4 Causes of Iliac Crest Pain
Iliac crest pain questionnaire
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What is iliac crest pain?
The iliac crest is the top part of your ilium bone, the largest of the three bones that make up your pelvis. You can feel it with your thumb when you put your hands on your waist.
Common causes of iliac crest pain include overuse injuries, excessive exercising, or a trauma such as a fall. These can cause damage or inflammation to the iliac crest or surrounding joints, nerves, muscles, tendons (fiber-like tissues), and ligaments (elastic-like tissues).
The type of pain you experience may feel like a dull ache, sharp pain, spasm, or tightening. You may feel the pain in areas beyond the side of your hip, like the back, buttocks, down the leg, or in the groin.
Some conditions, such as arthritis and sciatica, can also cause iliac crest pain. Your doctor can treat your symptoms with exercise, physical therapy, and pain medication.
Living with pain is awful. Although pain is expected in life, it shouldn’t be permanent. Your physician can help—whether educating you about what you can do at home or referring you for additional testing or treatment. Do not be afraid to discuss your problems with your primary provider… that is what they are there for. —Dr. Chandra Manuelpillai
- Iliac crest pain
Iliac crest pain can occur from a trauma to your pelvic bones or joints from an injury. Injuries that cause this type of pain include a fall and direct blows to the iliac crest from a car accident or assault. In some instances, you may just have a painful bruise of the bone. But if the trauma is severe enough, your iliac crest may break.
Injury of the muscles, tendons, and ligaments in the area can also cause pain. They may become overstretched or torn by repetitive movements, such as bending or twisting. (Stretched ligaments are called sprains, while stretched muscles are referred to as strains.) You’ll often feel the pain when you change position, bend, climb stairs, or do weight-bearing activities such as walking.
In addition, pregnant women can experience iliac crest pain. Pain may occur during the pregnancy (from the stretching required to accommodate the growing fetus) or after delivery from carrying and then giving birth to the baby.
The most common treatment for injuries is the R.I.C.E. protocol (rest, ice, compression, and elevation). You can also take pain medications including acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve).
Severe injuries may require surgery
- Iliac crest pain
Both osteoarthritis and inflammatory arthritis can cause iliac crest pain. Osteoarthritis can occur as you age, as the padding between the bones (cartilage) naturally wears down. When this happens, the bones may come in contact with each other and cause pain.
Your risk of osteoarthritis increases if you’ve had an injury, or from overuse (common in athletes and manual laborers) and obesity. The pain tends to be worse in the morning and improves once you start moving. But overuse, such as during strenuous exercise or manual labor, worsens pain, so it may feel intense again at the end of the day.
Inflammatory types of arthritis, such as rheumatoid arthritis and psoriatic arthritis, can occur at any age and may develop more rapidly than osteoarthritis. Rheumatoid arthritis is known for morning stiffness and pain that may take a while to improve. Inflammatory types may cause additional symptoms, such as fatigue or rashes.
Arthritis is often treated with NSAIDs including over-the-counter drugs like Advil and Aleve, or prescription strength medications like diclofenac (Voltaren). Tylenol may be helpful too. Physical therapy and steroid injections may be needed.
- Sharp, shooting, or burning pain near the iliac crest
- Muscle spasms
- Numbness or tingling of your leg
- Weakness of your leg
The sciatic nerve originates in your lower spine. It travels through your buttocks, then down the outside of your hip, and into your leg and foot. When this nerve becomes irritated—from a herniated disc, muscle swelling, inflammation, or other mass—you may experience sharp pains. Any part of the sciatic nerve can become painful.
Sciatica can occur with or without back pain. The pain may feel worse when you stand, sit, or lie down for long periods of time, as well as when you bend, lift, and twist.
Sciatica may be treated with NSAIDs (Advil and Aleve), or prescription strength medications like diclofenac (Voltaren). Tylenol may be helpful too. Other medications include muscle relaxants, steroids (either by mouth or injections), and nerve pain medications like gabapentin (Neurontin).
The R.I.C.E. protocol (rest, ice, compression, elevation) may also help. Other helpful treatments include stretching, physical therapy, and massage.
4. Sacroiliac joint dysfunction
- Dull or sharp pain
- Muscle spasms
- Numbness, tingling, or weakening of the leg
The joint where the ilium bone meets the sacrum (the lowest part of your spine) is known as the sacroiliac joint, which connects your pelvis to the spine. When the sacroiliac joint becomes painful, it’s called sacroiliac joint dysfunction.
The pain can be caused by excessive exercising, carrying heavy weight (from pregnancy or obesity), or from different types of arthritis. You’re most likely to feel the pain when you change position, stand for a long period of time, walk, climb stairs, or bend.
Sciatica may be treated with NSAIDs (Advil and Aleve), or prescription strength medications like diclofenac (Voltaren). Tylenol or muscle relaxants may be helpful too. You may need physical therapy and trigger point or steroid injections.
Other possible causes
Other conditions that can cause iliac crest pain include:
- Vascular problems that cause lack of blood flow, either from narrowing or blockage of the blood vessels
- Piriformis syndrome, which occurs when the piriformis muscle in the buttock is inflamed or spasming
When to call the doctor
See your doctor if you’re experiencing any of these symptoms:
- Unintentional weight loss
- Extreme fatigue
- Persistent or worsening pain for longer than 1 to 2 weeks that hasn’t responded to home treatment
- Numbness or weakness that prevents you from performing simple tasks, such as walking or standing
In some cases, at-home treatments may not be adequate in relieving your symptoms. If that happens, contact your medical provider to explore different avenues of treatment. —Dr. Manuelpillai
Should I go to the ER for iliac crest pain?
Usually, your symptoms will improve with home treatment. But you should go to the ER if:
- Your pain is worsening.
- You’ve experienced significant trauma.
- You’re experiencing ongoing or worsening weakness of your legs or numbness in your pelvis, groin, or legs.
- You’re unable to control your urine and bowel movements.
- Rest after intense or strenuous physical activity to allow injuries like muscle strains or inflammation to heal.
- Apply ice or cold compresses to the painful area 3 to 4 times per day for 15 minutes at a time.
- Take over-the-counter pain medications, such as NSAIDs (Motrin, Aleve, Advil) or acetaminophen for pain relief.
Iliac crest pain stretches
Exercising regularly to maintain a healthy weight and strengthen your lower back and abdominal muscles can help prevent or lessen iliac crest pain. Stretch before exercising to help prevent injuries and to treat contracted or tightened muscles that are causing iliac crest pain. Always talk to your doctor before you begin an exercise program.
Here are some exercises that may be helpful for iliac crest pain:
This hip abduction exercise strengthens your hip muscles and your knee muscles. It is done lying on your side, with your legs slightly bent, and raising one knee.
Hip flexor stretch
This stretches your hip flexors, or the front of your hips, by tilting the pelvis forward while on one knee.
Hip extensions/glute kickbacks
This glute exercise strengthens your muscles in your butt, your core, and your back, to support your hip.
Abdominal crunches can help strengthen your core muscles to support your hips.
In order to get the best results, it is important to be consistent in resting, applying ice as directed, taking regularly scheduled over-the-counter medications, and performing regular exercise/stretching in order. The majority of patients should improve significantly over the course of 1 to 2 weeks with consistent treatment. —Dr. Manuelpillai
Other treatment options
- Physical therapy
- Using assistive devices such as a walker
- Injections of medications such as corticosteroids or local anesthetics
- Surgery if other treatments have failed