Causes of Iliac Crest Pain and Exercises to Reduce Pain and Ache

Medically Reviewed by Sanjay Ponkshe on May 13, 2023
4 min read

The Ilium is the largest of the 3 pelvic (hip) bones. It has2 parts - a large wing shaped upper part called the ala, and a smaller lower part called the body. The iliac crest is the top border of the ala. To feel your iliac crest, put your hand on your waist and press firmly. You will feel a bony surface. That is your iliac crest.

There are different causes of iliac crest pain. It can either be direct pain that is linked to the ilium bone and the structures that attach to it, or it can be referred pain. This is pain that you feel on other parts of the body than the pain’s actual source. 

Causes of Direct Iliac Crest Pain

  • Trauma or fracture to the ilium bone. The iliac crest can be damaged because of a traumatic experience such as a car accident or a bad fall, causing you to feel pain in your hip area or lower back.
  • Weak muscles. Strong core muscles help your joints move with ease. But if your abdominal muscles or lower back muscles are weak, hip pain can occur. 
  • Injury. Injury to any of the ligaments attached to the ilium, such as the sacroiliac joint ligaments or iliolumbar ligaments, can cause iliac crest pain.
  • Pregnancy and childbirth. Pelvic girdle pain can start at any time during pregnancy, labor, or following birth. This pain is experienced between the iliac crest and gluteal fold, either the front or the back, and it can feel like an ache or severe pain that interferes with your daily activities.

Causes of Referred Iliac Crest Pain

Sacroiliac joint dysfunction. If you experience pain in your groin, lower back, or abdomen, your sacroiliac joint, which connects the ilium to the lower part of the spine, might be sore or damaged.  

The pain of sacroiliac joint dysfunction may start on one side of your lower back and buttocks, radiating to the lower hip, groin and upper thighs. This might be because of aging, arthritis, or activities such as jogging.

Symptoms may include tingling sensations, weakness in your legs, or numbness that worsens while sitting, sleeping, or walking up and down stairs.

Lower back pain. This pain can spread to other areas of the body, including down your legs and through the buttocks into your groin. You may feel pain while walking or bending.

Inflammation. Tenderness and swelling along the iliac crest can also be signs of iliac crest problems caused by physical trauma.

Strenuous activities. Iliac crest pain can occur when you involve yourself in activities like running, kicking, or jumping.

  • Rest. It may be helpful to rest after a strenuous activity that puts pressure on your lower back or hip bone.
  • Icing. You can wrap ice in a towel and place it on the affected area for 15 minutes, three times a day, to help reduce inflammation and pain. 
  • Elevate and compress.  It may help to elevate the injured area above your heart or use a compression bandage to reduce the swelling.
  • Anti-inflammatory medication. If rest, ice, and compressing and elevating the injured area isn't working, your doctor may recommend anti-inflammatory medication.
  • Physical therapy. If you want to reduce the pain and discomfort of iliac crest pain, your doctor may recommend physical therapy.
  • Topical ointments and creams. Topical medication can help treat pain or other problems in specific parts of the body. These ointments or creams are usually applied to the skin or mucous membrane.
  • Exercises and stretching routine.  Pain can develop when the muscles that help support the pelvis and sacroiliac joint are poorly conditioned. Regular exercise and stretching can help strengthen the muscles that connect to the sacrum, hip bones, and pubis bones. 

Hip Flexor Stretches. Hip flexor stretches can help relax tight muscles, improve hip flexibility and stability, and reduce the future risk of injuries.

  • Kneel with the affected leg on the floor while bending the other leg in front of you, foot flat on the floor. To avoid discomfort, you can place a towel under your knee. 
  • Keep your back straight while you gently push your hips forward until you feel a stretch in the upper thigh of your back leg and hip.
  • Hold the stretch for 15 to 30 seconds.
  • Repeat 2 to 4 times.

Hip flexors on the edge of the table:

  • Lie flat on the surface of the table or a bench, with your knees and lower legs hanging off the edge of the surface.
  • Grab your good leg at the knee, pulling it back to your chest. Let your affected leg relax and hang toward the floor. Remain like this until you feel a stretch in the upper thigh of your affected leg and hip.
  • Hold the stretch for 15 to 30 seconds.
  • Repeat 2 to 4 times.

Hip Abduction Stretch:

  • Standing abduction. Stand on your non-affected leg, holding a rail or table for support if needed. With your pelvis kept level, turn the painful leg inward, pointing across the body. Keep your leg straight, lift it to the side, and hold for 5 seconds.
  • Clamshell raises. Lie on your side with your knees and hips bent. Keep your feet together while lifting your upper knee. Aim for 100 repetitions.
  • Lateral leg raises. Bend the hip and knee on your non-affected side. Raise your top leg and hold for 5 seconds. Aim for 3 sets of 10.

Take Away

To avoid or manage iliac crest pain, regularly exercise and stretch the surrounding muscles. If these treatment options don't relieve the discomfort, your doctor may recommend anti-inflammatory medication.