Iliac Crest

What is Iliac Crest?

Iliac crest is situated on the top margin (superior corner) of the ileum. When you rest your hands on the hip, it is the iliac crest that support them and it is found on the upper region of the hip.

Iliac crest appears as a curved bony structure and is designed to help protect the pelvic region parts. This part of the ileum attached to fascia, muscles, and aponeurosis found nearby.

Sometimes, this curved region of pelvis can sustain injury or bruise, something that may result in pain. Iliac crest pain is a common syndrome witnessed in older individuals and athletes or runners. However, the pain may also affect any other individual depending on the cause. ¹

Anatomy and Location

The hip bone consists of a large, irregular bone structure that forms the frontal bony part and side wall of a person’s pelvis. There are three parts that make up the hip bone and they are; pubis, Ilium, and Ischium.

The largest part of hip bone is the Ilium, which is also divided into two parts; the ala (meaning wing- because of its wing-link appearance) and the other part known as the body. The iliac crest is that part, which stretches from the posterior superior iliac spine to the anterior superior iliac spine.

Iliac crest is found in the middle location between the posterior and anterior superior iliac spines. Usually, the highest or top most part of iliac crest is found at the level L4 of the vertebra. ³

Iliac crest serves as an important bone structure in the field of medicine because it has large amounts of bone marrow, and is frequently used to provide a source for stem cells and red bone marrow cells that are required to perform bone marrow transplantation procedures.

The bone marrow found in iliac crest is of similar quality to the spine bone marrow.

Iliac Crest Pain

When there is injury or bruise occurring to the Ilium and other parts of the pelvis region, it may affect the iliac crest. Iliac crest pain manifests in form of sudden, sharp pain with varying intensity.

The pain can be felt radiating along the iliac crest, although it can still extend and spread to other locations including the spine, sciatic nerve path, and the groin area.

Causes

Pain in the iliac crest may be caused by different things ranging from an inflammation, joint dysfunction, to an injury or bruising. Here are the likely causes of pain within this part of the Ilium.

Crest contusion

Also called hip pointer, it is an injury that results from having a blow directed to hit the pelvis or having a bad fall where you land with the iliac crest touching the surface first. A collision when engaging in sporting activity may also cause trauma or injury to this part of the Ilium of the pelvis.

An injury may damage the blood vessels causing bleeding to occur within the tissue surrounding the iliac crest. The injury also causes bruises where the skin turns black and blue. A person with hip pointer or crest contusion will show symptoms and signs such as:

Bruising under the skin as well as pain and swelling or tenderness that runs along the iliac bone crest area
An individual may have difficulties walking and the pain may increase when the person runs or walks around.
There may be muscle spasms being experienced by the individual.
While crest contusion isn’t a severe condition, it requires proper treatment and the pain will dissipate in a few weeks.

Iliac apophysitis

Common among runners, iliac apophysitis causes pain and inflammation that radiates along the iliac crest part. Because iliac crest provides the location for attachment of abdominal muscles, with strenuous exercises and activities, it could result in weakening of muscles and inflammation.

A person with apophysitis may have symptoms such as:
Swelling, tenderness, and pain that becomes worse when he or she attempts exercising or engaging in sports activity.
There may also be increased temperature within the area where iliac crest is found.

Dysfunction of sacroiliac joint

The area where the iliac bone and sacrum of the pelvis join together is called the sacroiliac joint. It is an essential supportive joint for the body and it allows a lot of movements.

When an individual has problems with the sacroiliac joint, they may experience symptoms such as:
Pain that runs along the crest iliac apophysitis, hip pain, and lower back pain.
The individual may also have pain and discomfort, especially when they stand for long durations or sit for an extended time.
Having a bad body posture may also contribute to pain and discomfort.
The likely causes of sacroiliac joint dysfunction are such as trauma, pregnancy, muscle tightness, different leg length, and arthritis.

Problems with the gluteal muscle

The gluteal muscle is a group of muscles that attach along the iliac bone. When there is tightness and stretching of the muscles, it can result in pain and discomfort.

The pain may be felt just below the iliac crest. When you have pain in this part, it could interfere with your ability to walk. You may have reduced range of motion and your ability to flex the hip joint may be impaired.

Iliolumbar syndrome

When there is an injury or inflammation affecting the iliolumbar ligament, it may result in iliolumbar syndrome.

This is the ligament stretching from the spine and it extends to the iliac crest. An injury to this ligament is mostly caused by twisting motion or repetitive bending. These activities tend to irritate the ligament hence causing an inflammation.

Iliolumbar syndrome manifests with symptoms such as:
Tenderness and pain occurring after long periods of sitting
Referred pain occurring in the rectal or groin area
Pain within the hip, pelvis, and along the iliac crest.

Other causes

Pain in the iliac crest may be caused by other things such as arthritis, bursitis, herniated disc, cancer, and avascular necrosis.

Diagnosis

Because pain in the iliac crest can be caused by different things, a doctor has to evaluate the patient and determine the possible cause for an effective treatment. A doctor will physically examine the location and find out about the history of the patients.

A doctor will study the patterns of the pain including its highs and lows, severity, radiating features, and activities that aggravate the pain. The doctor finds outs about any history of trauma and if a patient was involved in any mechanism of injury. The occupation status, pain alleviating and aggravating factors are also looked into.

The symptoms are studied and the doctor may order for functional tests that are relevant to the tendons, muscles, and joints. Imaging tests may be done using X-rays and MRI scans to find out if there may be fracture or injury in the iliac crest area and its severity and nature.

Treatment

Treating iliac crest pain depends on the causative factor and the severity of the injury or pain. While some cases of the pain may go away on their own with simple home remedies like resting and mild exercising, others may require use of pain management medications.

In severe cases, surgery may be performed to help stop the pain. Medical treatment options for iliac crest pain include:

Range of motion exercises (ROM) done by the individual to help in toning and relaxing the muscles. Such exercises can help in rehabilitating the injured part of the iliac crest.
Using anti-inflammatory drugs, analgesics, and aspirins helps in alleviating pain and reducing inflammation on the affected area
If the pain is being caused by strain of the tendon or muscles, tendinitis, or osteoarthritis, a patient may use OTCs such as naproxen, ibuprofen, and acetaminophen
In case of acute cases of iliac crest contusions, surgery may be performed
Muscle therapies such as use of the transcutaneous electrical nerve stimulation (TENS) or ultrasound devices help in creating electrical impulses as well as sound waves that aid in relieving the tension and pain of the muscles.
Injecting steroid to the affected area also helps relieve the pain
Sports massage may also help in alleviating pain

Home Remedies

If you have pain in iliac crest, you can manage it by observing the following:

Refrain from any activity that causes pain. If the pain is occurring due to bad posture or extended sitting, ensure that you take time to get out of the sitting positions and walk around. If strenuous activities are causing the pain, stop doing them first until you recover.
Rest your body as it helps in healing of an injury
You may use icing to help calm inflammation and relieve pain. However, you should not apply the ice directly onto the skin because it could cause ice burns. You may want to wrap it using a piece of cloth and apply for about 15 minutes, a number of times in a day.
You can stretch yourself, however, make sure that stretching does not aggravate the pain. Stretching can reduce the tension and pain in muscles. It helps reduce muscle spasms.

Reference List

Iliac Crest Pain.http://diseasespictures.com/iliac-crest-pain/
Iliac Crest Pain – Causes, Treatment and Prevention.http://helpyourback.org/health/iliac-crest-pain-causes-treatment-and-prevention/
Iliac Crest.http://healthfixit.com/iliac-crest/
Iliac Crest Syndrome.https://www.medigoo.com/articles/iliac-crest-syndrome/
Iliac Crest Pain.http://www.newhealthguide.org/Iliac-Crest-Pain.html