What are the main causes of sacrum pain?

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:

• an X-ray;
• an MRI or CT scan (to follow, for diagnostic completion).

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.

"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.