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Iliac Crest Pain: Symptoms, Causes, Treatments, and Prevention

Iliac Crest Pain: Symptoms, Causes, Treatments, and Prevention
Iliac Crest Pain: Symptoms, Causes, Treatments, and Prevention | Source

What Is Iliac Crest Pain?

Among the general population, iliac crest pain is not very common, but it is common in people with lower back pain, older individuals, and athletes (especially runners). However, this does not mean that a "regular" person cannot suffer from this condition.

The pain varies in intensity, and it is usually sharp and sudden. While sufferers feel it along the iliac crest, the pain can also extend through the hip, along the sciatic nerve path, to the groin area, and the spine. To help ensure suitable recovery, the condition needs to be addressed as soon as the pain develops. It is crucial to determine the exact location and cause of the pain. This will direct the patient to the right treatment path and help speed recovery.

Anatomy and Location of Iliac Crest

The hip bone (coxal bone or pelvic bone) is an irregular, large flat bone, which forms the bony side and front wall of the pelvis. In humans, it consists of three bones: the ischium, pubis, and ilium.

The ilium is the largest and the uppermost part of the hip bone. It is divided into two parts—the ala (wing of the ilium) and the body. The iliac crest is the part of the ilium that stretches between the posterior superior and anterior superior iliac spine.

Many different muscles of the thigh and trunk are connected to the iliac crest. The sartorius and tensor fasciae latae muscles of the thigh begin at the anterior superior iliac spine. The transverse abdominis muscle and the external and internal oblique muscles of the abdomen originate from the tendons next to the anterior border of the iliac crest. The gluteus maximus muscle (found at the buttock) originates from the posterior superior iliac spine, while one of the starting points of the latissimus dorsi muscle is the posterior border of the iliac crest.

In the entire human body, the iliac crest is considered as one of the essential skeletal landmarks. It represents a substantial part of the separating line between the pelvis and the abdomen, and it is clinically used to locate the L4 vertebra to apply lumbar punctures. It is palpated easily from the exterior of the body, which makes it an easily recognizable marker. Because of the huge amount of red bone marrow and bone tissue found in the ilium and the proximity of the iliac crest to the surface of the body, it is used in bone marrow transplants and bone grafting procedures.

The following table contains some of the common causes, symptoms, and treatment options of iliac crest pain, which will be further explained afterward.

Causes, Symptoms, and Treatment Options

Causes
Symptoms
Treatment
Sacroiliac Joint Dysfunction
Pain in the lower back and/or hip; leg pain
Ice, heat, and rest; medications; chiropractic manipulations; braces/supports; exercise/physical therapy; sacroiliac joint injections; sacroiliac joint fusion
Ilium Apophysitis
Dull ache or throbbing and possible mild swelling of the front of the hip
Rest; ice or cold therapy; medications; massage
Trauma - hip pointer injury
Pain, tenderness, and swelling on the iliac crest area; difficulty in walking or running; bruising under the skin; muscle spasms
Rest; cold therapy; medications
Iliolumbar Syndrome
Severe lower back pain, especially after prolonged standing or sitting; pain in the groin or hip area
Medications; surgery; Prolotherapy
Iliotibial Band Syndrome
Pain/inflammation in the knee joint; reduced knee range of motion
Medications; massage; stretching; physical therapy; therapeutic ultrasound techniques
Piriformis Syndrome
Pain at the back of the thigh, foot, and calf; decreased hip joint range of motion; dull pain in the buttock; intense pain after prolonged sitting; pain when walking up inclines or stairs
Stretching exercises; physical therapy; deep massage; ice massage; heat therapy; medications; injection; electrotherapy;
Gluteus Medius Pain
Reduced range of motion, reduced flexibility, and increase of pressure in the gluteus medius area
Rest; ice; gentle stretch; medications; physical therapy

Consult Your Doctor

Always consult your physician to diagnose your symptoms and treat the condition.

1. Sacroiliac Joint Dysfunction

In the forming of the pelvis, the sacroiliac joint is where the iliac crest and sacrum join together. It is located beside the bottom of the spine, above the tailbone and below the lumbar spine. This joint does not allow too much movement, as it is one of the most significant supportive joints in the body. Sacroiliac joint dysfunction is believed to trigger iliac crest, leg and/or lower back pain. The leg pain could be intensely difficult and feel like sciatica (pain caused by lumbar herniated disk.

The sacroiliac joint normally has these features:

  • Small and really strong, strengthened by tough ligaments surrounding it.
  • Serves as a shock-absorber.
  • Transmits all the energy of the upper body to the hips (pelvis) and legs.

It is not clear what causes sacroiliac joint dysfunction, but it is believed that a change in the regular joint motion could be what causes the pain. The following are the possible sources of pain:

  • Too little movement (fixation or hypomobility). The pain is usually felt on the buttocks or either side of the lower back, and could spread out down the leg. While the pain typically stays above the knees, it can sometimes reach the ankle or foot.
  • Too much movement (instability or hypermobility). The pain is usually felt in the hip and/or lower back and could spread out into the groin area.
  • Arthritis
  • Difference in leg length
  • Muscle tightness
  • Trauma
  • Pregnancy

This condition typically manifests itself through:

  • Pain along the iliac crest
  • Pain in the lower back
  • Hip pain
  • Discomfort and pain when standing or sitting for prolonged periods

In general, sacroiliac joint dysfunction is more common in middle-aged and young women.

Background
The sacroiliac joint was thought to be one of the causes of iliac crest pain, leg pain and/or lower back pain, but it is difficult to prove it using standard diagnostic tests, which left many medical experts skeptical.

Moreover, in the past two decades or so, medical experts have been focusing more on disogenic pain (degenerative disc disease, herniated disk) as a common cause of leg pain and/or lower back pain. As a matter of fact, until now, medical professionals are still having difficulty in diagnosing sacroiliac joint dysfunction. However, anesthetic injection blocks that are applied to the sacroiliac joint are considered as the benchmark.

Diagnosis
It may be difficult to accurately diagnose sacroiliac joint dysfunction because the symptoms are the same as other conditions, including lumbar spine conditions (such as radiculopathy and disc herniation) and mechanical back pain conditions (such as facet syndrome).

Medical experts usually arrive at a diagnosis by eliminating other causes through physical examination and/or injection (used to prevent the pain).

Physical Examination
During physical examination, by means of movement of the joint, the doctor will try to find out if the sacroiliac joint is what causes the pain. If it reproduces the pain and there is no other possible cause of pain that could explain it, then the sacroiliac joint could be the cause of pain.

Doctors can also use some orthopaedic provocative tests to try to recreate the symptoms related to sacroiliac joint dysfunction. In general, a number of positive tests that recreates the pain located specifically at the sacroiliac joint increase the possibility of accurately diagnosing sacroiliac joint dysfunction.

Physical examinations may include:

  1. The patient would lie on their back on the edge of the examination table and the leg of the afflicted side would hang down on the side of the table on a stool or towards the floor, so that the sacroiliac joint would rest on the edge on the examination table.
  2. The patient can draw their opposite knee to their chest to even more isolate the sacroiliac joint on the hanging leg. This position does not have support for the hip joint, so the patient's pain may be reproduced by pressing the upper thigh or the iliac crest.
  3. There is a need to directly find the location of the pain along the sacroiliac joint because other pelvis and lumbar spine structures are also stressed.

Injections to Identify the Source of Iliac Crest Pain Caused by Sacroiliac Joint Dysfunction

Sometimes referred to as sacroiliac joint block, a sacroiliac joint infection could be a helpful diagnostic test. Only a highly experienced physician can administer the injection into the exact part of the sacroiliac joint. For this reason, the physician typically uses X-ray as a guide to ensure that they perform the procedure properly. They sometimes use a test called arthrogram, in which a contrast material (dye, air, water, or a combination of these) is injected to better visualize the joint.

The physician uses a fluoroscopic guidance or live X-ray in this test and injects a numbing solution called lidocaine into the sacroiliac joint. If it eases the pain, then it can be concluded that the source of the pain is the sacroiliac joint. At the same time, a steroid solution is typically injected to reduce inflammation and pain in the sacroiliac joint.

Treatment Options
Usually, the treatment options for sacroiliac joint dysfunction are nonsurgical and mainly focus on attempting to bring back the normal motion in the joint.

  • Rest, ice, and heat - doctors will initially recommend using ice or cold packs, which will be applied as needed with intervals of 15-20 minutes to reduce inflammation and irritation in the area. Depending on how long the patient experiences severe pain, application of ice can continue between 2 days and 2 weeks. It may be advisable to go back to regular activities when the inflammation has subsided. Applying heat (like a hot bath or heat wrap) may contribute to the treatment, but not when the pain is too intense.
  • Medications - these are the first line of treatment, which often includes pain and anti-inflammatory medications. These help lessen the inflammation that mostly causes the pain.
  • Chiropractic manipulations - an osteopathic doctor, chiropractor, or other trained health professional could help in manual manipulation. This could be quite effective when the sacroiliac joint is "stuck" or fixated, and it could be aggravating if the sacroiliac joint is hypermobile. This procedure is done using several methods, including instrument-guided methods, drop technique, side-posture manipulation, and blocking techniques. The health expert will use a method that they think is the most suitable for a certain case.
  • Braces or support - when the sacroiliac joint is too loose or hypermobile, the patient can use a brace or "orthotic" that is approximately the size of a wide belt, which they will wrap around the waist and pull tightly to stabilize the area. This can be really helpful when the joint is swollen and aching. They can stop using it when the inflammation, or leg/lower back/iliac crest pain has subsided.
  • Exercise and physical therapy - gradual, limited physical therapy could help properly increase the range of motion and strengthen the muscles along the sacroiliac joint. Additionally, any kind of low-impact, gentle aerobic exercise can help increase blood flow to the area and will initiate a healing response. Water therapy could be a good option for intense pain because the water reduces pressure on the afflicted joint and offers flexibility for the body.
  • Sacroiliac joint injections - the main purpose of sacroiliac joint injections is to find out if the sacroiliac joint is what causes the pain, but it also helps to immediately relieve the pain. An anesthetic, together with an anti-inflammatory medication (like corticosteroid), is typically injected to help lessen inflammation in the joint and ease the pain. Because of this pain relief, the patient can start a physical therapy program and go back to regular levels of physical activities.
  • Sacroiliac joint fusion - surgery could be a potential treatment option for high intensity pain that is not relieved even after several weeks or months of any or a combination of the aforementioned treatments. This surgery involves small titanium implants that the doctor will insert in a slightly invasive process along the sacroiliac joint. It is meant to create a strong construction to stabilize the sacroiliac joint.

2. Iliac Apophysitis

Iliac apophysitis is a condition that causes pain and inflammation along the iliac crest. Abdominal muscles attach to the iliac crest and frequent rigorous activities can result in inflammation and temporary muscle weakness. This injury usually occurs in adolescents, children, and adults who have stopped growing and participate in sporting activities.

Symptoms

  • Increased temperature along the iliac crest area
  • Tenderness in a certain area at the front of the hip
  • Mild inflammation
  • Iliac crest pain or pain above the hip (at the front of the pelvis) that gets worse during sports sessions, exercise, or other similar activities

Causes
Bone growth happens in an area of the bone called epiphyseal or growth plate. This is the last part of the bone to completely become hard from cartilage, so it is still rather soft in adolescents and children. People who have really tight hip muscles could suffer from iliac apophysitis. When muscles are repetitively pulled on the growth plate, it can lead to inflammation and irritation of the area. Iliac apophysitis most frequently hits at either anterior superior iliac spine (ASIS) or anterior inferior iliac spine (AIIS) at the front of the hip.

Treatment Options

  • Rest from strenuous physical activities until tenderness and pain subside.
  • Apply cold therapy products or ice to relieve inflammation and pain.
  • A health expert may prescribe an anti-inflammatory medication.
  • Sports massage therapy can help relax extremely tight muscles like the hip flexors.
  • Stretching exercises for the hip muscles may be allowed when the patient does not feel any pain during daily activities.
  • Patient can gradually return to sports and other activities when the pain is gone.
  • A full warm-up is essential and the patient has to stop when there is pain.
  • The condition will get better by itself when the bone is completely matured and growth is finished.

3. Trauma - Iliac Crest Contusion or Hip Pointer Injury

Iliac crest contusion or hip pointer injury may be inflicted by a collision, a bad fall impacting the iliac crest, or a direct hit to the pelvis or hip bone. This injury causes damage to the blood vessels, which may bleed into nearby tissue and cause skin discoloration (bruise). Iliac crest contusion may also cause intense pain.

This injury is quite common when playing full contact sports (American football, rugby) because these have high chances of forceful impacts that can lead to bruising in the iliac crest. Some other cases may involve an avulsion fracture wherein a tiny portion of a bone is torn away by the connected muscle. Inadequate padding from fat storages and lack of protection makes the area particularly at risk when it is impacted by a direct blow.

When the area that surrounds the hip (front and side of the hip, gluteus minimus gluteus medius, and the abdominals) begins to bleed, in would lead to swelling, which becomes even more painful during hip movement.

Symptoms

  • Iliac crest and hip pain (or pain in the surrounding area) - patient feels pain while performing activities
  • Difficulty in walking - patient feels severe pain when walking or running
  • Tenderness and swelling in the iliac crest region
  • Reduced range of motion
  • Muscle spasms
  • Bruising under the skin

Diagnosis
To diagnose iliac crest contusion, the medical professional performs a medical history and in-depth physical and subjective evaluation. An X-ray is usually required to rule out the fractures and check the severity of the injury.

Treatment Options

  • Rest
  • Cold therapy - relieves the pain
  • Anti-inflammatory medications - Aspirin, Naproxen, Ibuprofen, and Celebrex can help ease the pain
  • Corticosteroid injections - the medication is directly injected into the hip for severe cases of iliac crest pain
  • Avoiding activities that could worsen the symptoms
  • Sports massage - helps reduce inflammation, loosen up the muscle fibers, and prevent formation of scar tissue
  • Hip pointer exercises - exercise can speed up recovery from the injury and can also help prevent muscle weakness. The recommended exercises include non-weight bearing graded exercises done in the pool and graded exercises, such as standing hip pointer stretch, kneeling hip pointer stretch, and wall hip pointer stretch.

Recovery
Iliac crest contusion or hip pointer injury is not a career-ending condition. While the injury could take a few days to several weeks to heal, the patient typically experiences complete recovery.

Sacroiliac Joint Dysfunction, Iliac Apophysitis, Trauma - Iliac Crest Contusion, Iliolumbar Syndrome, Iliotibial Band Syndrome, Piriformis Syndrome, Gluteus Medius Pain
Sacroiliac Joint Dysfunction, Iliac Apophysitis, Trauma - Iliac Crest Contusion, Iliolumbar Syndrome, Iliotibial Band Syndrome, Piriformis Syndrome, Gluteus Medius Pain | Source

4. Iliolumbar Syndrome

Iliolumbar syndrome involves a tear or inflammation of the iliolumbar ligament, a ligament that stretches from the iliac crest (back of the pelvis) to the spine. It can result to pain in the pelvis, hip, back, groin, and even the rectal, vaginal, and testicular areas. This condition can be extremely painful because these ligaments connect the lower lumbar spine to the hip bones.

The entire lumbar area of the body is vulnerable to injury and pain, and the function of the iliolumbar ligaments is to provide support, stabilize it, and allow the body to move the lumbar vertebrae.

Causes
A person can acquire this condition either by repeated twisting and bending, such as by playing sports like volleyball and golf. Trauma caused by an accident may also lead to iliolumbar syndrome.

Symptoms

  • Severe lower back pain - recurrent attacks of pain in the area of "multifidus triangle," which includes the iliolumbar ligaments, erector spinae muscles, quadratus lumborum, facet joints, and the lumbar fascia.
  • Painful attacks caused by physical activities involving twisting and bending of the lumbar spine.
  • Pain after prolonged standing or sitting or upon getting out of bed in the morning.
  • Pain in the groin or hip area.
  • Tenderness in the area involved.

Diagnosis
To diagnose the condition, Patrick's test or FABER is typically done. It is a physical test to assess pathology of the hip joint. A person may have iliolumbar syndrome if this test is painful. When palpation is done, there is tenderness along the medial aspect or posterior of the iliac crest. Other sources of pain in the surrounding areas (hip pain, sacroiliac joint pain, iliac crest pain, etc.) will also be considered. A combination of medical history, physical tests, and imaging can result in accurate diagnosis.

Treatment Options

  • Rest - treatment for mild cases.
  • Cold therapy - reduces swelling and pain.
  • Deep tissue sports massage - mobilizes the soft tissue within the area, specifically the hip and buttock muscles.
  • Medications - painkillers to relieve pain.
  • Stretching exercises - techniques that target the hips and buttocks. A physical therapist can recommend a program when the patient no longer feels pain. This is crucial in boosting support and strength for the lumbar spine to avoid similar injuries. This also helps maintain smooth movement along the affected areas.
  • Combination of local anesthetic and corticosteroid - injection along the posterior iliac crest to relieve inflammation and pain in chronic cases.
  • Prolotherapy (proliferation therapy) - this is a regenerative medical treatment that offers the most beneficial results when treating severe pain caused by iliolumbar syndrome. It involves injecting an irritant solution into the iliolumbar ligaments to relive pain. This is an effective treatment because it targets the source. Moreover, Prolotherapy also stimulates strengthening of the tissue.
  • Other regenerative medical techniques - platelet rich plasma and stem cell therapies also offer effective relief from iliolumbar syndrome. These treatments can improve the body's capability to heal itself. They promote rapid tissue regeneration and speed the recovery by isolating certain cells from other parts of the body and injecting these cells into the affected area.

5. Iliotibial Band Syndrome

Iliotibial band syndrome is an injury caused by the overuse of the connective tissues found on the outer or lateral part of the knee and thigh. Sufferers feel tenderness and pain in these areas, particularly just above the knee joint, as well as the hip area. Lateral knee pain in bicyclists and runners is most commonly caused by iliotibial band syndrome.

The iliotial band starts at the iliac crest, runs through the lateral area of the thigh, and then goes across the knees to connect into the top area of the shinbone or tibia. Through the range of motion of the iliotial band, it helps in stabilizing the outer part of the knee. It is also responsible for keeping the pelvis stabilized, so it may be aggravated when there is an imbalance between legs.

When the knee is bent, the iliotial band can be found at the back of the femoral epicondyle, which is a bony extension of the thighbone or femur at the knee joint; when the knee is extended, the iliotial band moves forward through the condyle. A bursa or sac allows it to smoothly glide through the condyle, but if there is inflammation within the area, the increased friction from frequently rubbing the band through the bony condyle could cause pain, particularly in the lateral or outer part of the knee joint.

Ignoring the symptoms can continue the inflammation and scarring may develop in the bursa, which decreases the range of motion of the knee causing reduced activity and increasing pain within the area, including iliac crest pain.

Causes
This condition could be the results of a number of issues, including poor muscle flexibility, poor training habits, and other mechanical imbalances, particularly those that involve the knees, hip, lower back, and pelvis.

Sufferers may be predisposed to develop the syndrome. Anatomy issues that may cause the condition include discrepancies in the lengths of the legs, bowed legs, and an irregular tilt to the pelvis. These issues could make the iliotibial band extremely tight, which results in increased friction when it goes back and forth through the femoral epicondyle while in motion.

Mistakes in training could cause runners to experience symptoms of iliotibial band syndrome. Roads are somewhat tilted and the center of the road is higher than the outer edges so that water can flow. When a runner runs on the same side all the time, the body may have the same impact as being afflicted with a leg-length discrepancy. This is because one leg is downhill all the time compared to the other, making the pelvis tilt in order to adjust to the activity. Another cause of inflammation of the iliotibial band is running too many slopes. Running downhill can put even more stress on the iliotibial band because it works to keep the knee stable.

Bicyclists can also suffer from iliotibial band syndrome if they "toe in" and have an incorrect posture when they pedal. This is probably because of the way the toe clips are lined up, which forces the foot to be "toed in" or rotated internally. Having bowed legs have similar effect, which increases the angle of the iliotibial band as it goes across the knees and increases the chances of inflammation.

Activities that have more intense knee flexion can also cause iliotibial band syndrome, especially with too much squatting, including weightlifting and rowing.

Symptoms
The most common symptom of this condition is pain on the outside of the knee (lateral knee pain). This is because of the inflammation within the area where the iliotibial band slides across back and forth along the femoral epicondyle. Pain could also radiate from the knee to the thigh and hip, causing iliac crest pain. At first, there could be a needle-like pricks or stinging sensation, which is often disregarded. This may slowly develop into pain each time the heel hits the ground and eventually could become intensely painful when running or walking, especially when going up or down.

Some people suffering from the condition could feel a popping or snapping sound at the knee. There could also be swelling below the knee where it connects to the tibia or where the iliotibial band slides across the femoral epicondyle.

Diagnosis
The diagnosis of the condition can often be done through the patient's history of symptoms. Usually, the patient would describe the development of lateral knee pain, which becomes more painful when the heel hits the ground. Moreover, physical examination can help with the diagnosis as palpation can make the patient feel swelling and tenderness at the femoral epicondyle, which is the location of the sac or bursa.

The medical professional could also check for muscle imbalance, tightness in the back and legs, and leg-length discrepancy. The patient would feel tenderness in the outer thigh above the knee joint and the hip and knee joints are normal when examined.

To determine other possible causes of lateral knee pain, a physical examination of the legs and lower back is usually done, including the knees, ankles, and hips.

While plain x-rays are not normally needed to diagnose iliotibial band syndrome, medical experts can use MRI to check for inflammation along the iliotibial band. This test could also eliminate other causes of lateral knee pain, including muscle tendon inflammation, sprained lateral collateral ligament, and torn cartilage.

Treatment Options

  • Initial treatment for this condition includes rest, ice, elevation, and compression.
  • Medications - anti-inflammatory medications like naproxen and ibuprofen could help. Remember that over-the-counter medications could have side effects and interactions with prescription drugs. For any concern, ask a pharmacist or medical professional about the safe use of these drugs.
  • Home treatment - this may include stretching, use of foam rollers, and massage at the location of inflammation and pain.
  • Physical therapy - to reduce the inflammation at the iliotibial band, physical therapy may be necessary when the first line of treatment fails. Some therapy programs focus on stretching and flexibility. Friction rubbing could also be performed along the iliotibial band to stop inflammation and prevent scarring.
  • Phonopheresis - use of ultrasound to propel anti-inflammatory medications into the swollen tissue.
  • Iontophoresis - introduction of ionic medicinal compound through the skin into the body by means of electricity.
  • Gait Analysis - the medical professional could also help assess the underlying cause of the injury and check the balance, flexibility, muscle strength, and gait analysis (observing the patient walk, run, or cycle). It would be helpful to use shoe orthotics if there is pelvic tilt, leg-length discrepancy, or gait problem as a possible cause of iliotibial band syndrome.
  • Corticosteroids - injected at the site to ease inflammation.
  • Arthroscopy - a surgical procedure to find the inflammation around the iliotibial band and remove it. While it is rare that the nonsurgical treatment would fail, orthopedic surgery is an option if other types of treatment are unsuccessful. There are also other surgical options available, such as taking away a small triangular portion of the iliotibial band to extend it to allow a larger space for it to move across bone.

Recovery
Most patients who suffer from iliac crest pain because of iliotibial band syndrome are able to recover from the injury. However, it could take weeks or months to go back to regular activities without pain. For the best results, it is required to have patience to allow the body to heal.

Knowing the significance of balance in the body can help prevent iliotibial band syndrome. Symptoms may develop when there are activities that alter that balance.

Runners may suffer from iliotibial band syndrome when they never switch sides while running on a banked road or when they never change directions while running indoors. This can cause an unnatural tilt to the pelvis and can produce greater risk of acquiring pain and inflammation. When running on an indoor track, it is recommended to switch directions, especially for longer distances. Some indoor tracks reverse directions every day, while others on alternate days. Running in the direction of traffic is an essential safety plan, but finding means of running on the other side of the road could reduce the risk of having iliotibial band syndrome.

As mentioned, bicyclists may develop iliotibial band syndrome if their toes are rotated internally when they pedal, which may cause the iliotibial band to be abnormally stretched. To minimize the risk of having symptoms, bicyclists should know pedaling strategies and properly set the pedals and clips.

It is important to always stretch the muscles and other structures to prevent various musculoskeletal conditions like iliotibial band syndrome.

6. Piriformis Syndrome

Piriformis syndrome is a disorder that causes numbness, pain, and tingling in the buttocks and within the pathway of the sciatic nerve, which may radiate along the pelvis and hips, causing iliac crest pain.

Background
The piriformis is a small muscle that is found deep in the buttock. It begins at the lower spine and attaches to the upper region of every femur or thighbone. It helps in the rotary movement of the hip and turning the foot and leg outward. The piriformis muscle runs diagonally and the sciatic nerve runs vertically underneath it. However, in some people, the sciatic nerve runs through the piriformis muscle.

Causes
While the exact cause of this condition is still unknown, there are suspected causes, including:

  • Spasm in the piriformis muscle - this is either due to irritation along the muscle itself or of a nearby structure like the hip or sacroiliac joint.
  • Tightening of the piriformis muscle - this is in response to spasm or injury
  • Inflammation of the piriformis muscle - this is also because of spasm or injury.
  • Bleeding in the area surrounding the piriformis muscle.

Either one or a combination of these problems may affect the piriformis muscle and cause buttock pain. They could also affect the nearby sciatic nerve and cause numbness, pain, or tingling in the calf, foot, or the back of the thigh.

Symptoms
The patients most commonly describe to feel intense tenderness along the buttock, sciatica-like pain in the calf, foot, and the back of the thigh, and also iliac crest pain. The symptoms of piriformis syndrome include:

  • A dull pain in the buttock
  • Pain when walking up inclines or stairs
  • Pain along the calf, foot, and the back of the thigh
  • Decreased hip joint range of motion

The patients often feel worse pain after prolonged sitting, running, or walking, and the symptoms may improve after the patients lie down on their back.

Diagnosis
The diagnosis of this condition is based on a physical examination, evaluation of the patient's medical history, and diagnostics test. To reach a diagnosis, the medical professional would often rule out other possible conditions that could be causing the symptoms such as sacroiliac joint dysfunction or lumbar disc herniation.

  1. Physical Examination - this involves an examination of the legs and hips to check if movement increases lower extremity pain or low back pain. Movement of the hip would often recreate the pain. The examination would also rule out or determine other possible causes of the pain, such as testing for muscle strength or local tenderness.
  2. Medical History - this involves a thorough analysis of the patient's symptoms, including how long the patient has the symptoms, whether they began gradually or after an injury, the activities or positions that make the symptoms worse or better, and the treatments that they have tried. This will also involve an analysis of the medical conditions that could be present in the patient's family.
  3. Diagnostics Test - X-rays, MRI, nerve conduction tests, and other imaging tests cannot identify if the piriformis muscle is being irritated. However, these diagnostic tests may be done to rule out other conditions that may cause the same symptoms to piriformis syndrome. Anesthetic injection with or without steroid could help check if the source of the symptoms is the piriformis muscle.

Treatment Options

  • Ice massage
  • Heat therapy
  • Anti-inflammatory medications
  • Stretching and range of motion exercises - careful and gradual stretches and range of motion exercises for the piriformis muscle.
  • Physical therapy - the program depends on the patient's situation.
  • Deep massage - helps recovery by reducing muscle spasm and increasing blood flow around the area.
  • Anesthetic and corticosteroid - direct injection into the piriformis muscle to reduce pain and spasm.
  • Electrotherapy - this uses an electrical stimulator into the buttock to help reduce muscle spasm and block pain.

7. Gluteus Medius Pain

Many common daily movements involve the use of the gluteus medius muscle. Most people will not even notice it until they feel pain in the area. Because of the central location of the gluteus medius muscle, it is at risk from injury caused by trauma, overuse, and compensation for pain in the surrounding areas. A strain could be painful, but nonsurgical treat is often all that is required. Regular strengthening and stretching exercises can prevent future recurrence of injury.

When there is pain in the gluteus medius muscle, pain can also be felt in the iliac crest. The gluteal muscle group connects along the iliac bone, so aggravation and tension in the muscle may trigger pain and discomfort below the iliac crest. This may result in other conditions like reduced range of motion, reduced flexibility, and reduced elasticity. It may also lead to reduced nerve and muscle function, increase of pressure, and blood circulation problem in the area.

Background
The gluteus medius muscle begins at the top of the pelvis and runs towards the head of the femur or thighbone. It is the main hip abductor that is responsible for lateral movement. It is also one of the muscles that stabilize the legs to keep them pointing forward when walking. People who have degenerated or underdeveloped gluteus medius muscle would often develop an abnormal gait.

Causes
The gluteus medius muscle is essential to almost all lower body activities, so there is a great risk of injury. Runners are particularly prone to this injury, but any athlete playing high-impact sports or sports involving abrupt lateral movement (like basketball or football) can easily hurt a weak gluteus medius muscle. Adjusting posture or gait to compensate for back pain may also have a negative impact on the muscle. The most common cause is overuse injury, which results from not being able to properly strengthen and stretch the muscle. Trauma, such as a direct blow or fall, can also be the cause of injury.

Treatment Options

  • Grade 1 injury - rest, ice, and anti-inflammatory medications.
  • Grade 2 injury - involves a partial tear of the gluteus medius muscle. This uses the same treatment as grade 1 injury, but for a longer period.
  • Grade 3 injury - involves a complete muscle tear, which may require surgery.

Prevent Iliac Crest Pain

Taking good care of the body might prevent the conditions that cause pain in the iliac crest, but most people do not focus on prevention, so they end up in pain. Here are some ways to prevent this condition:

  1. Wear appropriate footwear - athletes, especially runners, should pay careful attention to their shoes. There are specially-designed shoes for a certain sport. Moreover, worn-out shoes should also be replaced as soon as possible. Shoes wear out over time and will not be able to provide enough support for the feet. Replace them with a tougher pair to provide the necessary stability for the legs and shock absorption.
  2. Warm up properly - most people do not see the importance of warming up. Running or playing without warming up or stretching the muscles and joints can lead to severe consequences.
  3. Avoid uneven road - for those who cannot afford good-quality tracks, make sure to at least find an even stretch of road and avoid running on slopes because this can put extreme pressure on the legs.
  4. Cool down - cooling down and stretching can help with muscle recovery after sports or strenuous physical activities.
  5. Strengthen muscles - the pain on the iliac crest, especially on the side, could be caused by irritation to the core muscles. The right exercises like stretching can strengthen these muscles. Improve core and hip strength so that the body will not develop an unnatural gait. Strength deficits can make the hip to drop on the non-weight bearing leg, which could strain the muscles on the afflicted side of the pelvis.

If You Have Iliac Crest Pain

... immediately stop the activity that causes the pain. Some people try to ignore the pain; e.g., a runner who wants to finish a race. This is not a good idea. Consult a doctor for proper diagnosis and treatment.

Which part of the hip bone is the iliac crest located?

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