Sacral pain - causes, symptoms, therapy

Signs and therapy of sacral pain

Whether it's a lumbago or an existing joint disease - pain in the sacrum at the lower spine are usually extremely unpleasant. The pain symptom now occurs in almost all age groups. But what is behind it and how can sacral pain be successfully resolved or prevented?

contents

• Signs and therapy of sacral pain
• definition
• Causes of Sacral Pain
• Unhealthy everyday habits as the main cause
• Sacral pain due to spinal disorders
• Sacral pain and organ diseases
• Mental complaints and sacral pain
• Associated symptoms
• diagnosis
• therapy
• Protection and movement therapy
• Physiotherapeutic and orthopedic measures
• Home remedies and medicinal herbs
• Medicines and surgery

definition

The medicine called sacral pain pain symptoms that occur specifically on the sacrum (sacrum) or radiate into this area. The vertebral bone together with the pelvis (Pelvis) forms the so-called pelvic girdle (Cingulum membri pelvinii), whose movements significantly shape the sacral bone. In general, the spinal bone is in many ways a central functional element for movements in the middle of the body. For example, the sacral bone forms the connecting link between the living spine and the coccyx (coccygeal bone) and thus supports the forward and backward bending of the spine.

Sacral pain is present in all age groups today. (Image: BillionPhotos.com/fotolia.com)

On the sides of the sacrum is also connected to the ilium (ilium) and the sacroiliac joint (Articulation sacrooiliaca). At this bone and joint formation join the hip and thigh bone, which are essential for any run, standing and sitting movement.

The special function of the sacrum in the musculoskeletal system - as well as the associated, versatile pain potential - becomes all the more evident when one looks at the nerve cords that emerge from this bone section. These are 5 sacral nerve pairs, called S1 to S5, each of which represents a so-called spinal nerve (Nerus spinalis). Spinal nerves are also known as spinal nerves because they originate from the spinal cord located in the spinal canal (medulla spinalis). From there, the spinal nerves next to the chest area in particular in the body extremities, ie neck, arms and legs, continues.

The spinal nerves form an essential part of the peripheral nervous system, which both sends movement impulses to the musculature of the extremities, and is therefore also responsible for sensory and thus pain stimuli in the arms and legs. The spinal nerves of the sacrum form together with the spinal nerves from the lumbar region a special network of nerves, namely the lumbar-intervertebral mesh (plexus lumbosacralis). After emerging from the spinal cord, the sacral and lumbar nerves merge into new nerve fibers, which continue into the lower extremities. Important nerves that arise from the nerve segments of the sacrum are:

• Upper buttock nerve (Nervus glutaeus superior) - responsible for movement impulses in the hip and buttocks area.
• Lower buttock nerve (Nervus glutaeus inferior) - responsible for movement impulses in the hip and thigh region.
• Anal-rump nerve (Nervi anococcygei) - important parts of another neural network, the coccyx (coccygeus plexus), which among other things, the dam muscles and sphincter function in the anal area co-responds.
• pudendal nerve (Nervus pudendus) - responsible for sensations in the pelvic and genital area as well as for local movements; It also controls the urinary tract muscles, such as the urinary bladder sphincter to prevent incontinence.
• Rear thigh skin nerve (Nervus cutaneus femoris posterior) - responsible for movement impulses on the thigh back and in the knee.
• sciatic nerve (Sciatic Nerve) - responsible for thigh movement, with the sciatic nerve splitting into two major major branches:
  1. Fibula nerve (Nervus fibularis) - important for extension and flexion of the knees, ankle and toes,
  2. Tibial nerve (Nervus tibialis) - also responsible for complex movements of the foot and ankle motor.

It is not difficult to see that pain stimuli in the region of the sacrum can originate in all indicated nerve areas. In addition, sacral pain can also be caused by nerve complaints that originate directly from the lower spinal canal or the lumbar spine. Often, one of the following three pain syndromes comes to the fore:

• Lumbago: Better known as "lumbago", the sacral pain originates here in the course of a lumbar back pain originating from the lumbar spine. Since it is usually a complex pain complex, which may possibly be accompanied by other accompanying symptoms in the lumbar region, this is also referred to as the local lumbar syndrome. The term "lumbal" comes from the Latin word lumbus for "loin".
• sciatica: The pain comes from the sciatic nerve, again involving the sacrum. This variant of sacral pain is also commonly referred to as sciatica or sciatic nerve syndrome.
• sciatica: The pain in the area of ​​the sacrum results from a combination of lumbago and sciatica. Thus, both the sacral, lumbar and sciatica regions are affected by the pain.

Many nerves on the cruciate ligament can trigger pain. (Image: Romario Ien / fotolia.com)

Causes of Sacral Pain

The area of ​​the lower back, where sacral pain is localized, consists of numerous articulations between the vertebrae and pelvic bones, which in turn are held by ligaments and muscles. Thus, in this area increased stability is achieved, which is necessary to allow upright walking and to keep the center of gravity. Likewise, in the pelvic area a certain flexibility is needed to be able to guarantee normal activity changes between upright walking, sitting, standing and lying down.

And it is precisely these two very contrary requirements placed on the anatomical area around the sacrum that make this pelvic bone very susceptible to disorders and damage in our time. The modern everyday life is therefore particularly noteworthy, because compared to earlier epochs of human history, it holds much more and sometimes also very unnatural stress factors for the spine and pelvis. All in all, dysfunctions and damage to the musculoskeletal system as a cause of sacral pain can be divided into three categories:

• Causes degenerative nature,
• Causes of functional nature,
• Causes structural nature.

Unhealthy everyday habits as the main cause

Today degenerative signs of wear are the most common cause of sacral pain. The facilitating factor here is the change in our way of life towards a daily routine that involves more and more seat-bound activities. A special risk group here are people who work in the office. From the secretary to the computer scientist, office workers complain almost regularly of low-back pain - triggered by a lack of exercise and a monotonous or crooked posture during work. Corresponding movement deficits are then unfortunately often not compensated for enough by exercise in the leisure time. On the contrary, seated behavior often continues after work in front of the TV, computer, or game console.

A further risk group is provided with regard to back pain due to back-loading activities of craftsmen, warehouse workers, construction and mining workers. Here it is an increased weight load, as it arises in particular by the constant lifting and carrying heavy loads. And even overweight persons are usually at an increased risk of contracting sacral pain due to excessive weight bearing on their back and hips. Considering that being overweight is now a veritable widespread disease based on the over-consumption of convenience foods and fast foods, the modern way of life can again be seen as the originator of the problem.

By the way: Even children and adolescents complain more and more often about lower back pain. The reason for this is, on the one hand, the rampant overweight among the youngest in society. On the other hand, the school life of children is always more focused on performance, which is associated with longer periods of sitting in the school itself, but also at home when learning or doing homework. In addition, especially young people tend to move in their spare time too little and instead prefer to watch TV and play computer or video games.

An everyday life dominated by sitting promotes cruciate ligament pain. (Image: Elnur / Fotolia.com)

No matter which of the named cause mechanisms exists, the result is always the same. As a result of the persistent poor posture or incorrect loading of the lower spine it comes to

• muscle tension,
• muscle shortening,
• local nerve irritation
• and inflammations.

In the long term, the detrimental effects of creeping demolition and remodeling processes in the affected tissue regions result. This degeneration process can affect both the muscles and nerves, as well as bone structures, ligaments and discs. It should be noted that pain in the sacral and lumbar region already occur during tissue irritation and thus before the onset of actual degeneration. Often, however, they quickly disappear in these early stages and are therefore not taken seriously enough. Only when degenerative processes cause ever longer lasting and more intense pain, many sufferers recognize the sacrum pain as a harbinger of signs of wear, which painfully adds to the sacrum.

Sacral pain due to spinal disorders

From a certain age, a certain amount of spinal wear is quite normal. The risk of wear and tear therefore increases significantly from 40, whereby harmful everyday behavior and occupational heavy lifting can significantly reduce the average risk age. The most common disease that causes age-related pain in the sacrum here, is the herniated disc in the lumbar region. Here, the dismantling and reconstruction processes in the vertebral bodies and the intermediate intervertebral discs cause the disc serving as a shock absorber to slip out of position and thereby irritate the surrounding tissue. The irritation concerns in particular the spinal nerves emerging from the spinal cord at the height of the lumbar spine. For this reason, it can also come in the course of the herniated disc to a sciatica or lumbago. Such a scenario is all the more likely if the prolapsed disc causes a narrowing of the spinal canal, the so-called spinal canal stenosis.

Ab- and rebuilding processes in the vertebral bodies can also lead to additional bone tissue being formed at locations of particularly high stress. These bone formations refer to physicians as spondylosis. It can in principle occur on all vertebral bodies, but in many cases mainly affects the cervical and lumbar spine, which is why neck and sacral pain are relatively typical for this clinical picture. If the spondylosis also causes local inflammation, it is called spondylitis.

In contrast, inflammatory spinal disorders such as rheumatism are less responsible for low back pain. In contrast to the degenerative diseases, the global spread is relatively small at just over two percent. However, if one of these diseases occurs, it mostly affects the cervical and lumbar spine areas.

As a rule, no isolated cause for the inflammations of the vertebral bodies, vertebral joints and intervertebral discs can be identified. Rather, the doctors assume a multifactorial event. For example, in rheumatoid arthritis or Bechterew's disease, sufferers often have several of the following disease-promoting factors:

• Genetic predisposition,
• Assessment of the immune system to overwhelm immune responses, as it is typical for allergy patients and patients with autoimmune disease,
• previous infection,
• temporary physical and / or emotional overload.

As a result of the inflammatory processes, in addition to some very severe and movement-restricting pains, there are also ossifications in the area of ​​the spine, which cause an additional restriction of the mobility. The medical term of the disease ankylosing spondylitis, ankylosing spondylitis, means in this context, for example, nothing more than "stiffening inflammation of the vertebrae". It is still regarded as incurable, despite increasing medical research, because it is based on genetic factors for which there is currently no suitable therapy. Fortunately, some therapeutic measures can at least inhibit a severe course and relieve the symptoms of concomitant symptoms such as the disease-typical sacrum pain. Other, only conditionally treatable spinal disorders that are repeatedly associated with sacral pain, are:

• Humpback(kyphosis,)
• Hollow back (lordosis),
• Hunchback (hyperkyphosis),
• Spinal curvature (scoliosis).

A special case are spinal injuries.

Especially dangerous are sacral pain when they are caused by injury. Traumatic forces acting on the sacrum, such as when lifting heavy loads, in falls or in accidents are considered as causes in this case. However, inflammatory and rheumatic processes also pose an increased risk of injury in the later stages. The blockade of the sacroiliac joint plays a special role in this regard. In this event, also known as ISG blockade, there is tilting due to incorrect loading in the area of ​​the joint between the crura and ilium, which can cause immobility and severe pain in the sacrum. The pain usually gets worse when you lean forward or sit cross-legged. Often in the morning after getting up or in the event of changes in position after prolonged sitting, a cracking in the joint can be felt and heard.

Sacral pain and organ diseases

The sacrum, in conjunction with the pelvic bones, also houses some of the internal organs, providing them with protection and support. Due to this anatomical proximity, diseases and pathological processes on internal organs can also lead to sacral pain without any direct structural damage to the sacrum. To distinguish from diseases of the musculoskeletal system but falls on the fact that the pain

• often continuously available,
• regardless of movements occur,
• their intensity can not be influenced by changes in their position,
• often run like a colic or shear,
• Accompanying symptoms such as fever, abdominal pain or a burning urination are present.

Since corresponding organ diseases are extremely versatile, below is a brief overview of conceivable causes of the disease:

Organ / organ system	Possible clinical pictures
Female genitalia	Ovarian inflammation (pelvic inflammatory disease) Pelvic organ prolapse Ectopic pregnancy (Extrauterine pregnancy) endometriosis Fibroids and tumors of the uterus
Male genitals	Prostatitis (Prostatitis) Testicular inflammation (orchitis)
Urinary tract and kidneys	bladder infection Wanderiere, horseshoe kidney Pyelonephritis (pyelonephritis) kidney metastases lithiasis Adhesions, inflammations and abnormalities
Intestine, pancreas and gallbladder	pancreatitis (Pancreatitis) Appendicitis (appendicitis) intestinal perforation intestinal mucosal inflammation colon cancer Intestinal obstruction (ileus) Pancreatic head carcinoma pancreatic cysts gallstones
Aorta, large iliac arteries and veins	abdominal aortic aneurysm Beck vein thrombosis Beck artery occlusion

Mental complaints and sacral pain

Considering how many nerves go through the sacral region, it is not difficult to guess that emotional problems may be responsible for the pain. It is not without reason that proverbs such as "that broke his spine" or "he has a hard time" exist. In fact, nerves like sciatica often respond to mental stress more than thought. In order to understand this connection, one has to move mentally away from the conventional medical concept of local and physical causes.

Psychosocial factors such as loneliness, lovesickness, debt, unemployment, a lack of social network and bullying in the workplace can put the body and mind in a state of permanent tension, which also affects the back and the nerves along the spine. In addition to initial muscular tension, it comes with time to restraint and nerve irritation, which are initially barely noticeable, but in turn trigger further tension.

Mental stress can lead to sacral pain. (Image: nenetus / fotolia.com)

If this vicious circle is not interrupted, a so-called chronic back pain develops, which ultimately can even cause detectable changes in the skeletal system with imaging techniques. Chronic pain then further restricts the quality of life. Everyday things are increasingly torture and the pain is increasingly in the foreground. Living a normal life is becoming more and more difficult and sufferers reach their physical and emotional limits. In addition, if the causal, mental stress is not resolved, this further aggravates the symptoms.

Sickle pain can therefore both be the cause of mental illness as well as a psychosomatic symptom of mental stress. Some conceivable psychological triggers or consequences of the sacrum pain are:

• mental trauma (for example, through loss or abuse experiences),
• mental disorders (e.g., depression),
• Eating disorders (e.g., bulimia or anorexia),
• Anxiety and panic disorders (e.g., social phobias),
• Addictions (e.g., drug or alcohol dependence).

Associated symptoms

Suffering pain in the sacral region should always be considered as a possible warning sign of injury or serious illness of the spine, like all chronic back pain. Although in about 50 percent of all cases an easily cured cause of the pain can be identified and most patients are able to perform and work again after about one week, the number of conceivable functional or degenerative disorders in the spine area is very large. Just a nerve damage such as the sciatica should be diagnosed early in this context, as the healing of this largest nerve of the body can sometimes drag on for up to a year. The occurring pain is often of very different nature and severity in all its multiple causes. It is conceivable, for example, a pain that

• dull or strong stinging and pulling,
• concentrating locally on a limited point,
• to the back, buttocks and / or thighs radiates,
• becomes weaker or stronger during exercise,
• caused severe loss of motion,
• associated with overheating, redness or bruising,
• accompanied by tingling, numbness or paralysis of the legs,
• together with problems with urination / incontinence.

diagnosis

Information about the presence of sacral pain gives the doctor, of course, above all the conversation with the patient. In the course of the conversation, he should also address any concomitant symptoms, everyday habits, underlying diseases as well as his or her own emotional state. Thereafter, treating physicians perform standard motion and pain tests, which may include the lumbar and pelvic area as well as the rest of the spine and the lower extremities. In order to find out the cause, many investigative measures are possible, such as ultrasound, X-ray, CT or MRI, blood and urine tests and psychotherapeutic diagnoses. The doctor usually goes on suspicion or acts on the principle of exclusion diagnosis.

therapy

Sacral pain is one of those symptoms that can often be well cured by self-initiative. Of course, the prerequisite is that there is no serious underlying illness or injury. Under certain circumstances, medicinal or surgical measures may also be necessary.

Protection and movement therapy

The most important step in alleviating sacral pain is to make the sacrum less stressful in everyday life. That does not mean you should not move your pelvis anymore. Rather, avoid monotonous and crooked postures and strengthen the pelvic muscles for more stability through exercise (such as aquagym). Overall, the everyday life should be designed so that as little as possible muscular, but also mental stress acts on those affected. Relaxation activities such as yoga, meditation or liberating conversation therapy are recommended.

Physiotherapeutic and orthopedic measures

Also physiotherapeutic exercises help to cure slight causes of sacral pain as well as the pain itself. In addition, physiotherapists can give valuable tips on back support and back protection in everyday life. A visit to the orthopedist may be necessary if a medical corset (orthosis) is needed to correct posture. This is important, for example, in the case of advanced degenerative diseases and congenital deformities of the spine. In addition, a visit to a back school is recommended.

Home remedies and medicinal herbs

There are some herbs that help with back and back pain. These include in particular:

• arnica,
• chili,
• elder,
• St. John's Wort,
• chamomile,
• mullein,
• lavender,
• marjoram,
• mint,
• myrtle,
• clove,
• oregano,
• rosemary,
• sage,
• star anise,
• devil's claw,
• juniper.

For example, one can use the herbs for a warming healing wrap, because warmth generally does backache very well. Chilli, in particular, is now even part of numerous back salves and thermal patches for back pain (for example, Finalgon, ABC or horse balm) due to its warming and pain-relieving properties. Furthermore, herbal oils from appropriate medicinal plants can be used for a soothing massage. However, we advise you to be massaged only by trained specialist staff, as wrong hand movements in case of low back pain only aggravate the symptoms even further. This is especially true if a disease of the spine is behind the problem. Here, the wrong massage technique can also increase the spinal damage.

Medicines and surgery

Of course, spinal column and organ diseases often require drug treatment for sacrum pain. Which preparation is suitable here must be decided on a case by case basis, depending on the underlying disease. In addition, anti-inflammatory ointments and painkillers can be administered.

If a severe herniated disc, massive injury, or degenerative bone or joint disease is present at an advanced stage, it may also require surgery to correct the position or use implants, but this is very rarely the case. (Ma)