The sacrum is an element of the spine that serves to support the upper body and ensure the functionality of the pelvic organs and legs. This ensures not only mobility, but also all vital functions. In the process of human development, the individual vertebrae of the sacrum fuse into a single whole, due to this the ability to maintain weight and a stable position of the torso increases. The sacral region does not need flexibility, this is explained by the peculiarities of physiology. The vertebral bodies are more pronounced, and the processes of the bones have almost atrophied and are hardly noticeable.
Sacral vertebrae
Toward the coccyx, a decrease in the thickness and area of the sacral vertebrae that formed the bone is clearly noticeable. In these places the load is much less than in the upper part; nature does not tolerate irrational decisions . There are frequent cases of fusion of the fifth vertebra (the last in the lumbar region) with the first sacral (sacralization) or separation of the first and second vertebra of the sacrum (labialization). Both phenomena are recognized by medical science as completely physiological and are not considered deviations from the normal development of the spine. In women, the sacrum is slightly shorter, but wider than in men. At the same time, women have a flatter sacral bone; such differences are explained by the function of procreation programmed by nature.
From the base to the apex of the sacrum the bone is pierced in a curved shape by the sacral canal
Anatomy of the sacrum in humans
The sacrum is a triangular-shaped bone located at the base of the spinal column (lumbosacral region).
Structure and muscular system
The sacrum consists of five sacral vertebrae fused together. The function and anatomy of this bone may vary depending on age. So, up to 25 years, the sacrum consists of separate vertebrae with cartilage, and after 25 it is a solid bone. Such fusion ensures withstanding and distribution of loads.
The structure of the human sacrum
The existence of the sacral region is impossible to imagine without the following muscles:
- Pear-shaped . The origin of the piriformis muscle is the ligamentous apparatus, the sacrum, and the greater sciatic foramen. From here, bundles of muscle fibers depart, which subsequently connect and go towards the greater trochanter of the femur. The task of the piriformis muscle is to provide rotational movements of the hip joint.
- Ileum . The iliacus muscle originates from the bone and ends in the area of the lesser trochanter of the femur. The task of this muscle is to provide flexion of the lower limb.
- Multipartite . Multifidus muscle fibers are located in the grooves of the sacrum and are involved in bending the back backward.
- Gluteal . The gluteal muscle fibers begin at the sacrum and coccyx and extend to the gluteal tuberosity. The gluteal muscle is the largest in the sacral region. It is responsible for rotation and flexion of the lower extremities.
Functions
The sacrum performs several important functions:
- protects internal organs located in the pelvic cavity;
- helps the skeleton maintain an upright position;
- is responsible for uniform load distribution.
Note! The vertebrae of the sacrum are immobile, so it is not capable of performing motor functions.
Video: “Structure of the sacrum”
Diagnosis of pain
Diagnosis of the condition will begin with a survey and examination of the patient. The doctor will determine whether there is excess weight, lumps in the lower back, redness, increased temperature of certain areas of the skin, etc. After this, the neurologist
can send you to:
- Ultrasound;
- ;
- MRI
; - x-ray
.
Blood tests and other studies are also additionally prescribed if the suspicion falls on problems associated with internal organs, pain from which radiates to the lower back. To prevent pain in the lower back, tailbone and sacrum from becoming chronic and preventing your condition from getting worse, consult a doctor who will determine the cause of the pain and prescribe appropriate treatment.
Anatomy of the coccyx in humans
The coccyx is the lower part of the spine, consisting of two to five fused rudimentary vertebrae . The coccyx is a remnant of the caudal bodies, which has practically lost its original functions. This structure is distinguished by the presence of nerve endings and sufficient mobility. Therefore, any injuries and pathological processes in the coccyx have severe symptoms and worsen the quality of life and well-being.
Structure and muscular system
The shape of the tailbone resembles a bird's beak - narrow at the end and wide at the base. In medical terms, it has the shape of an inverted pyramid. The wider base of the coccyx connects to the spinal column, and the narrow apex is tilted forward and down. In this case, the width of the organ always exceeds its length.
In most people, the coccyx consists of 3-4 vertebrae (less often - 5). It connects to the sacrum with the help of an intervertebral disc (this is what explains the mobility of the tailbone and the ability to deviate). In people aged 50 and older, the organ becomes less flexible or completely immobile.
Usually the coccyx consists of 3-4 vertebrae
Usually the fusion of the vertebrae of the sacrum and coccyx is completed at 12 years , but in some cases this process is delayed up to 40-45 years. Sometimes unilateral fusion of the vertebrae occurs, which is considered absolutely normal and is taken as an individual special skeletal structure.
The anterior sections of the coccyx are intended for attachment of ligaments and muscles involved in the functioning of the organs of the genitourinary system, as well as the distal sections of the large intestine (iliac, pubic and coccygeal muscles, anal-coccygeal ligament). In addition, some muscle bundles of the gluteus maximus muscle, which is a powerful hip extensor, are attached to the tailbone.
Functions
As mentioned earlier, the coccyx is a remnant of the tail that does not perform any major functions.
However, he takes an active part in the work of the musculoskeletal system , namely:
- serves as a place for attachment of muscles that ensure the normal location and maintenance of the intestinal organs, as well as the urinary system;
- ensures normal mobility of the hip joints;
- ensures discrepancy and mobility of the pelvic floor in women during childbirth and pregnancy;
- provides support for the vertebrae when performing active movements, as well as during squats and bends;
- promotes proper distribution of the load on the spinal column.
Why might pain occur?
Pain in the area of the final part of the spine can be caused not only by diseases of this part of the spinal column itself, but also by a fairly large list of pathological conditions. The main reasons are given in the table.
| Cause | Manifestations |
| Osteochondrosis | It is one of the most common causes of pain. This is due to the fact that the resulting osteophytes (bone growths) compress the nerve endings, causing pain, numbness, a burning sensation or crawling sensations. |
| Injury | Injury (bruise, crack, fracture, dislocation) can occur when falling and landing on the buttocks or in the event of a direct blow to the coccygeal area. It is rarely possible to determine what kind of injury it is based on clinical signs. All injuries are accompanied by pain, local swelling and bruising. An examination is necessary to make an accurate diagnosis. |
| Pathological birth | Excessive posterior deviation of the tailbone is possible with a large fetus or if the woman has a narrow pelvis. |
| Epithelial coccygeal tract | Such a cyst is a congenital pathology, which is a narrow, blindly ending canal in the subcutaneous tissue of the intergluteal region. Under unfavorable circumstances (decreased immunity or direct infection), suppuration of the contents may occur. If the disease is started, an abscess or secondary fistula forms. |
| Inflammatory processes in the pelvis | Diseases of the pelvic organs (urethritis, salpingitis, endometritis, oophoritis, prostatitis) can be accompanied not only by nagging pain in the lower abdomen, but also in the coccyx area. |
| Tumors | Pain in this area can be caused by bone tumors (sarcomas) or cartilage tumors (chondrosarcomas), as well as metastases of malignant neoplasms of the ovaries and prostate gland. |
| Colon diseases | Diseases of the rectum and sigmoid colon (hemorrhoids, proctitis, anal fissures, rectal tumors) quite often lead to pain in the coccygeal region. |
| Scars and adhesions | The formation of adhesions and scars after operations on the pelvic organs, anus, sigmoid and rectum can cause pain in the tip area. |
| Pregnancy | The cause of pain is the tension of the ligaments of the pelvic bones as the uterus grows. Typically, such pain is also accompanied by discomfort in the groin area. |
| Sciatica | If the sciatic nerve is pinched, pain may appear in the tailbone, buttocks and the back of the thigh. |
Features and differences in the structure of the sacrum and coccyx in women and men
In women, the sacrum is wider, shorter and less curved than in the stronger sex. At the same time, this structure is more mobile: ligaments allow it to deviate by an angle from 8 to 14 degrees. Actually, it is due to this that the female body is more flexible than the male one.
There are also differences in the structure of the coccyx. The female pelvis is shorter and wider, adapted to labor. The size of the hole also differs: in women it is large enough for the baby’s body to pass through it.
It is noteworthy that this hole, thanks to the movable coccyx, increases during labor . As for men, their tailbone is less mobile and therefore less susceptible to bruises and injuries.
Video: “Structure of the spine”
Spinal pathologies are the most obvious causes of sacrodynia
The high prevalence of back problems has become humanity's price for upright walking, which is so beneficial for us. Unlike that of dogs or primates, our spine is forced to serve as a shock absorber for any type of movement, from innocent rocking from heels to toes to extreme jumps on a hard surface. And if the cervical vertebrae have to support only a three-kilogram head, then the sacrum has to bear almost half of the body weight.
It itself does not contain cartilage tissue, which is elastic but vulnerable, but pain occurs when the above and underlying discs are damaged. They can be the result of an intervertebral hernia, a fall on the edge of a staircase, and osteochondrosis inclusions of hard bone matter.
The development of sacrodynia is promoted by inflammation of the joints, through which the wide pelvic bones are attached to the sacrum.
What is sacralization and lumbalization?
There are a number of anomalies in the development of the base of the spinal column and sacrum that affect the functioning of the spine. Such anomalies include sacralization and lumbalization .
The sacrum is a solid bone in the human skeleton, consisting of 5 fused vertebrae and located between the bones of the pelvis. The upper part of the sacrum is connected to the last lumbar vertebra, and the lower part is connected to the coccyx. It is here, at the top in the sacrum or in the last lumbar vertebra, that congenital pathological processes of sacralization and lumbarization arise.
During lumbarization, the uppermost vertebra of the sacrum does not fuse, but moves freely , participating together with the neighboring lumbar vertebrae in spinal activity. Often the additional mobile vertebra is called “additional”, which can cause confusion in the patient’s mind.
But in fact, no “additional vertebra” is observed during lumbarization. It’s just that there is one less fixed vertebra and one more movable one.
As for sacralization, here the lower lumbar vertebra fuses with the ilium or sacrum . Sometimes the pathology is accompanied by an increase in the transverse processes of the vertebra and a change in its shape.
With lumbarization and sacralization, the articulation of the transitional vertebra or its separation from the sacrum occurs completely or partially.
Prevention
Some pathologies of the sacrum cannot be prevented, for example, congenital anomalies or fractures, as well as neoplasms. But many conditions are preventable. It is recommended to control body weight and prevent its excessive increase, which will create a load on the sacral region.
In addition, patients whose professional activities involve staying in one position for a long time should strengthen their back muscles with the help of special exercises. This will prevent poor posture and displacement of the vertebrae.
An additional method of prevention is diet correction. It is worth eating foods rich in calcium and B vitamins.
This menu will saturate the nerve fibers and bone tissue with the necessary substances. If the patient suffers from any chronic disorders of the spine, it is necessary to regularly visit a neurologist and undergo a course of treatment to prevent complications.
Common diseases of the sacrum and coccyx
Did you know that...
Next fact
The most common pathologies of the coccyx and sacrum are listed below.
Osteochondrosis
Osteochondrosis of the lumbosacral region is accompanied by deformation of intervertebral cartilage tissue . It becomes dry, less elastic, and begins to change shape. Degenerative-dystrophic processes lead to the appearance of pain and impaired mobility in the lumbar region.
Lumbosacral spondylosis
When the load on the intervertebral discs becomes too great, their height decreases. The bony bodies of the vertebrae touch each other, and friction occurs between them. The body grows new bone tissue (to replace the deformed one), and its excess forms on the sides of the vertebrae in the form of spines.
These spikes point towards the cartilage and injure them even more. The friction between adjacent vertebrae increases, the destruction of the discs accelerates - as a result, the deformations close in a “vicious circle”.
Osteochondrosis and spondylosis - often found in the lumbosacral area
Lumbar protrusion
The intervertebral discs of the lumbar region consist of a soft nucleus pulposus and a dense fibrous membrane surrounding the nucleus. Together they are an elastic structure that ensures mobility of the spine. With osteochondrosis, the discs dry out and become less elastic.
Under the influence of load, the fibrous membrane partially protrudes (this phenomenon is called “protrusion”). Cartilage tissue that exceeds physiological limits can pinch nerves and cause unpleasant symptoms in the form of pain, paresthesia and stiffness. The main danger of the pathology is that it can lead to the development of a lumbar hernia.
Lumbar hernia
When the integrity of the fibrous membrane is compromised, the soft pulp partially comes out . Typically, in this position, the lumbar nerve root experiences severe compression.
A hernia occurs as a result of osteochondrosis
To relieve pain, the body contracts the psoas muscles, which leads to neurological symptoms. The sensitivity of the lower extremities worsens, the functioning of the pelvic organs is disrupted, and the pain begins to radiate to the legs.
If the hernia is directed dorsally (backward), a narrowing of the spinal canal may occur. The spinal cord experiences compression, which can lead to paralysis and lifelong disability.
Often it is possible to get rid of a hernia and prevent the development of complications only through surgery. Moreover, with a dorsal hernia, surgical intervention is complicated by the specific localization of the pulp exit.
Study the structure of other parts of the spine:
- You can familiarize yourself with the structure of the spine in the lumbar region here
- Anatomy of the vertebrae and muscles of the spine in the cervical region
- You can find out where the deep and superficial back muscles are by following this link.
- The anatomy of the neck muscles and its organs is on the page
Sciatica
Sciatica (lumbosacral radiculitis) is a disease in which the sciatic nerve becomes inflamed and pinched.
Sciatica occurs due to pathological changes in the spine, which leads to compression of the sciatic nerve
It is accompanied by the appearance:
- severe pain that intensifies when trying to sit down;
- lumbago when trying to get up;
- heaviness when walking, bending forward and to the sides;
- symptoms of paresthesia of the lower extremities;
- hip pain radiating to the feet.
At first, the painful sensations are mild and localized in the lumbosacral and pelvic areas. As the disease progresses, pain appears in the lower extremities. Sciatica in this form can exist for a long time. Injuries, sudden movements, or exposure to low temperatures can transform the disease into an acute phase.
Lumbodynia
Shooting in the lower back is also a relatively common consequence of a pinched nerve in the spine. Lumbodygia in medicine refers to a lumbago in the lumbar region, accompanied by stiffness and sharp pain.
The cause of lumbodynia is compression of the lumbar nerve root.
To protect nerve tissue from further deformation, the brain sends a signal to contract to nearby muscles.
The result is severe muscle spasm, limiting the ability to move. Thus, lumbago is the body’s protective reaction to damage to the nerve roots.
Lumbar lumbago cannot be called an independent disease.
This is a symptom of lumbar pathology, which manifests itself against the background of hernias, protrusions or sudden movements of a person with osteochondrosis.
Treatment
Pre-hospital assistance
For bruises and hematomas, rest should be ensured. Suspicion of a sacral fracture is an indication for immediate hospitalization. The patient must be placed on a backboard and given an anesthetic. For non-traumatic pathologies of the spine and neurological disorders, warming, anti-inflammatory and local anesthetics are effective.
For dysmenorrhea, analgesics are allowed. If you suspect other gynecological pathologies, especially those that suddenly arise and are accompanied by increasing pain, self-medication can be dangerous. An urgent examination by a gynecologist is required.
Conservative therapy
The plan of conservative measures is determined by the nature of the pathology. The list of treatment methods used includes:
- Protective mode
. Recommended for injuries, diseases of the spine and nervous tissue. May include bed rest, load limitation, and the use of orthopedic devices. - NSAIDs
. Indicated for rheumatic pathology, chronic pain caused by damage to the musculoskeletal system. Prescribed in the form of tablets, injections and topical medications. - Chondroprotectors
. Used for degenerative diseases to restore cartilage tissue. - Physiotherapy
. Physiotherapeutic measures are carried out for pain in the sacrum that is not associated with volumetric processes. Electrophoresis, heat therapy, magnetotherapy, and laser therapy are used. For many pathologies, the treatment regimen includes massage, exercise therapy, and acupuncture. - Chemotherapy, radiation therapy.
Necessary for oncological lesions. They can be carried out as an independent treatment or as an addition to surgery.
Surgery
The tactics of surgical treatment depend on the localization of the pathological process:
- Spinal diseases
: nucleoplasty, microdiscectomy, discectomy, facetectomy, laminectomy, sequestrectomy, tumor removal. - Women's diseases
: removal of paraovarian cyst, hysterectomy, panhysterectomy, supravaginal amputation of the uterus, amputation of the cervix, instrumental removal of the ovum, etc. - Urological and andrological pathologies
: tumor removal, bladder resection, cystectomy, prostatectomy, cryoablation and FUS ablation of the prostate gland.
In the postoperative period, restoration measures are carried out. For some pathologies, reconstructive interventions are subsequently performed.
How are they treated?
Before starting treatment, it is necessary to find out the cause of the pain syndrome; for this, diagnostic measures are carried out. Which doctor should I contact? You can consult a specialist in the field of neurology, orthopedics, gynecology, urology, traumatology, manual therapy. Therapeutic measures are long-term; various methods are used to reduce and eliminate pain in the sacral and lumbar zones.
Treat with medications (blockades, painkillers, anti-inflammatory drugs). Pain should also be treated with massage, physiotherapeutic procedures, acupuncture, and physical therapy. These methods will eliminate muscle spasms, improve microcirculatory processes, and unblock the spinal segments.
If the cause of the pain syndrome is unclear, then the temperature parameter is first measured, it will show the presence of an inflammatory process or infectious pathology. They determine the accompanying symptoms, call a doctor and get examined. If the root cause is established, then take a non-steroidal drug that relieves inflammation. Treated with Diclofenac, Ibuprofen. The inflammatory process will be eliminated, pain will decrease.
Medicines that reduce pain are also prescribed; they normalize microcirculation and restore neurons. The patient is treated with tablets, ointments, and gels. Eliminate the inflammatory process and spasms with Novocaine, Lidocaine, Cortisone, Dexamethasone and other medications. A diuretic is taken once. Treated with Veroshpiron, it will eliminate swelling and enhance microcirculatory processes. Using a towel or a special belt, tighten the lumbar region, it will be fixed, the muscles and bones will be in a stable position.
Contact a doctor for further diagnosis and therapeutic measures. It is important to remember that before performing manual treatments on the spine, the chiropractor must refer the patient for a computed tomography or magnetic resonance imaging scan. If a large intervertebral hernia is diagnosed, then surgery is indicated. The hernia is removed, the nerve roots are restored, and the pain goes away.