Sacrum Pain: Causes, Symptoms, and Treatment

Treatment Options and When to Seek Medical Care

Pain at the base of the spine can stop a person in their tracks. The sacrum sits right where the spine meets the pelvis, and when something goes wrong there, simple activities like sitting, standing, or walking become difficult. Sacroiliac joint syndrome is a source of pain in about 15% to 25% of people with mechanical low back pain, yet many people have never heard of it. Understanding the causes, symptoms, and treatment options helps individuals receive appropriate care more quickly. Doctronic.ai provides initial guidance on sacral pain symptoms before scheduling a doctor visit.

Understanding Sacrum Pain and Anatomy

The Role of the Sacrum in the Spine

The sacrum is a triangular bone at the bottom of the spine. It connects to the hip bones on each side through the sacroiliac joints. These joints carry the weight of the upper body and transfer it to the legs. The sacrum also protects nerves that travel to the legs, bladder, and reproductive organs. When this area works well, people do not notice it. When problems develop, every movement can hurt.

Differentiating Sacral Pain from Lower Back Pain

Many people confuse sacral pain with general lower back pain, but they are not the same. Sacral pain sits lower, right above the tailbone and near the buttocks. Lower back pain typically occurs higher up, around the lumbar vertebrae. Sacroiliitis can cause pain and stiffness in the buttocks or lower back, and the pain might go down one or both legs. This radiating pattern helps doctors tell the difference.

Common Causes of Sacral Discomfort

Sacroiliac (SI) Joint Dysfunction

SI joint dysfunction is the most common cause of sacral pain. The joint can become too loose or too stiff, both of which cause problems. Too much movement creates instability. Too little movement creates stiffness and grinding. Causes for sacroiliac joint issues include injury, arthritis, and pregnancy.

Traumatic Injuries and Stress Fractures

Falls, car accidents, and sports injuries can damage the sacrum directly. Stress fractures develop over time from repeated strain, common in runners and athletes. These fractures may not show up on regular X-rays right away, making them tricky to diagnose.

Pregnancy and Hormonal Changes

Pregnancy puts extra stress on the sacroiliac joints. Hormones released during pregnancy loosen ligaments to prepare for childbirth. This loosening can make the SI joints unstable and painful. Many women experience sacral pain during the third trimester or after delivery.

Inflammatory Conditions like Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory disease that often starts in the sacroiliac joints. It causes the joints to fuse over time, leading to stiffness and chronic pain. People with this condition typically notice symptoms before age 45, and the pain improves with movement rather than rest.

Identifying Key Symptoms and Warning Signs

Localized Tenderness and Radiating Pain

The main symptom is pain right over the sacrum or slightly to one side. Pressing on the area makes it hurt more. The pain often spreads into the buttocks, hips, or down the back of the thigh. Some people feel it in the groin. Sitting for long periods usually makes it worse.

Impact on Mobility and Range of Motion

Sacral problems limit how well a person can move. Bending forward, twisting, or climbing stairs may become painful. Getting out of a chair or car can be difficult. Some people develop a limp to avoid putting weight on the painful side.

When to Seek Immediate Medical Attention

Certain symptoms require urgent care. These include sudden weakness in the legs, loss of bladder or bowel control, numbness in the groin area, or fever with back pain. These signs could point to serious nerve problems or infection. Doctronic.ai can help users understand if their symptoms need immediate attention or can wait for a scheduled appointment.

Diagnostic Procedures for Sacral Issues

Physical Examination and Provocation Tests

Doctors use specific tests to check the sacroiliac joints. They press on specific sites and move the legs in different ways to determine what causes pain. The FABER test, where the leg is bent and rotated outward, is one common method. If several tests cause pain in the same area, SI joint dysfunction is likely.

Imaging: X-rays, MRIs, and CT Scans

X-rays show bone pathology such as fractures or arthritis. MRIs reveal soft tissue damage, inflammation, and nerve issues. CT scans give detailed bone images. Sometimes doctors inject numbing medicine into the joint. If the pain goes away, it confirms the SI joint as the source.

Effective Treatment and Management Strategies

At-Home Care and Lifestyle Modifications

Most sacral pain improves with simple measures. Ice helps reduce inflammation in the first few days. Heat relaxes tight muscles after the initial swelling goes down. Over-the-counter pain relievers like ibuprofen can help. Avoiding activities that make pain worse gives the area time to heal. Sleeping with a pillow between the knees reduces stress on the joints.

Physical Therapy and Corrective Exercises

Physical therapy is often the most effective treatment. Therapists teach exercises to strengthen the muscles around the pelvis and improve joint stability. Core strengthening is key because weak abdominal muscles put more strain on the sacrum. Stretching tight hip flexors and hamstrings also helps. Most people see improvement within six to eight weeks of consistent therapy.

Medical Interventions and Injections

When home care and therapy are insufficient, physicians may recommend injections. Corticosteroid injections reduce inflammation directly in the joint. The global sacroiliac joint fusion and radiofrequency ablation market was estimated at USD 520.8 million in 2024, indicating the widespread adoption of these treatments. Radiofrequency ablation uses heat to disable pain-causing nerves.

Surgical Options for Chronic Instability

Surgery is a last resort for people who do not respond to other treatments. SI joint fusion permanently connects the sacrum to the hip bone, stopping painful movement. Recovery takes several months, but most patients report significant pain relief.

Preventive Measures for Long-Term Sacral Health

Maintaining sacral health requires attention to posture, strength, and movement habits. Regular exercise that includes core strengthening protects the lower back and pelvis. Maintaining a healthy weight reduces stress on the joints. Using proper lifting techniques prevents injury. People who sit for long periods should take breaks to stand and stretch. Wearing supportive shoes helps keep the pelvis aligned. Doctronic.ai provides ongoing health guidance that can help track symptoms and suggest preventive strategies.

The Bottom Line

Sacral pain is common and treatable when properly diagnosed. Most people improve with physical therapy, lifestyle changes, and sometimes medical interventions. Getting help early leads to faster recovery and prevents chronic problems.