscles to be strong as these muscles provide support to the upper half of the body and for an individual to move and ambulate freely. If these muscles are weak, then the person can experience hip or Iliac Crest Pain.[3]
- Trauma: This is one of the most common causes of Iliac Crest Pain. The injury or trauma can occur as a result of a motor vehicle accident or a direct fall on the back from a height. The injury to the iliac crest can cause swelling, inflammation, and palpable tenderness to the iliac crest region. In case of a serious injury to the iliac crest causing severe symptoms then it is medically termed as hip pointer.[3]
- Sacroiliac Joint Dysfunction: Sometimes, damage to the sacroiliac joint can also result in Iliac Crest Pain. The sacroiliac joint connects the iliac crest to the sacrum or the lower part of the spine. The primary cause of damage to the SI joint includes medical conditions like arthritis, age, or overexertion.[3] In cases of SI joint dysfunction or damage, the pain that the person will experience will be around the buttocks and low spine that can go towards the hip, groin, and thighs. Some people with SI joint dysfunction also have numbness, tingling and weakness in the legs. These symptoms may get worse with sleeping, sitting, or negotiating stairs.[3]
- Ilium Apophysitis: Apophysis is the name given to a form of growth plate and the point where bones are attached to the muscles. This the area where the rest of the bone grows meaning that it is the last part of the bone that fully hardens. Thus, this area is extremely soft and sensitive in children and adolescents.[3] As is common with children, they tend to participate in a lot of sporting activity in school and home. This may at times cause irritation and inflammation in the apophysis. This at times results in the child experiencing iliac crest pain. However, this is a self-limiting condition and once the growth plates are closed the symptoms resolve.[3]
- Iliolumbar Syndrome: This condition occurs when there is a tear of the iliolumbar ligament. The primary cause for this tear is repeated twisting and bending activities. At times, a trauma or an injury such as in a motor vehicle collision can also cause iliolumbar syndrome. Primary symptoms of this condition include frequent bouts of excruciating pain in the low back that can radiate to the hip and groin. The symptoms tend to get worse with any activity.[3]
- Piriformis Syndrome: This is yet another cause for Iliac Crest Pain. Piriformis Syndrome is caused when the muscles become too tight mainly due to inactivity and sedentary lifestyle. Natural degeneration and wear and tear also is one of the reasons for Piriformis Syndrome. This results in pressure being exerted on the sciatic nerve causing pain in the hip radiating to the buttocks and down the legs.[3]
- Gluteus Medius Pain: Any issue with the gluteus medium muscle can also cause Iliac Crest Pain. Additionally, the flexibility, mobility, and muscle and nerve function abnormality can also cause due to gluteus medius pain.[3]
Ways to Manage Iliac Crest Pain
Following the RICE protocol is the primary treatment for Iliac Crest Pain. An individual with Iliac Crest Pain will be recommended to rest and avoid any activities that may worsen the symptoms. Application of ice and heat over the affected area for 15 to 20 minutes two to three times a day is also quite beneficial for people with Iliac Crest Pain. Some people also find compression bandage to also be quite effective in managing Iliac Crest Pain.[3]
Additionally, over the counter pain medications can also be used effectively for treatment of Iliac Crest Pain. In some cases, especially in people with iliolumbar syndrome, steroid shots may also have to be given to calm down the pain and inflammation. For Iliac Crest Pain caused due to ilium apophysitis, aside from RICE anti-inflammatories are also quite useful in managing the symptoms.[3]
Physical therapy to make the core muscles strong is also one of the primary treatments for Iliac Crest Pain. There are a variety of stretching and strengthening exercises that are quite effective for managing people with Iliac Crest Pain. However, caution should be maintained and the exercises should be stopped immediately if the symptoms start to worsen.[3]
Some of the exercises that are effective for Iliac Crest Pain include hip flexor stretching, lunges, and hip extension exercises. These exercises should be repeated as much as possible as long as the person feels comfortable doing them. However, before starting an exercise regimen it is better to consult with a physician or a physical therapist who can advise better on the pros and cons of the exercise.[3]
In conclusion, Iliac Crest Pain can be quite discomforting. It interferes with daily activities and makes walking, running, bending, lifting, and negotiating quite difficult. Iliac Crest Pain can occur in both adults and children. In children and adolescents, it may occur when the growth plates around the hip gets irritated and inflamed. This happens due to overexertion and sporting activities which is quite common in children. It is a self-limiting condition and once the growth plates are closed the symptoms of pain and discomfort resolves.[1,2,3]
In adults, there are a variety of medical conditions that can cause Iliac Crest Pain. In most of the cases, muscle weakness is the primary cause of Iliac Crest Pain. However, other conditions like sacroiliac joint dysfunction, gluteus medius pain, and iliolumbar syndrome are also some of the primary cause of Iliac Crest Pain in adults.[1,2,3]
The treatment of Iliac Crest Pain is mainly following the RICE protocol and avoiding any activities that may aggravate the condition until the symptoms subside. Over the counter pain medications and at times steroids, especially in cases of iliolumbar syndrome, are beneficial to calm down the inflammation and manage the symptoms of Iliac Crest Pain. Additionally, stretching and strengthening the core muscles of the body also are quite beneficial for making the lower body and strong and manage the symptoms of Iliac Crest Pain.[1,2,3]
