What to do for pain in the sacral spine? Bobyr Clinic

The sacrum is the section of the back located in the lower part of the spine, below the lumbar spine. It is a single triangular bone formed from fused vertebrae. If the sacrum hurts , it is usually the most severe of all back pains. Therefore, when they appear, it is important to immediately consult a doctor.

Pain in the sacrum occurs more often in women than in men. This is due to the fact that women have weaker vertebrae, and this part bears a greater load during menstruation and pregnancy.

Minimally invasive techniques

Therapeutic blockade

Therapeutic blockades are performed by injecting an anesthetic into the area of a peripheral nerve or spasmodic muscle. The blockade not only relieves pain, but also helps to relax muscles, normalize blood flow and improve tissue trophism.

Radiofrequency denervation (RFD)

Radiofrequency denervation (RFD) is a modern and safe non-surgical method suitable for patients for whom other treatment methods are ineffective or impossible.

When is this technique used?

If conservative drug therapy is ineffective - when painkillers, even the most powerful ones, do not help enough or cannot be prescribed due to side effects;
With a long wait for surgery, the patient often finds himself in a situation where he has to wait more than several months for surgery. In this case, RFD can reduce the intensity of pain and make the wait for the operation more comfortable;
If surgery is not possible - when the presence of severe concomitant diseases or other reasons do not allow radical surgery to be performed, RFD is the most effective and safe alternative;

How is radiofrequency denervation performed?

After a standard examination by an algologist, additional examination and diagnostics if necessary, a decision is made to perform radiofrequency denervation.

The procedure is performed on an outpatient basis. Under sterile conditions, the doctor, under X-ray control, inserts special needles into the area that needs to be treated. After the doctor is sure that the tip of the needle is exactly in the right place, a local anesthetic is injected so that the denervation is painless. After this, a thin electrode is inserted through the needle channel, which is connected to a radio frequency generator and the tip of the needle is heated to a predetermined temperature. The patient, as a rule, does not experience discomfort; the most painful moment of the procedure is the usual injection.

In some cases, a therapeutic and diagnostic blockade is first performed in order to determine how effective the technique will be for this particular case. Under sterile conditions, under the guidance of an x-ray system, the needles are precisely positioned in the area to be treated. To reduce discomfort, all manipulations are performed using local anesthesia. After installing the needles, a small amount of anesthetic is injected, interrupting the pain impulse.

Causes and risk factors

The main reason for the formation of a sacral bedsore is prolonged compression of the skin between the bone and the bed. People who are bedridden cannot change their position on their own. When the pressure exceeds capillary arterial pressure, then there is a violation of blood circulation in this area, which causes the death of the soft tissues of the gluteal region. The development and rejection of these necrosis leads to the appearance of deep wounds, the bottom of which may be the sacral bone. Bedsores do not form with proper care and the use of special mattresses with a massage effect. The pressure exerted on the skin, soft tissues, muscles and bones depends on the weight of the patient and the characteristics of the surface on which he lies (sits). This load often exceeds the capillary pressure in the skin (~32 mm Hg), which reduces the possibility of blood supply in the integumentary and soft tissues. In patients with reduced sensitivity or immobility, compression does not cause changes in body position. In a short time, if preventive measures are not used, they may develop necrosis of compressed skin and the formation of a purulent-necrotic wound.

Diagnostic methods

The primary diagnosis is made on the basis of an external examination of the patient, his complaints, and a study of the medical history. The location and intensity of pain is often a clue to identifying the cause of sarcodynia. To confirm the diagnosis and differentiate other diseases, radiography, MRI, CT, and ultrasound are performed. If an infectious origin of sarcodynia is suspected, biochemical, serological studies, and bacterial culture of biological samples are carried out.

Symptoms

Pain in the sacrum manifests itself differently depending on the underlying disease.

Osteochondrosis provokes acute, aching pain radiating to the buttock and leg.
Protrusion and disc herniation by pain in the morning, after prolonged standing. The intensity of the pain syndrome varies; often the patient is forced to take a special position in order to alleviate his condition.
Damage to the sacroiliac joint is characterized by unilateral pain in the sacral region, lameness and muscle cramps.
With radiculitis, the pain is shooting or aching, radiating to the leg and buttock.
Pathology of the pelvic vessels is accompanied by diffuse pain in the sacrum, lower back, and lower abdomen.
Gynecological diseases are accompanied by nagging pain in the sacral and lumbar region. Pain intensifies before menstruation, during sexual intercourse and defecation.
Prostate diseases are accompanied by a dull pain in the sacrum, radiating to the groin.

Why does it hurt?

Pain in the sacral spine indicates pathological changes in the musculoskeletal system. Severe back strain and trauma contribute to pain in the lumbosacral spine. Pain in the sacral spine in women can occur due to pathologies of internal organs; such pain syndrome is a signal of the development of a pathological process.

If the lumbosacral spine hurts, then the reasons for such pain are that:

The nerve roots are compressed due to injuries to the lumbar spine, and the pelvis is injured. Pain in the sacral area will appear long after the person has fallen.
The patient has thrombophlebitis changes, and there are other vascular pathologies.
Dystrophic, degenerative changes in the spinal column occur due to impaired water and salt metabolism. They occur due to incorrect posture, prolonged sitting, and heavy physical labor. Such overload leads to displacement of the vertebrae, causing aching pain.
Oncological processes are developing. Metastasis often causes damage to the sacral region.
Inflammatory processes caused by infection occur in the body.
People are depressed and suffer from prolonged stress.
There are pathologies of the gastrointestinal tract (GIT).
A woman is pregnant or has her period, gynecological pathology, prolapsed or prolapsed uterus, hormonal imbalance.
A man has an inflamed prostate, pain radiates to the lower limb, and may be in the tailbone.
Osteoporotic changes lead to destruction of bone tissue, which is why the sacrum hurts.
Colitis is exacerbated; due to intestinal dysfunction, accumulated feces lead to lower back pain.

When it hits the lower back

If pain syndrome of the lumbar spine occurs, osteochondrosis is often the cause. The patient has back pain in the area of the sacrum, lower back, pain radiates to the lower extremities. A person will feel overstrain in the back, it will be stiff. Sometimes sensitivity is impaired. Such tension will lead to the spine losing flexibility and motor activity becoming difficult.

Pain in the sacral spine and lower back occurs when a person sneezes, coughs, turns sharply, stays in an uncomfortable position for a long time, or lifts heavy objects. It will hurt less when taking a horizontal position. Positioning on all fours will also reduce pain; you can also squat and bend your legs at the knee joints or lie on your side.

Pain is also possible with hernias between the vertebrae of the lumbar segment

Pain from a hernia will radiate to the groin and legs. They will intensify in the morning, subside in the evening, and may decrease after the person has walked. When a person is sick with thrombophlebitis, the veins of the pelvic and iliac zones are affected, and there will also be pain in the lumbar and sacral zones. Another pain syndrome will appear when the sigmoid colon adjacent to the sacrum is dilated. It expands due to accumulated feces or inflammation of the intestinal tract.

If an injury occurs

Pain syndrome of the lumbar segment will manifest itself during injury, when a lumbar bruise occurs. A spasm of the myofibers of the lower back and sacrum will occur. A person is forced to take a non-physiological position to reduce the intensity of pain. After the injury, the pain will go away within two days; the patient requires bed rest and medical consultation.

When it hurts on the right or left side

Sometimes the patient will have pain on the right or left side. This indicates an inflammatory process of the sacral and iliac joints, the legs are poorly supplied with blood, and the pelvic bones are displaced. The patient's gait is disturbed, leg muscles hurt, and cramps occur. If the right side of the pelvic zone is displaced, the patient will lose weight, develop diarrhea, and disrupt the function of the gastrointestinal tract. A woman has gynecological problems.

If the pelvis is displaced on the left side, the function of the lungs and heart will be impaired, immunity will decrease, constipation will occur, and excess body weight will appear. If a woman has unilateral pain syndrome in the sacral region, then she probably has malignant neoplasms of the uterus. In a man with pain on one side of the sacrum and irradiation to the lower limb, there is a high probability of developing chronic prostatitis.

The coccyx and sacrum hurt

Pain syndrome, which simultaneously manifests itself in the coccygeal and sacral zones, is often associated with the inflammatory process of the joints of the coccyx and sacrum or there has been an injury. Injury that occurred earlier will lead to the formation of a callus. It, together with salt deposits, causes joint stiffness. The patient is unable to change his body position; when he gets out of bed, he has difficulty straightening up.

If he stands for a long time, it will be difficult for him to bend. The pain will be dull, it proceeds monotonously, sometimes it is paroxysmal in nature and manifests itself acutely.

Often pathological changes in the sacral and coccygeal segments do not appear on x-ray examination

If the spine develops incorrectly

If the spinal column has an abnormal structure, pain may suddenly appear when:

The patient leans to the sides.
Increased load on the spine.
A man fell from a height.
A sudden careless movement has been made.

If the sacrum aches

An aching pain syndrome will occur with spondylolisthesis, in which the 5th lumbar vertebra is displaced. Such pain is also observed with inflammation, injury to the buttocks, sacral ligaments, and iliac region. In men, aching pain develops with chronic prostatitis.

When does it hurt with gynecological pathologies?

Pain syndrome in women is associated with pathologies of the female reproductive system, the following is observed:

with posterior parametritis (pain will intensify with physical overload);
weakened ligaments that support the uterus;
external endometriosis (pain appears cyclically, intensifies during menstruation);
incorrect position of the uterus, when it prolapses, is tilted backward, or prolapsed. The pain will intensify after a long walk, as well as if you stand for a long time;
with oncological processes in the uterus.

Pain and infection

Painful sensations in the sacral area also occur due to infection entering the body, for example, caused by staphylococcus or Koch's bacillus. A person will suffer from such pain constantly, but it will not be intense.

For oncology

Metastasis often affects the sacrum; the initial source of metastasis is located:

in the lungs;
kidneys;
stomach;
mammary gland;
thyroid gland, prostate;
intestinal tract.

The sacral bone is affected when the oncological process has developed without symptoms.

Pain syndrome manifests itself at the final stage of the formation of malignant neoplasms. It manifests itself constantly and has a nagging character

If your metabolism is disturbed

It will hurt in the sacrum when the bones become brittle (with osteoporosis) or soft (with osteomalacia). Sometimes there may be no pain. As a rule, the pain will be dull, not severe, but long-lasting.

Benefits of our Pain Clinic

Fast and safe methods of pain relief; unique proven methods of pain relief: blockades, anesthesia, microinfusion pumps, RFD, port systems for long-term pain relief

Possible complications and consequences

Since sarcodynia is not a disease, it is not capable of causing any complications, unlike the pathologies that caused it. If you ignore pain in the sacrum and do not seek medical help, inflammatory and degenerative processes rapidly progress. Therefore, sarcodynia is the first signal of a pathology developing in the body. The sooner its cause is discovered, the sooner treatment will begin. And this will avoid the development of serious complications.

Consequences

Painful sensations in the sacrum indicate the progression of serious diseases. The symptoms cannot be ignored. If the disease is not treated in a timely manner, deterioration of health and disability may occur. If left untreated, damage to internal organs can lead to problems with the digestive system and problems with the urination process. If the cause of pain in the sacrum is a malignant neoplasm, death is possible if left untreated.

Causes of pain in the sacral area

Pain in the sacral region is a consequence and sign of an emerging, developing or worsening pathology in the human body. This discomfort may indicate a variety of problems - the initial stage of radiculitis, acquired or congenital anomalies, displacement of the lumbar vertebra, pathological processes in tissues and muscles, etc. If pain in the sacrum occurs in women (usually on the left), then this is often a symptom of a gynecological disease. Another cause of pain in the sacral spine may be problems with the genitourinary system. Age-related changes, various metabolic problems, etc. also lead to painful discomfort. Only a doctor (for example, a neurologist)

) after a thorough examination and diagnosis.

Injuries

Pain in the sacrum does not just happen. There are always reasons for this. One of the most common are injuries that bring even greater discomfort when a person takes a certain position. Injury can be caused accidentally due to an accident, a car accident, a fall, or caused to a person intentionally. If you are injured, you should see a doctor immediately to begin treatment and minimize the risk of serious consequences. Very often, trauma leads to displacement of the sacral and pelvic bones, which causes problems with the functioning of nerves and blood vessels. There are two types of displacement, each of which has its own characteristics:

when the right pelvic bones are displaced, severe pain and disruption of the right leg are observed, as well as problems with the gastrointestinal tract, the person loses weight and often feels unwell;
when the left pelvic bones are displaced, a person has problems with the functioning of the left leg and additionally has symptoms such as frequent constipation, colds, impaired functioning of the lungs and heart, as well as excess weight.

If after an injury or bruise the pain does not go away, but only intensifies, contact a specialist immediately.

Osteochondrosis

Osteochondrosis in the lumbosacral region, as one of the common diseases, occurs in many people due to an unhealthy lifestyle, poor nutrition, constant stress, as well as due to injuries and age-related changes. The disease can also develop due to inflammation of the joints of the spine, ankylosing spondylitis and arthritis. How to recognize osteochondrosis in the sacrum? The following symptoms may indicate this disease:

regular occurrence of pain in the lumbosacral spine, that is, the lower back constantly hurts for no apparent reason, even at rest. Sometimes the pain may radiate to the legs and buttocks;
in advanced cases, pain occurs even when a person coughs or sneezes and with the slightest physical activity;
the mobility of the lower back is impaired, and it becomes painful to even bend over a little;
to this is added general irritability, weakness, sleep disturbances, since it is difficult for a person to find a comfortable position.

Chronic prostatitis

If in women pain in the spine in the sacral region can be associated with gynecological diseases, then in men the discomfort is often caused by chronic prostatitis. In this case, the pain is often aching in nature, radiating to the leg or spreading either along the right or left side. Such signs already indicate that the disease is in an advanced stage. With chronic prostatitis, pain can appear not only in the sacral area, but also in the lower abdomen, in the rectum and anus, in the genitals and radiate to the legs.

Causes

Pain in the sacrum accompanies many diseases, not always associated with the musculoskeletal system.

These include:

injuries - falling on your back, lifting heavy objects, etc.;
pathology of bone tissue and muscle structures - osteochondrosis, osteoporosis, abnormal shape of the lumbosacral vertebra, anteroposterior displacement of the V lumbar vertebra, pathology of the sacroiliac ligament;
neurology - lumbosacral radiculitis, disc herniation in the lower lumbar region;
gynecological sphere - female diseases, painful menstruation, pregnancy, operations;
urology in men - prostatitis, adenoma, prostate cancer;
tumors - multiple melanoma, lymphomas, metastases;
infections - tuberculosis, infection with staphylococcus and colibacterium;
other diseases - thrombophlebitis of the pelvic veins, persistent constipation with dilatation of the sigmoid colon, pathology of the urinary system.

Diagnostics

At Dr. Dlin’s clinic, patients with complaints of lumbar pain undergo a thorough diagnostic examination using the latest equipment.

Basic examination methods:

Anamnesis collection.
Primary medical examination with assessment of the patient’s neurological status.
X-ray of the lumbosacral region in several projections.
MRI, CT.

Since pain in the lumbosacral region can be caused by diseases not associated with spinal pathology, additional examination and consultation with various specialists are prescribed as part of the differential diagnosis.

Patient examination

History taking

When collecting anamnesis, it is important to conduct a thorough interview with the patient, pay attention to the “red flags” and identify exactly how the symptoms of the disease affected the person’s performance. The following questions will help determine whether a patient has pelvic dysfunction.

How often do you pee? (normally – every 2-4 hours, or 6-8 times a day).
Have you experienced urine leakage when coughing, sneezing, laughing, or exercising?
Has urine leaked during a sudden strong urge to urinate?
Have you ever been unable to go to the toilet on time?
Have you ever found yourself in situations where you couldn't control your bowels?

The best place to start assessing pain is by completing the Oswestry Low Back Pain Disability Index questionnaire. The choice of treatment strategy will depend on the number of points scored.

Physical examination

Posture assessment.
Palpation.
Neurological examination.
Range of active movements in the lower back and hip joints.
Assessment of joint mobility of the lumbar spine.
Make sure that the cause of the pain does not lie in the hip joint. To do this, perform a hip quadrant test (hip flexion with abduction and adduction) and a FABER test (flexion, abduction and external rotation). The cross-sectional study by Dufour et al supports previous research suggesting that the FABER test can be used to identify pelvic floor weakness, which in turn is one of the parameters of low back pain.
Assessment of the sacroiliac joints (Gaenslen test).

The majority of patients with low back pain and pelvic floor incompetence will likely require core stabilization exercises. The decision to perform a full pelvic floor examination depends on the patient's initial complaints.

A complete pelvic floor examination includes:

Vaginal palpation is a qualitative assessment of the correctness of muscle contraction. Digital examination allows us to better understand the relationship between lumbopelvic pain and the condition of MTD. Most often, manual examination reveals their soreness, followed by weakness.
Transabdominal ultrasound to assess the quality of voluntary and involuntary activation of the MTD and transverse abdominis muscles.
Assessment of MTD force should be performed using a perineometer and/or an electromyograph (EMG) needle to obtain quantitative data on muscle contractions.

Treatment of pain in the sacrum

Treatment is prescribed individually, depending on the disease being diagnosed. There are a number of measures that are carried out for most ailments that affect this area:

Anesthesia. The patient is prescribed medications to help relieve pain. These can be tablets, intravenous or intramuscular injections, blockades. The blockade is done in case of severe pain. It involves the injection of a drug into the spinal canal and pain points in muscle tissue.
Manual therapy and massage. This helps relieve tension in the sacral area, restore normal blood flow and the correct position of internal organs when they are displaced.
Physiotherapy. Physiotherapeutic procedures help eliminate swelling in the sacral area and reduce pain, as well as increase mobility.
Physiotherapy. Used in combination with other methods, it is aimed at stretching and strengthening the back muscles.

Methods and types of these procedures are selected individually for each patient after diagnosis.

In case of severe injuries and other pathologies that cannot be treated conservatively, surgical intervention is prescribed. Its types and methods of restoration are again individual in each case. This could be osteosynthesis, removal of scar tissue, prosthetics, and so on.

For any questions about pain in the sacrum, you can call +7 . Or send a personal message in a special form from the contacts section: I will answer you as soon as possible.

Physiological causes of low back pain in women

One of the main natural causes of back discomfort in women is hormonal fluctuations throughout life. They occur during adolescence, every month during the reproductive period, during pregnancy and at the onset of menopause. In each of these cases, the level of some hormones in the body increases and others decrease. Against the background of complete health, such processes are physiological and do not cause any dangerous changes in the functioning of individual organs and entire systems. But with existing disorders, fluctuations in hormone levels can cause a number of diseases, some of which may be accompanied by lower back pain.

The appearance of aching, weak pain more than 2 times a month in non-pregnant women of reproductive age is a sign of abnormalities and requires consultation with a specialist.

Thus, the physiological causes of low back pain in women are:

menses;
pregnancy;
menopause

Also, discomfort of varying severity in the lumbar region can occur after a hard day at work or active work in the gym or on the ground. It is caused by overstrain of the back muscles and goes away on its own. Sometimes too much stress on the lower back can cause muscle and ligament strains. In such cases, the pain is more acute, which requires consultation with a specialist and the creation of the most gentle conditions for the lower back in order to avoid rupture of muscles and ligaments.

Pregnancy

Pregnancy is a difficult period for every woman’s body. Over the 40 weeks from conception to birth, a lot of changes occur in it, ranging from hormonal changes to a sharp increase in weight, a shift in the center of gravity and an increase in the natural deflection in the spine. This leads to the almost inevitable occurrence of lower back pain of varying degrees of intensity. If they are not accompanied by bloody vaginal discharge and are not acute in nature, they are regarded as a variant of the norm.

But at the same time, physiological changes for pregnancy contribute to the exacerbation of chronic diseases and the manifestation of those that were previously hidden. They also create the preconditions for the development of new disorders, especially in the spine. Therefore, kidney pathologies, osteochondrosis, protrusions and intervertebral hernias are often diagnosed during pregnancy. All this can also be signaled by lower back pain.

Climax

The decline of a woman’s reproductive function is accompanied by a decrease in estrogen production and an increase in the production of other hormones. This leads to so-called hot flashes, mood swings, as well as pressure surges and sometimes lower back pain.

But back discomfort during menopause often does not indicate menopausal changes themselves, but the development of osteoporosis, i.e., a decrease in bone density. This, in turn, can lead to disruption of the integrity of the vertebral bodies and the occurrence of compression fractures of the spine.