Massage.
LandmarkHipDraft

Iliac crest

The curved upper rim of the pelvis, running from the ASIS at the front to the PSIS at the back.

BoneIlium (hip bone)
RegionHip

Find it

  1. Client prone, supine or side-lying.
  2. Place your hands flat on the client's waist and press gently down and in: the firm ridge you meet is the crest.
  3. Trace it with your fingertips from the front (ASIS) round to the back (PSIS); it can be felt along its whole length.
  4. Note the height: a line across the tops of both crests is at about the level of the L4 vertebra, which helps when counting lumbar spinous processes.

The crest has an outer lip, an inner lip and a line between them. Tensor fasciae latae, external oblique and latissimus dorsi attach to the outer lip; internal oblique to the middle line; and transversus abdominis, quadratus lumborum, erector spinae and iliacus (part of iliopsoas) to the inner lip. The fascia lata of the thigh attaches along its whole length.

Working just above the crest in side-lying or prone reaches quadratus lumborum and the lower back muscles.

Muscles attaching or palpated here

  • Erector spinae — Three long columns of muscle (iliocostalis, longissimus and spinalis) running beside the spine from the sacrum to the skull that extend and side-bend the back and hold the trunk upright.
  • External oblique — Broad, outermost muscle of the side of the abdomen that flexes, side-bends and rotates the trunk to the opposite side.
  • Gluteus maximus — The largest and most superficial buttock muscle, and the main extensor of the hip.
  • Gluteus medius — Thick, fan-shaped muscle on the outer side of the pelvis that abducts the hip and keeps the pelvis level when you stand on one leg.
  • Gluteus minimus — The smallest and deepest of the three gluteal muscles, lying under gluteus medius, that abducts and medially rotates the hip.
  • Iliopsoas — Deep hip flexor made of psoas major and iliacus, running from the lumbar spine and inside of the pelvis to the lesser trochanter of the femur, and the strongest flexor of the hip.
  • Internal oblique — Middle layer of the side abdominal wall, lying under the external oblique, that flexes the trunk, compresses the abdomen and rotates the trunk to the same side.
  • Latissimus dorsi — Broad, flat, fan-shaped muscle of the lower and middle back that extends, adducts and medially rotates the arm.
  • Quadratus lumborum — Deep, four-sided muscle between the iliac crest, the 12th rib and the lumbar spine that side-bends the lower back and hitches the hip.
  • Tensor fasciae latae — Small muscle at the front of the outer hip, just below the ASIS, that tightens the iliotibial band and helps flex, abduct and medially rotate the hip.
  • Transversus abdominis — Deepest of the abdominal wall muscles, wrapping horizontally around the waist like a corset to compress the abdomen and help stabilise the trunk.

Sources

  1. Wikipedia: Iliac crest
  2. Gray's Anatomy (1918), The Hip Bone (Bartleby, archived)