Ultrasound-Guided Platelet-Rich Plasma Injections Ease Iliac Crest Pain Syndrome and Low Back Pain

A research team from Plovdiv Medical University and the Kaspela University Hospital in Bulgaria reports that ultrasound-guided injections of platelet-rich plasma (PRP) produced substantial improvements in patients with Iliac Crest Pain Syndrome (ICPS) and the associated low back pain. In the study, published in Frontiers in Medicine, 46 patients received PRP injections directly into affected soft tissue attachments at the pelvis, and every outcome measured over six months improved. ICPS has been established as a discrete and common soft-tissue cause of low back pain.

Previous studies on the syndrome proposed enthesopathy of the erector spinae muscle and the thoracolumbar fascia at the posterior superior iliac spine (PSIS), as well as pathology of the long posterior sacroiliac ligament, as the main pathological substrates. PRP is an orthobiologic treatment that has been found to be especially efficacious in soft tissue pathology such as enthesopathy and ligamentopathy, which motivated the team to test it at these specific attachment sites. The study was partially funded by a postdoctoral research grant from the Medical University of Plovdiv.

Each of the 46 participants received two intralesional PRP injections into the erector spinae, thoracolumbar fascia, and long posterior sacroiliac ligament entheses at the PSIS, spaced three weeks apart. Every procedure was performed under direct ultrasound guidance, and the authors emphasize that the protocol was strict and easily reproducible. The primary endpoint was pain reduction on a 100-millimeter visual analog scale (VAS) at six months.

Pain at rest fell from an average of 53 millimeters to 16 millimeters, while pain on motion dropped from 69.5 millimeters to 18 millimeters. Function improved alongside pain. The average range of motion in the lumbar spine increased by 2.5 centimeters in both the sagittal and the coronal planes.

The secondary endpoints told a consistent story. On the Roland-Morris Disability Questionnaire (RMDS), scored from 1 to 24, the average fell from 15 to 6.5 points. The Health Assessment Questionnaire (HAQ), scored from 0 to 3, improved from 1.13 to 0.62.

Patient satisfaction, assessed on a five-point Likert scale, was also recorded as a secondary outcome at six months. According to the study team, the findings position ultrasound-guided PRP injections at the PSIS as a valid and efficacious treatment option for patients with ICPS and the associated low back pain. The study was an open treatment series of 46 patients reported at the abstract level, and the authors note that all claims expressed in the article are solely those of the authors.

Subject of Research: Ultrasound-guided platelet-rich plasma injections for Iliac Crest Pain Syndrome and associated low back pain

Article Title: Ultrasound guided intralesional injections of platelet rich plasma in the treatment of iliac crest pain syndrome and the associated low back pain

Article References: Todorov, P. T., Mekenyan, L., Seventekidis, L., & Batalov, A. (2026). Ultrasound guided intralesional injections of platelet rich plasma in the treatment of iliac crest pain syndrome and the associated low back pain. Frontiers in Medicine, 13, Article 1943518. https://doi.org/10.3389/fmed.2026.1943518

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1943518

Keywords: Iliac Crest Pain Syndrome, low back pain, platelet-rich plasma, ultrasound guidance, enthesopathy, posterior superior iliac spine, musculoskeletal ultrasound, orthobiologics, rheumatology, patient-reported outcomes, Ultrasound, guided