Sacrum pain

introduction

Pain in the buttocks and sacrum can present in different ways. Depending on the underlying cause, those affected have e.g. especially pain when moving or at rest, it may be difficult to walk, sit or lie down. The severity of pain can also vary greatly. The exact localization of the complaints and a possible radiation of the pain to the buttocks or back, as well as to the legs can provide information about the cause of the pain.

Blocked sacrum-iliac joint

The sacrum-iliac joint (Sacroiliac joint) is, as the name suggests, the flexible connection between the sacrum and the iliac bone, which forms part of the pelvic vane.

The sacroiliac joint (ISG) is not a conventional joint, such as the shoulder joint, but still has low degrees of movement, which are crucial for daily movement sequences.
This type of joint is known as amphiarthrosis. It is held by a stable ligament and surrounded by muscles.
When lifting to heavy loads or, for example, when stepping into space (typically missing stairs) the joint can become blocked. This is noticeable by a pulling pain that occurs on the affected side at the level of the joint and when bending over and rotating the leg outwards (e.g. Cross legged) gets stronger.

Concomitant symptoms

The pain in the sacrum can manifest itself in many forms and with accompanying symptoms. The pain can be described as dull and diffuse, stabbing or pulling. An important indicator is whether the pain can be provoked by external touch and pressure or by movement. In the case of chronic pain, the pain occurs mainly dull after long periods of immobility while sitting or standing.

A frequent accompanying symptom when the nerves are involved is the radiating of pain through the buttocks and into the legs. Initially, you may experience a tingling sensation in your toes. In severe cases, numbness and paralysis are possible.

If there are acute injuries to the sacrum, external symptoms can be recognized. Hardening, broken edges and overheating can be felt. In addition, externally visible bruises can appear as reddening.

Read more on this topic at: Sacrum pain

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The sacroiliac joint can also be affected by arthritic changes that cause similar symptoms. During the aging process, the cartilaginous joint surfaces wear down over time, so that a certain incongruence arises in the joint and increased friction occurs. This then leads to irritation of the surrounding tissue and nerves, and in severe cases to bad posture.

In the context of some rheumatic diseases, this joint is also often affected by inflammation, e.g. in Bechterew's disease, an inflammatory rheumatic disease. Inflammation of the sacroiliac joints is also known as sacroiliitis. It usually regresses with treatment of the underlying disease. In addition, ankylosing spondylitis usually has a pronounced morning stiffness in the spine, which lasts for at least half an hour and eventually improves with movement.

Additional hip pain

Pain in the hip joint can extend into the sacrum and the deep spine. There can be several structures behind this. Hip osteoarthritis can be the cause, especially in older patients. This is a long-term wear and tear of the joint head and the joint socket.

Symptoms of the SI joint can also cause such pain. The most important clinical picture is the ISG blockade, whereby a muscular blockage of the joint takes place, which is very painful when moving. After a fall, especially in the elderly, one or more bones must always be considered. Especially if there is also osteoporosis, even slight falls to fractures on the sacrum, tailbone and femoral neck and hip can occur.

Additional pain in the pubic bone

Simultaneous pain in the pubic bone and sacrum are common during pregnancy. The pressure and weight load in the pelvis causes not only the displacement of the spine but also a stretching of the pubic symphysis. This creates tension on the pubic bone, which can be painful. A less common cause of this pain can be found in athletes. In the context of long-term exposure, for example from playing football, small micro-fractures occur in the pubic bone, which can become painful.

Pain when stooping

Bending over is a dangerous starting point for acute disc disease and back pain in the sacrum. When you bend over, the spine presses on the intervertebral discs in the front area and squeezes them backwards. After many years of lifting heavy weights from the back, the intervertebral discs can tear and the inner liquid core can leak out. This is a herniated disc.

Even in childhood, people have to be taught a different type of stooping in order to avoid pain and illness in the long term. It is important not to bend down to pick up weights such as heavy moving boxes, but to get up from your knees with your back straight.

Additional pain in the lumbar spine

The lumbar spine is a very common source of sacrum pain. With predominantly office work and lack of exercise nowadays, complaints of the lumbar spine are more common. One speaks of a "lumbar spine syndrome". Since the lumbar spine is located directly above the sacrum, this is also often affected by the pain. Herniated discs also occur excessively between the lumbar vertebrae. In everyday life, complaints can be prevented by moving, building muscles and avoiding lifting heavy loads.

During pregnancy

Pain in the pelvis and lower spine is unfortunately not uncommon during pregnancy. During pregnancy, the female body releases the hormone "relaxin". This is supposed to loosen muscles and ligaments so that the birth can proceed more easily. However, it can also lead to muscle discomfort elsewhere in the body.
ISG blockade is not uncommon in pregnancy. The ligament structures between the hip bones and the lower spine are loosened, which means that stability is lost. During pregnancy, this should be treated with light exercise and muscle building. Medication should be avoided if possible. The pain in pregnancy increases again towards the end of the pregnancy, as the additional weight and pressure in the pelvis exerts forces on the spine.

Pain in the sacrum after pregnancy

The hormonal changes and physical stress that affect the female body during pregnancy should not be underestimated. In particular, the combination of relaxing hormones with a steadily increasing weight load exerts strong forces on the sacrum, the pelvis and the spine. The birth represents a very sudden change, after which the changed structures have to adapt again. This is why back pain often recurs after giving birth. Here, too, targeted exercises help to build up strength.

Sciatica / lumbar sciatica

Sciatica is the term used to describe pain syndromes that are caused by irritation of the sciatic nerve or the associated nerve root. Often the cause is a lumbar disc herniation (Disc prolapse), which compresses the nerve root.Typical symptoms are severe pain in the buttocks area, which, depending on the extent of the herniated disc, can radiate into the leg.
The pain extends over the back of the thigh and lower leg to the foot.
Even a vertebral canal that is too narrow can press on the nerve roots (Spinal stenosis). The symptoms can easily be confused with those of a herniated disc. With lumbago, the pain is concentrated in the lower back. The combination of the two is known as lumbar sciatica.

diagnosis

The diagnosis always begins with a targeted questioning of the patient. It is important in what context the pain occurs, how it feels exactly and whether it can be provoked by certain movements. For example, if the pain occurs after falling from a ladder, the focus will be on bruises and fractures. The diagnosis of such an injury can be confirmed using a radiographic image. Injuries to the bones can be easily recognized in X-rays or CT. However, if the cause lies in the soft tissues of the spine, an MRI scan can provide information.

In addition, if the spine is involved, further physical examinations must be carried out to determine the extent of the damage. This includes, for example, muscle exercises for the legs to rule out nerve damage.

causes

The causes of sacrum pain are numerous. Basically, the pain can have a muscular origin, acute blockages and injuries or be based on chronic diseases and changes. Muscular complaints are very often the focus. These can occur as a result of excessive loads, incorrect loads, jerky movements or for no apparent cause. This can lead to tears, tension and pinching of the gluteal muscles or the muscles of the lower back.

The ISG blockade can also be muscular. This is a very painful blockage of the sacroiliac joint, the joint between the spine and hip bone. Here, the muscles of the joint cramp and restrict its function. The causes are often the lifting of heavy loads, slight movement of the upper body, accidents or a dislocation described as a “step into the void”.

Also read on this topic: ISG blockage - this is how the blockage is released

The lumbar spine is a very common location for chronic pain. Usually this pain can be felt as a dull pain in the deep hollow of the back when moving or after sitting for a long time. They can radiate into the sacrum. The causes are weak muscles, a sedentary lifestyle and incorrect loads such as heavy lifting. Muscular hardening can often be felt in this area. Moving too fast and too strongly can lead to muscle strains, muscle fiber tears and bleeding, which can also be painful in the sacrum.

A sore sacrum can also occur as a result of falls and injuries. The coccyx and lower spine are exposed and are prone to bruises and fractures. The tailbone, sacrum or vertebrae of the lumbar spine can be affected and lead to the pain.

Another common cause of sacrum pain is a herniated disc in the lumbar spine. At this point in the spine, herniated discs tend to occur, often triggered by lifting heavy loads. Nerves that pull from the spinal cord can be involved and carry the pain down to the legs.

Muscular causes

The lower back and buttocks are particularly exposed to great stress. Many people nowadays have poor posture, as activities are often mainly sedentary and the muscles are too weak. Bad posture and lack of exercise tend to lead to tension in the muscles, which can manifest itself in uncomfortable lower back pain, especially after long periods of standing. One can often feel indurations in this area (so-called muscle tension).

Incorrect or excessive strain during physical activity can also cause pain in the sacrum. Muscle strains, torn muscles, sore muscles or symptoms of fatigue can occur. Athletes who make abrupt movements such as have to make quick start and stop movements. Bleeding into the gluteal muscle cannot be ruled out in sports injuries and can also be associated with pain in the sacrum and buttocks.

Coccyx fistula / abscess

An abscess is an encapsulated collection of pus in tissue that can cause severe pain. If the abscess is connected to the surface of the body or other structures by a small duct, it is called a fistula. So-called coccyx fistulas can occur on the coccyx, they are very painful and are accompanied by reddening and swelling of the corresponding area.
Those affected can often no longer sit because the inflammation causes them such severe discomfort.
The pain can radiate to the sacrum and buttocks. The coccyx fistula (also pilonidal sinus) is common in young, slim men with a lot of body hair.
The cause is the ingrowth of hair into the adjacent tissue with a subsequent inflammatory reaction and accumulation of pus. The coccyx fistula can ooze and bleed and usually need to be surgically removed to allow the tissue to heal.

Treatment / therapy

The therapy for pain in the sacrum depends heavily on the diagnosis made. Relatively harmless causes can easily be treated here. Muscle problems such as hardening, strains or tears often heal on their own and only need time to regenerate. This time can be bridged with the help of pain medication such as ibuprofen, heat treatments and massages.

Both fractures and herniated discs must be treated differently depending on their severity and, if necessary, operated on. The decisive factor here is the involvement of nerves and the resulting neurological limitation. In the event of a fracture, the stability of the spine must also be considered. In the event of a fracture of the sacrum, an operation must be performed if the ends of the fracture are not facing each other and therefore cannot grow together. This is called a dislocated fracture. A conservative, non-operative therapy usually consists of an initial immobilization with slowly increasing weight load.

Read more on this topic at: Treatment of a herniated disc

Duration

The duration depends heavily on the causes of the pain in the sacrum. Muscular problems can take different amounts of time. Smaller muscle fiber tears, strains, sore muscles and excessive strain often heal within a few days to a few weeks even without therapy. The healing of major injuries to the muscle can take a few months.

The fracture and bruise of the sacrum also take a few weeks to improve. The decisive factor is whether an operation takes place or not. Conservative therapy requires a further healing period of several months after 4 weeks of absolute bed rest. After an operation, stress and healing can start again sooner.

Herniated discs can vary greatly in duration. Often those affected no longer have pain after a few weeks. However, in some cases the pain can become chronic and last for a few months. Complaints of the lumbar spine or the sacroiliac joint can also take on chronic courses and persist for long periods of time.