Iliolumbar ligament pain syndrome: causes, symptoms, exercises

If you’re dealing with one-sided lower back pain that flares up with certain movements — like bending, twisting, or sitting too long — you may have iliolumbar ligament pain syndrome, a common but often overlooked source of low back discomfort.

There’s no debate about it: back pain can make everyday activities harder. But like many musculoskeletal issues, iliolumbar ligament pain often improves with simple, at-home treatments, including daily movement, targeted exercises, and massage therapy.

Here’s what to know about iliolumbar ligament pain syndrome, including what causes it, common symptoms, and how to find relief — especially with exercises recommended by Hinge Health physical therapists.

What is iliolumbar ligament pain syndrome?

Iliolumbar ligament pain syndrome occurs when the iliolumbar ligament — a small but important structure in your lower back — becomes irritated or strained.

Ligaments are strong bands of tissue that connect bones and provide stability to joints. “The iliolumbar ligament connects the lower spine, your L5 vertebra to be exact, to the top of your pelvis, also known as the iliac crest,” says Justin DePermentier, PT, DPT, a physical therapist at Hinge Health. “It plays a key role in stabilizing the lower back and pelvis.”

You have one on each side of your spine. When one becomes irritated, it can lead to pain on that side of the lower back and make certain movements uncomfortable.

Causes of iliolumbar ligament pain syndrome

Although the iliolumbar ligament is small — just over one inch long — it plays a big role in supporting and stabilizing your lower back and pelvis. This ligament is resilient, but sometimes, it can become strained.

“Irritation of the ligament is often brought on by a movement or load the area isn’t prepared for,” says Dr. DePermentier. Falls, repetitive motions, and even daily habits can all contribute. Common causes include:

• Acute injury. A fall or sudden impact can overstretch the iliolumbar ligament, leading to irritation or even a small tear. “When a force is greater than what the ligament is prepared for, it can become strained,” says Dr. DePermentier. This might happen if you slip, twist awkwardly, or land hard during activity.

• Overuse injury. Repeating the same movements — like bending, twisting, or lifting — over and over can gradually overload the ligament. This is common in sports like tennis and golf, and in physically demanding jobs. “It’s not always one big moment,” says Dr. DePermentier. “Sometimes repeated stress over time builds up and leads to irritation in this area.”

• Prolonged sitting. Sitting for long periods, even with “good posture,” can place ongoing stress on your lower back. That stress increases if you sit with rounded shoulders or stay in one position too long. Over time, this can irritate the iliolumbar ligament and contribute to stiffness and discomfort.

• Favoring one side. Consistently putting more weight or stress on one side of your body can lead to imbalance and irritation. This might look like always carrying a bag on the same shoulder, holding a child on one hip, or repeatedly twisting in one direction during sports or work. Over time, that uneven load can strain your ligament.

• Muscle imbalance. Your core, hips, and back muscles all work together to support your spine. If some of those muscles are weak or not working well together, more stress (or load) can shift to the iliolumbar ligament.

Symptoms of iliolumbar ligament pain

Not everyone with iliolumbar ligament pain syndrome will experience the same symptoms, but the discomfort is often felt on one side of the lower back. It may flare up during everyday activities or feel tender even at rest. Common symptoms include:

• Pain on one side of your lower back

• Sharp or aching discomfort

• Pain that worsens with bending, twisting, or sitting

• Tenderness in the lower back or top of the pelvis

• Stiffness or reduced movement

• Pain that may spread to the hip or groin

How movement can help ease iliolumbar ligament pain

If your back hurts, it’s natural to want to rest. But movement is medicine: staying active is one of the most effective ways to support healing. 

“Movement helps improve blood flow, reduce muscle tension and muscle spasms, and build stability around the area,” says Dr. DePermentier. “That takes pressure off the ligament and supports recovery.”

Even simple activities like walking can strengthen supporting back muscles, increase core stability, and reduce muscle stiffness and pain, according to a study in the journal Medicine. 

Start with gentle movement you can comfortably tolerate and build onto that gradually. Some discomfort is okay. The goal is to find your movement sweet spot, or the level of physical activity that supports your body without increasing pain.

Working with a physical therapist (PT) can also help. A PT can guide you toward the right types and amount of movement, and create a plan to help you prevent future issues.

These exercises support your back in a few key ways. Core-focused moves like bear plank, dead bug, bird dog, and Pallof press help your body better handle everyday bending and movement. Strengthening exercises like hip hinges and squats build stability and take pressure off your lower back.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for iliolumbar ligament pain

In most cases, iliolumbar ligament pain improves with simple at-home approaches, including heat and cold therapy, over-the-counter (OTC) medication, and massage, which can all help ease discomfort. Staying active throughout the day, in addition to doing targeted exercises, can help you build strength and stability, support healing, and reduce the risk of future back flares. 

Other treatments include: 

• Try physical therapy and targeted exercises. Targeted exercises can help strengthen muscles that support your iliolumbar ligament, helping offload pressure from the area. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. “A physical therapist can create a personalized plan to help you stay active while addressing the underlying causes of your pain, such as lifting and carrying habits, muscle imbalances, or repetitive activities like pickleball or golf,” says Dr. DePermentier. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay moving. Movement promotes blood flow to tender or sore areas, supporting healing and reducing stiffness. It also helps your body gradually build tolerance to physical activity, and can ease pain along the way, Dr. DePermentier says.

• Apply ice or heat. Ice and other forms of cold therapy can reduce inflammation and numb pain. Heat, on the other hand, can relax tense muscles and improve blood flow. Experiment to see which one provides the best relief for you, or alternate between the two.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have back pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.

• Try massage or manual therapy. Hands-on techniques can help ease muscle tension and improve circulation, which may support healing and reduce discomfort.

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for iliolumbar pain relief, such as acupuncture, dry needling, or chiropractic care.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce back pain. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

How to prevent iliolumbar ligament pain

You can’t always prevent iliolumbar ligament pain, but you can lower your risk by building strength and preparing your body for certain movements where you rely on that ligament to support you. Here are the most effective ways to help prevent iliolumbar ligament pain:

• Strengthen your core and hips. Strong muscles help support your spine and reduce strain on your lower back. In addition to the exercises above, Dr. DePermentier recommends moves like clamshell, bridge, and fire hydrant.

• Walk often. Research suggests that walking, especially when paired with stability exercises, can help reduce your risk of chronic back pain.

• Take movement breaks. Sitting or staying in one position too long can lead to stiffness and added strain on your lower back, says Dr. DePermentier. Try to move regularly throughout the day.

• Don’t skip warm-ups before your workouts. A dynamic warm-up helps prepare your muscles and joints for movement, lowering your risk of injury.

• Lift with control. Your back is designed to bend, twist, and help you lift and carry heavy weights and items, but your form matters. To protect your lower back, squat down and bend your knees when lifting something heavy, keeping the object close to your body.

• Pace your activities. Modify activities that trigger pain. If standing for long periods or lifting items, children, or pets usually aggravate symptoms, break up those activities into shorter sessions to help prevent discomfort.

When to see a doctor

Iliolumbar ligament pain often improves on its own with at-home treatments. But if your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:

• Symptoms that don't improve

• A feeling of instability, like your back is giving out

• Numbness, tingling, or weakness in your leg 

• Bowel or bladder changes

PT tip: Don’t overdo stretching

Ligaments are meant to provide stability, not stretch like muscles. “Iliolumbar ligament pain is a ligament issue,” says Dr. DePermentier. “Mobility is important, but too much stretching can make the area feel less stable. Focus on gentle mobility instead of trying to increase flexibility.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Dąbrowski, K., & Ciszek, B. (2023). Anatomy and morphology of iliolumbar ligament. Surgical and Radiologic Anatomy, 45(2), 169–173. doi:10.1007/s00276-022-03070-y

2. Nayak, B. K., Singh, D. K., Kumar, N., & Jaiswal, B. (2020). Recovering from nonspecific low back pain despair: Ultrasound-guided intervention in iliolumbar syndrome. The Indian Journal of Radiology & Imaging, 30(4), 448–452. doi:10.4103/ijri.IJRI_382_19

3. POOL-GOUDZWAARD, A. L., KLEINRENSINK, G. J., SNIJDERS, C. J., ENTIUS, C., & STOECKART, R. (2001). The sacroiliac part of the iliolumbar ligament. Journal of Anatomy, 199(4), 457–463. doi:10.1046/j.1469-7580.2001.19940457.x

4. Snijders, C. J., Hermans, P. F. G., Niesing, R., Spoor, C. W., & Stoeckart, R. (2004). The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clinical Biomechanics, 19(4), 323–329. doi:10.1016/j.clinbiomech.2004.01.006

5. Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain. Medicine, 98(26), e16173. doi:10.1097/md.0000000000016173