What to Know About Iliac Crest Pain?
Iliac crest (or ilio) pain is one of the most common types of back pain. It affects approximately 1 out of every 3 adults over 65 years old. According to the American College of Rheumatology, it accounts for 30% of all chronic lower back pain cases. 
The term “iliacus” comes from the Latin word “illium”, which means “wing”. The name refers to the fact that the pain originates in the upper part of your body, usually in your head or neck area. However, there are other possible causes such as a herniated disc or nerve root compression. There is no cure for iliac crest pain. Treatment consists of rest and physical therapy.
Your doctor will determine if surgery is necessary.
In general, the pain is worse during sleep. You may experience it while standing up, walking around, bending down or even sleeping. It often worsens with activity like lifting heavy objects or performing manual labor. If left untreated, the pain can lead to complications such as:
Fractures of bones in your spine (spondylolisthesis).
Possible damage to nerves and blood vessels in your spinal cord (medullary thrombosis).
What are the causes and risk factors of iliac crest pain?
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) explains that iliac crest pain is caused by degeneration of intervertebral discs between the vertebra of your spine. These discs (or “discs”) are located between each bone of your spinal column.
More specifically, the pain originates between your T12 and L1 vertebrae. Your iliac crest is on either side of your L5 vertebrae. The term “crest” refers to the raised border around the edge of a bone.
It is believed that these intervertebral discs are prone to wear and tear as you age. Other possible causes of iliac crest pain include:
Overexertion of your back
Significant injury to your back
As stated above, iliac crest pain has a genetic component. If other members of your family have experienced this type of back pain, you may be more likely to experience it as well.
It is important to note that iliac crest pain can lead to a serious condition known as spondylolisthesis. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, spondylolisthesis occurs when one of your vertebrae slips out of place and rests partially or completely on the one below it. The condition is usually caused by an injury that causes fractures in your spine.
What are the symptoms of iliac crest pain?
The main symptom of iliac crest pain is a sharp, searing pain that originates in your neck or upper back. You may also experience numbness or tingling in your arms and hands. The pain in your neck and upper back may extend to your lower back.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases explains that pain is often experienced while you are trying to fall asleep or when you wake up in the morning. Sleeping on your back is especially uncomfortable because it puts pressure on your iliac crests.
How is iliac crest pain diagnosed?
In most cases, your doctor can easily identify the likely cause of iliac crest pain by conducting a physical examination. Your physician may also ask you about any recent physical events that may have contributed to the condition.
Your doctor will also ask you to provide your medical history. Your answers may lead him or her to rule out other potential causes of your back pain such as kidney stones, a pinched nerve or a herniated disc.
If your physician detects signs of spondylolisthesis, he or she may order an X-ray of your back. This image will reveal any bone damage due to the slipped vertebra. Your physician may perform other imaging tests if necessary, such as an MRI or CT scan.
How is iliac crest pain treated?
The treatment of iliac crest pain may include over-the-counter or prescription pain medication. In addition, your physician may refer you to a physical therapist who can teach you how to stretch the muscles in your back and abdomen.
If you have spondylolisthesis, the Mayo Clinic suggests that you may need to wear a back brace for long periods of time. Your physician may also prescribe pain medication or anti-inflammatory drugs. In rare cases, you may need surgery to repair the damage to your spine.
What is the prognosis?
Most people who experience iliac crest pain recover completely as long as the underlying cause of the condition is addressed. The pain should subside within a few weeks or months.
The prognosis for people with spondylolisthesis is much more guarded. In most cases, the condition does not improve and can even worsen over time. In these situations, surgery may be necessary to repair the damage.
Are there any exercises I can do to prevent iliac crest pain?
While you may be able to manage the symptoms of iliac crest pain, you can take steps to prevent the onset of this condition.
The Mayo Clinic advises that you engage in core strengthening exercises on a regular basis.
Sources & references used in this article:
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Iliac crest bone graft in lumbar fusion: the effectiveness and safety compared with local bone graft, and graft site morbidity comparing a single-incision midline … by JC France, JM Schuster, K Moran… – Global spine …, 2015 – journals.sagepub.com
Backfill for iliac-crest donor sites: a prospective, randomized study of coralline hydroxyapatite. by JA Bojescul, DW Polly Jr, TR Kuklo… – American journal of …, 2005 – europepmc.org
Commentary: Iliac crest bone graft: are the complications overrated? by SS Hu – The Spine Journal, 2011 – Elsevier
Reconstruction of anterior iliac crest after bone graft harvest decreases pain: a randomized, controlled clinical trial by DK Resnick – Neurosurgery, 2005 – academic.oup.com
Postoperative pain following posterior iliac crest bone graft harvesting in spine surgery: a prospective, randomized trial by ED Sheha, DS Meredith, GD Shifflett, BT Bjerke, S Iyer… – The Spine Journal, 2018 – Elsevier
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Risk factors predictive of chronic postsurgical neuropathic pain: the value of the iliac crest bone harvest model by V Martinez, SB Ammar, T Judet, D Bouhassira… – Pain, 2012 – Elsevier
MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes by KJ Hébert, T Laor, JG Divine… – American Journal of …, 2008 – Am Roentgen Ray Soc