What are the main causes of sacrum pain?

What are the main causes of sacrum pain?

Publication date: 25-03-2024

Updated on: 25-03-2024

Topic: Orthopedics

Estimated reading time: 1 min

The sacrum is a bone structure formed by the fusion of 4 vertebrae. This single structure joints with the pelvic bones (the 2 iliac wings and frontally the ischial bones and pubic symphysis) and the coccyx. The sacrum is the last section of the spine that joints with the pelvis and transmits load and balance from the lower limbs to the torso and is involved in multiple movements.

Pain in the sacrum or sacralgia can be caused by a variety of reasons and must be thoroughly investigated. Dr. Marco Brayda-Bruno, Head of the Department of Spinal Surgery III at Ospedale Galeazzi - Sant'Ambrogio, outlines its main reasons.

The main reasons for pain in the sacrum

The main reasons for pain related to the sacrum are:

  • traumas;
  • musculoskeletal pain.

Coccyx subluxation and fracture of the sacrum

The most trivial and relatively common cause of sacrum pain results from a moderate trauma: "As a result of a fall or direct trauma, a subluxation of the coccyx with respect to the sacrum can be caused" - Dr. Brayda Bruno explains.

In this case the pain is radiating to the anal area and has no specific treatments other than manipulative and anti-inflammatory ones.

A more comfortable sitting position, with a cushion or donut pillow, and avoiding sitting on hard surfaces may be advisable to relieve the pain."

More significant pain in the sacrum may be caused by a more severe trauma causing a fracture of the sacrum: "In case of a more severe trauma and in the hypothesis of a fracture - the orthopedist outlines - it is necessary to perform:

The proper treatment for a plain fracture of the sacrum is rest. The spongy bone of the vertebrae will tend to bond naturally within 2 to 3 months.

However, in case of more extensive fractures involving the pelvis, a surgery may be required."

Musculoskeletal disorders

In cases where there is no trauma with a possible sacral fracture, pain may result from the irradiation of musculoskeletal problems of the lumbosacral passage. This might be due to:

  • discopathies;
  • overloading of the lumbosacral joints;
  • inflammation of the sacroiliac joint, which transmits load and mechanical stresses from the pelvis and lower limbs to the spine.

"These radiating pains may be more frequent among individuals who, for example, have a posture with pronounced lordosis and posteriorly overload the lumbosacral facet joints." - the specialist says.

Instrumental examinations such as MRIs and CT scans can provide evidence of the problem, localizing the area that causes pain.

Infiltrations can be a solution in cases of musculoskeletal pain. "Infiltrations must, however, be targeted at the suffering areas and joints. That is why we usually perform them guided by the scope or ultrasound," specifies Dr. Brayda-Bruno.

Sacrum pain: when it comes to causalgias

"We have analyzed so far the main causes for skeletal sacrum pain, however more rarely some pain radiating to the sacrum may be causalgia, that is, radiating posteriorly toward the spine (in this case toward the sacrum) due to abdominal or pelvic problems" - the orthopedist explains.

In this case, the pain could be caused by disorders of the lower abdomen or pelvis. Therefore, it is important to have a multidisciplinary consultation following the physical examination, clinical tests, and analysis of examinations in order to assess, possibly, the presence of, for example, pelvic lumps or infections.

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