Iliolumbar Syndrome


By Chris Faubel, M.D.

ICD 10 code:  M46.06 (lumbar spine enthesopathy)


  • Soft tissue injury to the iliac insertion of the ligament.
  • Can be from direct trauma, a fall in which the ligament is pulled at that iliac crest insertion site, or a lifting injury
Location of the ligament
  • Located typically 1-inch cephalad and 1-inch lateral from the ipsilateral posterior superior iliac spine (PSIS)


  • Usually chronic or recurring, unilateral low back pain with a tender point at the posterior iliac crest
  • The patient points to the most painful spot, which is lateral to the more midline facets.
  • Worse with prolonged sitting or standing

Physical Exam

  • Said to be frequently painful with the FABERs/Patrick test, though I have not seen this.
  • Tender point(s) along the posterior iliac crest — must cause concordant low back pain when pressed, otherwise it is just soft tissue pain from overzealous pressure by the examiner.
  • NOT painful with facet loading (as facetogenic pain would be)


  • Acute cases may resolve with relative rest, ice, and analgesics.
  • Friction massage along the ligament may also be tried (see video link here)
  • Chronic cases frequently need injections of local anesthetic (and sometimes steroid) along that posterior iliac crest. (INJECTION TECHNIQUE HERE)
Best done under fluoroscopic-guidance so the crest can be visualized and you can ensure an even distribution of injection sites.



Please enter your comment!
Please enter your name here