Pain along the prominent ridge of the hip bone, known as the iliac crest, is a common complaint often related to movement or posture. This discomfort can range from a dull ache to a sharp, localized pain, impacting daily activities like walking or sitting. Since the iliac crest serves as an attachment point for many muscles and ligaments, it is vulnerable to strain and injury.
Understanding the Iliac Crest
The iliac crest is the upper, curved border of the ilium, which is the largest of the three bones making up the pelvis. If you place your hands on your hips, you are feeling this easily palpable, bony ridge. The iliac crest stretches from the anterior superior iliac spine (ASIS) at the front to the posterior superior iliac spine (PSIS) in the back.
The structure provides stability by bearing the weight of the upper body and spine. It acts as an anchor point for numerous muscles, including the abdominal muscles, gluteal muscles, and the quadratus lumborum in the lower back. Because many powerful muscles attach here, the area is constantly subject to tension and the forces generated during movement, which can translate into pain along the crest.
Pain from Muscle Strain and Overuse
The most frequent source of iliac crest pain involves the soft tissues—muscles and ligaments—that attach directly to the bone. Muscle strains, often involving the oblique or gluteal muscles, cause localized tenderness and aching. Repetitive movements, such as twisting, bending, or improper lifting, can overstretch or tear these fibers, leading to inflammation where the tendon meets the bone.
Changes in physical activity, such as an increase in running mileage or starting a new core routine, can overwhelm the muscles and cause localized inflammation. In younger individuals, particularly adolescents involved in sports, rapid growth combined with overuse can lead to apophysitis. This condition is the irritation of the growth plate located at the crest’s attachment point.
Poor posture contributes to chronic muscle strain around the iliac crest. Standing with excessive weight shifted to one leg or prolonged slouching can strain the attachments of the quadratus lumborum muscle or the iliolumbar ligament. Furthermore, weakness in the core and lower back muscles can destabilize the pelvis, forcing attached muscles and ligaments to work harder and resulting in persistent discomfort.
Pain Related to Joints and Nerves
Beyond muscle strain, iliac crest pain can signal a deeper issue involving nearby joints or nerves. Sacroiliac (SI) joint dysfunction is a common culprit, as this joint connects the ilium (pelvis) to the sacrum (lower spine). Dysfunction, caused by either too much or too little movement, often refers pain directly along the iliac crest, lower back, or buttocks.
Symptoms of SI joint dysfunction frequently worsen with movements that stress the joint, such as standing up, climbing stairs, or standing with weight on one leg. The pain may present as a sharp, stabbing sensation or a dull ache that can radiate into the groin or down the thigh. This condition is often challenging to diagnose because its symptoms overlap with other sources of lower back pain.
Another source of localized pain is trochanteric bursitis, which involves inflammation of the fluid-filled sac (bursa) that cushions the hip bone’s outer prominence. Although the bursa is located slightly below the iliac crest, the resulting pain can spread upward, especially when lying on the affected side. This condition often causes tenderness and pain on the outer side of the hip that worsens with activities like walking or climbing stairs.
Nerve irritation or entrapment can cause sharp, burning, or shooting pain along the bony ridge. The superior cluneal nerves, which originate from the lower back, cross directly over the posterior iliac crest. Entrapment of these nerves as they pierce the surrounding fascia causes localized tenderness and radiating pain across the upper buttocks, sometimes mistaken for sciatica. This pain is often aggravated by prolonged sitting, bending, or direct pressure on the tender point.
Knowing When to Consult a Doctor
While many cases of iliac crest pain resolve with rest and self-care, certain symptoms warrant professional medical evaluation. If pain persists beyond 7 to 10 days despite avoiding aggravating activities, using ice, and taking over-the-counter anti-inflammatory medications, seek consultation. A healthcare provider can help differentiate between a simple strain and a more complex condition like SI joint dysfunction or nerve entrapment.
Immediate medical attention is necessary if you experience severe “red flag” symptoms. These include pain that is sudden and severe following trauma, inability to bear weight, or pain accompanied by fever, chills, or unexplained weight loss. Any new onset of numbness, tingling, or weakness that spreads down the leg, or a sudden loss of bowel or bladder control, requires prompt evaluation to rule out serious underlying issues.