The iliocostalis lumborum originates via tendinous slips from the iliac crest and posterior sacrum, forming the lateral column of the erector spinae. Its caudal tendinous attachment blends with the erector spinae aponeurosis and thoracolumbar fascia, while its cranial slips insert onto the angles of the lower ribs.
The iliocostalis lumborum tendon is a common site of traction injury during sudden unguarded trunk flexion. Localised tenderness over the iliac crest just medial to the PSIS distinguishes its involvement from gluteal or piriformis pathology. Load management and progressive erector spinae strengthening are the mainstays of rehabilitation.
Traction injury at the iliac crest origin producing acute lateral lumbar pain reproduced by passive trunk flexion and ipsilateral lateral rotation.
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