Iliac crest pain: causes, treatments, and exercises

Every time you bend down to pick up something off the floor, twist to look behind you, or stand upright, you engage the muscles around your iliac crest, or the bony tip of your pelvis. “Many muscles and ligaments connect to this area, so it plays a key role in a lot of everyday movements,” says Melia Lewis, PT, DPT, a Hinge Health physical therapist.

Iliac crest pain can sometimes make it hard or painful to move around. But, as is the case with many musculoskeletal issues, iliac crest pain often improves with conservative treatments, such as targeted exercises and stretches.

In this article, learn more about what causes iliac crest pain, along with how to treat it — especially with exercises recommended by our Hinge Health physical therapists. 

What is the iliac crest?

The iliac crest refers to the top edge of your ilium, the largest bone in your pelvis. To find it on your own body, stand up and place your hands on your waist with your fingers pointing forward. Press in gently on both sides of your body — you should feel a hard, curved ridge just beneath the skin. This is your iliac crest. 

This area is closely connected to many important soft tissues, including those in your lower back, hips, and abdomen. “When any of these muscles or ligaments become irritated or tense, you might experience discomfort or notice it’s harder to move with ease in this part of your body,” says Dr. Lewis.

Causes of iliac crest pain

Iliac crest pain is common, given its location around so many important muscles. Pain can stem from: 

• Muscle strains. A strain happens when your muscle stretches beyond what it’s ready for. It can happen instantly, when you’re playing sports or doing chores at home, or occur ‌over time from repetitive movements. Strains that occur in the hip flexors, low back, and abdominal muscles can cause pain in the iliac crest area. 

• IT band syndrome. The iliotibial (IT) band is a thick band of connective tissue that runs along the outside of your leg from your iliac crest down to your shin. Sometimes, overuse or muscle weakness can contribute to tension in this area, which may lead to discomfort or soreness around the iliac crest, Dr. Lewis says.

• A hard workout. An intense abdominal or back workout can sometimes leave you feeling sore around your iliac crest. “This doesn’t mean you did anything wrong — it might just mean your muscles weren’t fully prepared for that session,” says Dr. Lewis. If you have iliac crest pain after working out, take it as a sign to ease into your next session. Do a longer warm-up or less-intense exercises

• Osteoarthritis. Osteoarthritis (OA) commonly affects your lower back and hips, particularly as people age. OA (the most common type of arthritis) occurs when the protective cartilage that cushions the ends of bones changes over time. It contributes to joint stiffness, and when it’s severe, it can lead to pain. “When these joints feel irritated, it’s common for nearby muscles to become tense or guarded, which can contribute to iliac crest discomfort,” says Dr. Lewis.

• Injuries. A direct impact to the iliac crest, such as during a fall or a sports collision, can lead to soreness or irritation in the nearby muscles and ligaments. You might also notice some bruising or tenderness in the area as your body recovers.

Symptoms of Iliac crest pain 

Symptoms of iliac crest pain can vary depending on what’s contributing to it. One of the most common signs is a general ache or pain around the hip. “People often point to the area right on their hips, where your hands rest on your waist, and say it feels sore there,” says Dr. Lewis. Other possible symptoms of iliac crest pain include:

• A sharp pain or dull ache at the top of the pelvis

• Radiating pain that moves to the low back, buttock, or abdominal muscles to the top of the pelvis

• Stiffness or reduced range of motion in the hip area

• Difficulty getting out of bed, bending over to pick something, twisting and reaching behind you, or going up and down stairs

All of these exercises can help stretch and strengthen the soft tissues around your iliac crest. 

Stretching can help ease tight muscles and improve mobility in your abdomen and trunk, while strengthening moves can help prepare your muscles for the demands of everyday activities. “Anytime you have pain, it’s important to focus on mobility and strength exercises, so your muscles can comfortably move their full range of motion,” says Dr. Lewis. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for iliac crest pain

At-home treatment options can go a long way in alleviating and preventing iliac crest pain: 

• Try physical therapy and targeted exercises. Targeted exercises can help strengthen and stretch the muscles around your iliac crest, reducing pain and making everyday movements more comfortable. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active, but pivot to gentle movement. Any type of gentle movement, like walking, or doing a yoga or tai chi practice, can help your body recover from pain symptoms. “Movement helps increase blood flow, which brings in oxygen and increases the rate of healing,” says Dr. Lewis. Gentle movement also signals to your brain that it’s okay to move through a bit of pain, helping to relieve muscle stiffness and tension.

• Apply ice or heat: Ice can help ease inflammation and swelling in the muscles around your iliac crest. If you have muscle stiffness, a heating pad or hot compress can help warm muscles, easing tension and supporting healing. Try both or stick to the one that feels best for you. 

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can perform your targeted exercises and stay active when you have pain near your iliac crest. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle electrical impulses to interact with your nervous system and help reduce pain associated with the iliac crest area. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

• Complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for iliac crest pain relief, such as massage, acupuncture, or chiropractic care.

PT tip: Change up your sitting positions 

There’s no single right way to sit, but staying in the same position for long periods of time can lead to tense muscles and discomfort. That’s why it helps to vary your sitting throughout the day. If you’re experiencing iliac crest pain, try to notice how often you cross your legs and consider switching it up. “Crossing your legs isn’t inherently bad, but holding that position for a long time can contribute to lower back or hip tension,” says Dr. Lewis. Try crossing your legs at the ankles instead of the knees so it’s more gentle on your back and helps your pelvis stay balanced.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Paoloni, J. (2021, October 1). Approach to the adult with unspecified hip pain. UptoDate. https://www.uptodate.com/contents/approach-to-the-adult-with-unspecified-hip-pain

2. Uusi-Rasi, K., Patil, R., Karinkanta, S., Tokola, K., Kannus, P., & Sievänen, H. (2017). Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial. Journal of Osteoporosis, 2017, 1–7. doi: 10.1155/2017/3905492

3. Torres, D., Hanney, W. J., Velazquez, L., Pabian, P. S., & Pilkington, C. (2021). The Effect of Mobilization With Movement and Passive Stretching on Hip Range of Motion:

4. A Randomized Controlled Trial. Orthopaedic Practice, 33(3), 150-154.

5. Alaia, M. J. (2020, July). Hip Strains. Ortho Info—American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/hip-strains/