Orthopedics-Online

Iliac crest pain

definition

The iliac crest is one of the bone points of the hip bone that can be felt from the outside and represents the upper edge of the iliac blades. It serves as a starting point for various ligaments of the hip joint and is in the immediate vicinity of a large number of structures and organs of the pelvis. Due to these narrow conditions, an exact localization of the symptoms is very important in order to differentiate pain in the iliac crest from pain in the pelvic or abdominal cavity.

causes

There are a number of possible causes of pain in the iliac crest. If the pain comes directly from the bone, it can e.g. from inflammation, injuries as a result of an accident or also signs of wear and tear due to incorrect or excessive stress. Similarly, the muscles and their tendon attachments can also be damaged and cause the discomfort. Another possibility are diseases of the internal organs, which can lead to the transmission of pain to the external structures of the pelvis. A precise diagnosis and localization of the pain is therefore essential for complaints in this area.

Pelvic inclination

If the pelvis is inclined, the pelvis is crooked in its position. As a consequence, the back tries to compensate for the misalignment.

Without treatment, the poor posture can lead to a (severe) curvature of the spine, scoliosis, and worsening of the pelvic obliquity. Pelvic obliquity can initially be asymptomatic and lead to pain over time.

The pain can become more severe with wear and tear, especially after long periods of standing or sitting. Pelvic obliquity is often associated with back pain.

Pelvic crest pain when sitting

Pelvic pain while sitting is often a result of a muscular problem. The muscles are often tense or even shortened, which in turn leads to a tilt of the pelvis. As a result, there is more weight on one side of the pelvis than on the other when sitting. This incorrect load ultimately triggers the pain. Typical for such tension as a trigger of the pain is the improvement of the symptoms with movement as well as with heat treatment or massage.

In addition, the onset of osteoarthritis in the hip joint can also be the cause of pelvic pain. A typical symptom of this disease is pain, which occurs especially after lying or sitting for a long time and which improves significantly or disappears after a few minutes of movement.

Read more about this: Pelvic inclination

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Pain in the iliac crest when walking

Similar to the discomfort when jogging, pain that occurs during normal walking can also be the result of improper or excessive strain on the muscles attached to the pelvis or the bony structures. Another cause is more advanced osteoarthritis of the hip joint. Over time, this often leads to restricted mobility in the hip joint. This also leads to incorrect loading of the structures mentioned and, as a result, to significant discomfort and pain in the area of the iliac crest.

Read more about this under Hip osteoarthritis pain.

Pelvic crest pain when jogging

If the pain occurs mainly when jogging, a common cause is a muscle strain. This occurs primarily as a result of incorrect or excessive strain, e.g. too intensive or unfamiliar training. In order to prevent further damage to the muscles, if such a strain is suspected, a doctor should be consulted and the muscles should be spared. Another possible consequence of the overload are the smallest injuries to the bone. If there is insufficient time to heal, these can lead to very painful inflammations of the affected bone or periosteum. Is the pain a trauma, such as a serious fall, preceded by larger injuries to the pelvic bone, such as fractures, may be the cause of the pain. If there is any suspicion, this can best be checked using an X-ray.

Unilateral pain in the iliac crest

Unilateral complaints in the area of the iliac crest are usually the result of poor posture or incorrect loading. This can lead to muscle tension or severely irritate the tendons or bones at the tendon attachment points.

These symptoms usually improve after sufficient rest. However, a detailed analysis of the posture and load on the pelvis when walking is recommended in order to eliminate the causes and prevent the pain from recurring. A common cause of one-sided improper loading of the pelvis is e.g. a leg length difference.This can usually be compensated for with a simple measure, such as special insoles in the shoes. As a result, the pelvis is no longer unilateral, but evenly loaded and the symptoms recede.

If you unconsciously shift your weight to the other side due to injuries to a foot or leg, this can lead to long-term pain on the loaded side. At the same time, bad habits (always carrying a heavy handbag over the same shoulder) can also be associated with one-sided pelvic strain. The shift to one side is noticeable in the pelvic and hip area. A permanent one-sided load can lead to a tilted pelvis.

Pain in the iliac crest after a bone marrow harvest

After removal of bone material from the iliac crest, many patients complain of pain at the removal site. These arise from the fact that the so-called periosteum is injured during the procedure, which is very sensitive to pain. In the first few days after the operation, the pain makes walking and getting out of bed difficult. However, the symptoms can be reduced well with the usual painkillers and, with sufficient rest, often decrease significantly after a few days.

Further information on complications and complaints after a bone marrow harvest can be found here: Bone marrow donation

Concomitant symptoms

Depending on the cause of the pain, this can also be accompanied by different side effects. If the symptoms are based on inflammation, the typical signs of inflammation can often be identified. These consist of reddening of the affected area, overheating, swelling, pain and impaired function. In the pelvic area, the latter often consists of reduced mobility of the leg due to the pain.

If, on the other hand, a muscular problem is the cause of the symptoms, this is usually also associated with muscle tension, which can be felt from the outside as a significant hardening of the muscles. Here, too, there is often a restriction in the movement of the leg, which is caused by the increased tension in the muscles. Injuries to the bone can also be felt from the outside. This is especially the case with slim people. Possible palpable features of a bony injury are, for example, the rubbing of the broken edges against each other or small fragments. Furthermore, the pain can typically be significantly increased by applying slight pressure to the affected area, since the periosteum is very sensitive to pain and is already severely irritated by the lesion.

Pubic bone pain

If, in addition to pain in the iliac crest, there is also pain in the pubic bone, this may be due to a relaxation of the symphysis.

It is normal for the pelvic girdle to relax during pregnancy. After a certain amount of loosening of the pelvic girdle, severe pain can arise. The pain can affect the iliac crest, pubic bone, and sacroiliac joints.

Are you pregnant and suffering from iliac crest pain? - Then read all about: Hip pain during pregnancy

In addition to pregnancy, injuries to the hip, arthritic joint inflammation (arthritis) and being overweight can also lead to a loosening of the pelvic girdle.

Sacroiliac joint pain

Pain in the iliac crest can be accompanied by pain in the sacroiliac joints, SIJ.

Possible causes are poor posture, joint blockage (s) of the SI joint, loosening of the pelvic girdle and inflammatory causes. The SI joint is a joint that is under high mechanical stress and causes pain to many people as they age.

An examination by an orthopedic surgeon can help determine the exact cause of the discomfort.

diagnosis

In the case of problems with the iliac crest, the diagnosis is primarily based on the patient consultation (anamnese) and the detailed examination by the doctor in the foreground. Important information for narrowing down the cause of the pain is primarily the underlying illnesses, the onset of pain, possible triggering events, such as previous falls or accidents, the nature of the pain, the exact location and possible accompanying symptoms. During the examination, the doctor then first checks externally recognizable signs of inflammation, such as swelling or redness and other abnormalities, and then checks whether there are tenderness to pressure and restrictions in certain movements. Often, after these measures, a conclusion can be drawn about the cause of the pain and treatment can be started. If the pain is due to a bony cause, imaging procedures such as an X-ray can be used for more detailed clarification.

treatment

In order to achieve rapid relief from the symptoms, the usual pain medication can generally be used first for pain in the iliac crest. But even very simple home remedies are usually sufficient as an initial measure. In the case of inflammatory causes, application of the cold often helps, e.g. with cold packs, whereas with muscular problems, warmth usually leads to a significant improvement in the symptoms. Nevertheless, treatment of the cause should of course always be carried out, even after the acute symptoms have subsided. In the case of muscular problems, physiotherapy exercises and movement training are usually the therapy of choice. These help to achieve an even load on the muscles and prevent malpositions. If the pain is due to a tilted pelvis, e.g. Due to a difference in leg length, shoe insoles can help compensate for this and improve the symptoms. Inflammatory diseases, on the other hand, usually have to be treated with medication to prevent long-term damage.

Duration

It is very difficult to make statements about the duration of the complaints. On the one hand, this is due to the variety of possible causes. On the other hand, of course, the very personal circumstances of each patient, their physical constitution and possible concomitant diseases also make a significant contribution to the respective course of treatment. After a precise diagnosis, your doctor or therapist can often give you information about an approximate time frame.