Iliolumbar Syndrome | iliac crest pain syndrome

David N. Woznica, MDDr. David Woznica Prolotherapist 

In this article, we explain non-surgical options for the treatment of Iliolumbar Syndrome.

Prolotherapy is an injection treatment that strengthens and rebuilds ligaments on a cellular level. In our more than 25 years experience in this field, we have developed our approach to fixing the problems of iliolumbar ligament weakness and damage by using H3 Prolotherapy. This simple treatment will be explained below.

Why do you have back pain? The importance to spinal stability provided by the iliolumbar ligament

A combined research team from universities and hospitals in Switzerland, the United Kingdom, and Germany, discuss the importance to spinal stability provided by the iliolumbar ligament. Here is what they said:

The iliolumbar ligament connects the transverse process (the bony projections on either side of the vertebrae where ligaments and muscle attach themselves), of L5 to the iliac crest (uppermost part of the pelvis) and contributes to lumbosacral stability and has been associated with low back pain (when it is damaged or injured). However, different opinions exist regarding the functional relevance of the ligament.

iliolumbar syndrome

The iliolumbar ligaments

What the researchers in their study were investigating was just how important this ligament was to spinal stability. What they found was the tissue that connected the iliolumbar ligament to the bone, was of the more sturdy and stronger type fibrocartilaginous entheses, as compared to fibrous enthesis. What does that mean? It means according to the researchers:

“The existence of fibrocartilaginous entheses suggests that the insertion sites of the ligament are subject to both tensile and compressive loading. . . Our findings support the suggestion that the iliolumbar ligament might play an important role in the stabilization of the lumbosacral junction.”(1)

The iliolumbar ligament plays an important biomechanic role in anchoring the spine to the pelvic ring

Doctors in Ireland describing the possibility of using various injection techniques to treat Iliolumbar Syndrome also offered a good summary of the importance of the iliolumbar ligament. They wrote:

  • “The iliolumbar ligament plays an important biomechanic role in anchoring the spine to the pelvic ring and stabilizing the sacroiliac joint.
  • Iliolumbar syndrome is a back pain condition caused by pathology (wear and tear injury) of the iliolumbar ligament.
  • History and physical examination are important in the assessment of back pain, but they lack sufficient specificity (pinpoint ability to find the pain generator).
  • Injection of small volumes of local anesthetic into the structure considered to be the source of the pain  increases the specificity of the diagnostic workup.”(2)

In H3 Prolotherapy treatments, we know that we need to find the source of pain and instability. A Prolotherapy injection at this site and the work of the anesthetic in the solution can tell us immediately if we have found the spot because the patient has immediate pain relief.

Prolotherapy treatment strengthens the ligaments of the lower spine to stabilize the low back into a pain free environment

Iliolumbar syndrome

Iliolumbar syndrome, also known as iliac crest pain syndrome, involves an inflammation or tear of the iliolumbar ligament. As mentioned above, this ligament extends from the spine to the iliac crest. It can lead to referred pain in the groin, the pelvis, the hip, the back and even the testicular, vaginal and rectal areas.

Twenty years ago doctors began to examine the significance of treating and repairing low back pain by treating and repairing the iliolumbar ligament.

In research from 1996, Doctors from the University of North Texas Health Science Center at Fort Worth speculated that:

  • micro-trauma to the iliolumbar ligament is the primary cause of many cases of chronic low back pain because
    • it is the weakest component of the multifidus triangle (a collection of supportive soft tissue including the facet joints, erector spinae muscles, lumbar fascia, quadratus lumborum (a small group of muscles) and the iliolumbar ligaments.)
    • there is increased susceptibility to injury due to its angulated attachment.
    • it is a primary inhibitor of excess sacral flexion (bending too far).
    • it is a highly innervated nociceptive tissue; (it has significant pain awareness because of the nerve tissue present) and,
    • it plays an increased role with progressive disc degeneration.(3)

The H3 Prolotherapy approach to Iliolumbar Syndrome

Since iliolumbar syndrome usually involves pain in the low back, hip and/or groin or pelvic area, the pain is typically acknowledged as muscle strain and would be treated with ice and rest. Problematic in that these components of RICE therapy are considered as the least optimum for injured tendons and ligaments. key components of muscle movement.

Also considered are the use of steroids and anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Although cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, both result in long-term loss of function and even more chronic pain by inhibiting the healing process of soft tissues and accelerating cartilage degeneration.

Since unresolved chronic groin, low back and hip pain problems (as well as pelvic, rectal, testicular and vaginal pain of unknown origin) most often involve weakness of or injury to the iliolumbar ligament, a better approach is to strengthen this ligament with Prolotherapy.

A patient’s story reported in the medical literature

A case study in the Journal of Prolotherapy describes  the effects of a single Prolotherapy injection series on the left iliolumbar ligament. To be clear this is not a single injection but a single treatment as the one displayed above.

  • The patient is a 32 year-old female.
  • Her job tasks as a physical therapist required her to twist turn and bend; putting pressure on her pelvis and the ligament system.
  • Treatment results indicated that after the initial Prolotherapy treatment, there was growth in the left iliolumbar ligament.
  • Patients that experience lower back pain and or pelvic shifting may benefit from the usage of Prolotherapy to strengthen the ligaments surrounding their pelvis.

The research concludes: “Our positive findings move us one step closer to showing how, for patients with lower back pain, Prolotherapy can prove to be a good adjunct to increase stability in the lumbar spine and pelvis.”(4)

Prolotherapy Specialists Shoulder Adhesive Capsulitis Treatment

If you have questions about treatment of pain and instability caused by the spinal ligaments, get help and information from our Caring Medical staff

1 Viehöfer AF, Shinohara Y, Sprecher CM, Boszczyk BM, Buettner A, Benjamin M, Milz S. The molecular composition of the extracellular matrix of the human iliolumbar ligament. The Spine Journal. 2015 Jun 1;15(6):1325-31. [Google Scholar]

2 Harmon D, Alexiev V. Sonoanatomy and injection technique of the iliolumbar ligament.Pain Physician. 2011 Sep-Oct;14(5):469-74. [Google Scholar]

3 Sims JA, Moorman SJ. The role of the iliolumbar ligament in low back pain. Med Hypotheses. 1996 Jun;46(6):511-5. [Google Scholar]

4 Auburn A, Benjamin S, Bechtel R, Matthews S. Increase in Cross Sectional Area of the Iliolumbar Ligament using Prolotherapy Agents: An Ultrasonic Case Study. Journal of Prolotherapy. 2009;3:156-162. [1121]

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