Sacral pain - causes, symptoms, therapy

Sacral pain - causes, symptoms, therapy

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Signs and therapy of sacrum pain

Whether from a lumbago or an existing joint disease - pain in the sacrum on the lower spine is usually extremely uncomfortable. The pain symptom now occurs in almost all age groups. But what is it and how can you successfully fix or prevent sacrum pain?


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

On the sides, the sacrum is also connected to the ilium (os ilium) and the sacroiliac joint (articulation sacrooiliaca). The hip and thigh bones connect to this bone and joint formation, which are essential for any running, standing and sitting movement.

The special task of the sacrum in the musculoskeletal system - as well as the associated, versatile pain potential - becomes even clearer when you look at the nerve strands that emerge from this section of bone. These are 5 sacral nerve pairs, which are referred to as S1 to S5 and 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 (medulla spinalis) located in the spinal canal of the spine. From there, the spinal nerves continue in addition to the chest area, particularly into the extremities of the body, i.e. the neck, arms and legs.

The spinal nerves form an essential component of the peripheral nervous system, which both sends movement impulses to the muscles of the extremities, and is therefore also responsible for sensation and thus pain stimuli in the arms and legs. For this purpose, the spinal nerves of the sacrum, together with the spinal nerves from the lumbar region, form a special nerve network, namely the lumbar-cross network (lumbosacral plexus). After exiting the spinal cord, the sacrum and lumbar nerves merge into new nerve strands that continue into the lower extremities. Important nerves that arise from the nerve segments of the sacrum are:

  • Upper gluteal nerve (Superior gluteal nerve) - responsible for movement impulses in the hip and buttocks area.
  • Lower buttock nerve (Inferior gluteus nerve) - responsible for movement impulses in the hip and thigh region.
  • Anal coccyx nerves (Nervi anococcygei) - important parts of another nerve plexus, the coccyx plexus (plexus coccygeus), which among other things is responsible for the perineum muscles and sphincter function in the anal area.
  • Pubic nerve (Nervus pudendus) - responsible for sensations in the pelvic and genital areas as well as for movements there; also controls the muscles in the urinary tract, such as the sphincter sphincter to prevent incontinence.
  • Posterior femoral nerve (Posterior cutaneus femoris nerve) - responsible for movement impulses on the back of the thigh and in the back of the knee.
  • Sciatic nerve (Sciatic nerve) - responsible for thigh movements, with the sciatic nerve splitting into two other major branches:
    1. Fibula nerve (Fibular nerve) - important for stretching and bending movements in the area of ​​the knees, ankle and toes,
    2. Shin nerve (Tibial nerve) - also responsible for complex movements of the foot and ankle motor system.

It is not difficult to see that pain stimuli in the sacrum area can originate in all of the nerve areas shown. In addition, sacrum pain can also be caused by nerve problems that come directly from the lower spinal canal or the lumbar spine. One of the following three pain syndromes comes to the fore particularly often:

  • Lumbago: Better known as "lumbago", the sacrum pain arises here as a result of back pain from the lumbar spine. Since it is usually a multifaceted complex of pain that may be accompanied by other accompanying symptoms in the lumbar region, this is also referred to as local lumbar syndrome. The term "lumbal" comes from the Latin word lumbus for "loin".
  • Sciatica: The pain originates from the sciatic nerve, again involving the sacrum. This variant of sacrum pain is also popularly known as sciatica or sciatica syndrome.
  • Lumboischialgie: The pain in the sacrum area results from a combination of lumbago and sciatica. So the sacrum, lumbar and sciatic region are affected by the pain.

Causes of sacrum pain

The area of ​​the lower back in which the sacrum pain is localized consists of numerous articulated connections between the vertebral bones and pelvic bones, which in turn are held by ligaments and muscles. This provides increased stability in this area, which is necessary to enable an upright gait and to maintain the center of gravity. A certain flexibility is also required in the pelvic area in order to be able to guarantee normal activity changes between walking upright, sitting, standing and lying down.

And it is precisely these two very contradictory requirements for the anatomical area around the sacrum that make this pelvic bone very susceptible to disorders and damage in our day and age. Modern everyday life is particularly noteworthy because, compared to earlier epochs in human history, it contains significantly more and sometimes very unnatural stress factors for the spine and pelvis. All in all, functional disorders and damage to the musculoskeletal system as the cause of sacrum pain can be divided into three categories:

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

Unhealthy everyday habits as the main cause

Nowadays, degenerative wear and tear is the most common cause of sacrum. The beneficial factor here is the change in our way of life towards an everyday life that includes more and more seated activities. A particular risk group here are people who work in the office. From the secretary to the computer scientist, office workers complain of low back pain almost regularly - triggered by a lack of movement and monotonous or crooked sitting posture during work. Corresponding deficits in movement are then often not adequately compensated by sporting activities in leisure time. On the contrary: the seat-bound behavior often continues after work in front of the television, the computer or the game console.

Another risk group is posed by lower back pain caused by activities of craftsmen, warehouse workers, construction and mining workers. Here it is an increased weight load, as it arises in particular from the constant lifting and carrying of heavy loads. And even overweight people usually have an increased risk of contracting sacral pain due to excessive weight on the back and hip. If you consider that obesity is now a real widespread disease, which is based on the predominant consumption of finished products and fast food, the modern way of life can again be identified as the author of the problem.

By the way: Children and adolescents are also complaining more and more about low back pain. On the one hand, this is to blame for the fact that overweight is rampant among the youngest of society. On the other hand, the day-to-day school life of children is also increasingly performance-oriented, which is associated with longer sitting times at school itself, but also at home when studying or doing homework. In addition, young people in particular tend to exercise too little in their free time and instead prefer to watch TV and play computer or video games.

No matter which of the cause mechanisms mentioned is present, the result is always the same. As a result of the persistent incorrect posture or incorrect loading of the lower spine, it happens

  • Muscle tension,
  • Muscle shortening,
  • local nerve irritation
  • and inflammation.

In the long run, the harmful effects result in gradual dismantling and remodeling processes in the affected tissue regions. This degeneration process can affect the muscles and nerves as well as bone structures, ligaments and intervertebral discs. It should be mentioned that pain in the sacrum and lumbar region already occurs during the tissue irritation and thus before the onset of the actual degeneration. However, they often disappear quickly in these early phases and are therefore not taken seriously enough. It is only when degenerative processes cause pain that lasts longer and more intensely that many sufferers recognize the sacrum pain as a harbinger of wear and tear, which painfully affects the sacrum.

Sacral pain due to diseases of the spine

From a certain age, a certain amount of spinal wear is normal. The risk of wear and tear diseases therefore increases significantly from the age of 40, but harmful everyday behavior and heavy lifting due to work can also significantly reduce the average risk age. The most common clinical picture that causes age-related pain on the sacrum is the herniated disc in the lumbar region. Here, the dismantling and remodeling processes in the vertebral bodies and the intervertebral discs in between cause the intervertebral disc, which serves as a shock absorber, to slide out of its position and thereby irritate the surrounding tissue. The irritation particularly affects the spinal nerves emerging from the spinal cord at the level of the lumbar spine. For this reason, sciatica or lumbago can occur in the course of the herniated disc. Such a scenario is all the more likely if the herniated disc causes a narrowing of the spinal canal, the so-called spinal stenosis.

Dismantling and remodeling processes in the vertebral bodies can also lead to the formation of additional bone tissue in places of particularly high stress. Medical experts refer to these bone formation as spondylosis. It can generally occur on all vertebral bodies, but in many cases mainly affects the cervical and lumbar spine, which is why neck and sacrum pain are relatively typical for this clinical picture. If the spondylosis also causes local inflammation, one speaks of spondylitis.

Inflammatory spinal diseases such as rheumatism, on the other hand, are less frequently responsible for lower back pain. In contrast to degenerative diseases, the global spread is relatively low at just over two percent. However, if one of these diseases occurs, it mostly affects the cervical and lumbar region.

As a rule, there is no isolated cause for the inflammation of the vertebral bodies, vertebral joints and intervertebral discs. Rather, the doctors assume a multifactorial process. In rheumatoid polyarthritis or ankylosing spondylitis, for example, those affected very often have several of the following factors that promote disease:

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

As a result of the inflammatory processes, in addition to pain that is sometimes very severe and restrictive of movement, there is also ossification in the area of ​​the spine, which causes an additional restriction of mobility. The medical term for the disease Bechterew's disease, ankylosing spondylitis, in this context means nothing else than "stiffening inflammation of the vertebrae". It is still considered incurable, despite increasing medical research, because it is based on genetic factors against which there is currently no suitable therapy. Fortunately, some therapeutic measures can at least prevent a severe course and alleviate the manifestation of accompanying symptoms such as the disease-typical sacrum pain. Other spinal disorders that can only be treated to a limited extent, which are always associated with sacrum pain, are:

  • Humpback(Kyphosis,)
  • Hollow cross (Lordosis),
  • Round back (Hyperkyphosis),
  • Spine curvature (Scoliosis).

A special case is spinal injuries.

Sacral pain is particularly dangerous if it arises from injury. The main causes are traumatic forces on the sacrum, such as when lifting heavy loads, falls or accidents. However, inflammatory and rheumatic processes also pose an increased risk of injury later on. Blockage of the sacroiliac joint is of particular importance in this regard. This event, also known as the ISG blockade, causes canting due to incorrect loading in the area of ​​the joint between the sacrum and ilium, which can cause immobility and severe pain on the sacrum. The pain usually gets worse when you lean over or sit cross-legged. Often, a crack in the joint can also be felt and heard in the morning after getting up or changing position after sitting for a long time.

Sacrum and organ diseases

Together with the pelvic bones, the sacrum also houses a part of the internal organs and thus offers them protection and support. Because of this anatomical closeness, diseases and pathological processes in internal organs can also lead to sacrum without structural damage to the sacrum. To distinguish diseases of the musculoskeletal system, it is noticeable that the pain

  • are often continuously present
  • occur regardless of movements
  • cannot be influenced in intensity by changing position,
  • often colic or relapsing,
  • There are accompanying symptoms such as fever, abdominal pain or a burning sensation when urinating.

Since corresponding organ diseases are extremely versatile, here is a small overview of the possible causes of the disease:

Organ / organ systemPossible clinical pictures
Female reproductive system
  • Ovarian inflammation (Adnexitis)
  • Pelvic floor subsidence
  • Ectopic pregnancy (Extra uterine pregnancy)
  • Endometriosis
  • Fibroids and tumors of the uterus
Male reproductive system
  • Prostate inflammation (Prostatitis)
  • Testicular inflammation (Orchitis)
Urinary tract and kidneys
  • Cystitis
  • Walking kidney, horseshoe kidney
  • Inflammation of the kidney (Pyelonephritis)
  • Kidney metastases
  • Stone suffering
  • Adhesions, inflammation and abnormalities
Intestine, pancreas and gall bladder
  • Inflammation of the pancreas (Pancreatitis)
  • Appendicitis (appendicitis)
  • Intestinal perforation
  • Inflammation of the intestines
  • Colon cancer
  • Bowel obstruction (Ileus)
  • Pancreatic head carcinoma
  • Pancreatic cysts
  • Gallstones
Aorta, large pelvic arteries and veins
  • Abdominal aortic aneurysm
  • Pelvic vein thrombosis
  • Pelvic artery occlusion

Psychological complaints and sacrum pain

Considering how many nerves pass through the sacrum region, it is not difficult to guess that mental problems can also be responsible for the pain. It is not without reason that proverbs exist, such as "that broke his backbone" or "he has a hard time carrying it". Indeed, nerves like sciatica respond more often than expected to mental stress. In order to understand this connection, one has to mentally distance oneself from the conventional medical concept of local and physically visible causes.

Psychosocial factors such as loneliness, lovesickness, debts, unemployment, a lack of social network and bullying at the workplace can put the body and mind in a constant state of massive tension, which also affects the back and the nerves running along the spine. In addition to the first muscular tensions, gentle postures and nerve irritations develop over time, which are hardly noticeable at first, but which in turn trigger further tensions.

If this vicious cycle is not broken, a so-called chronic back pain develops, which can ultimately cause demonstrable changes in the skeletal system even with imaging methods. Chronic pain then further limits the quality of life. Everyday things become more and more of a pain and the pain comes to the fore. Living a normal life is becoming increasingly difficult and those affected reach their physical and emotional limits. In addition, if the causal, psychological stress is not remedied, this increases the symptoms.

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

  • psychological trauma (e.g. 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 addiction).

Concomitant symptoms

Persistent pain in the sacrum region, like all chronic back pain, should always be seen by those affected as a possible warning of injuries or serious diseases of the spine. Even though an easy-to-cure cause of the pain can be identified in a good 50 percent of all cases and most patients are able to function and work again after about a week, the number of conceivable functional or degenerative disorders in the spinal area is very large. In this connection, nerve impairment such as sciatica should be diagnosed by a doctor at an early stage, since healing on this largest nerve in the body can sometimes take up to a year. The pain that occurs is often very different in nature and expression, with all the diverse causes. A pain is conceivable, for example

  • is dull or stinging and pulling,
  • focuses locally on a limited point,
  • to the back, buttocks and / or thighs,
  • gets weaker or stronger when moving,
  • causes severe loss of movement,
  • is accompanied by overheating, redness or bruising,
  • accompanied by tingling, numbness or paralysis of the legs,
  • along with urination / incontinence problems.


Information about the presence of sacrum pain naturally gives the doctor first of all the conversation with the patient. In the course of the conversation, this should also address any accompanying symptoms, everyday habits, underlying illnesses and one's own mental state. Thereafter, treating physicians conduct movement and pain tests as standard, which in addition to the lumbar and pelvic areas can also include the rest of the spine and lower extremities. In order to find out the cause, imaging tests such as ultrasound, X-rays, CT or MRI, blood and urine tests and psychotherapeutic diagnoses are all possible. The doctor usually acts on suspicion or acts on the principle of exclusion diagnosis.


Sacral pain is one of those symptoms that can often be cured on one's own initiative. The prerequisite is, of course, that there is no serious underlying illness or injury. Drug or surgical measures may also have to be used here.

Protection and exercise therapy

The most important step in relieving sacrum pain is to put less strain on the sacrum in everyday life. That doesn't mean you shouldn't move your pelvis anymore. Rather, monotonous and curved sitting postures should be avoided and the pelvic muscles strengthened for more stability through sport (e.g. water aerobics). All in all, everyday life should be designed in such a way that as little muscular and psychological tension as possible affects those affected. Relaxation measures such as yoga, meditation or liberating talk therapy are recommended.

Physiotherapeutic and orthopedic measures

Physiotherapeutic exercises also help to cure mild causes of sacrum and the pain itself. In addition, physiotherapists can provide valuable tips on back posture and back protection in everyday life. A visit to the orthopedic surgeon may be necessary if a medical corset (orthosis) is required to correct the posture. This is important, for example, in the case of advanced degenerative diseases and congenital malpositions of the spine. In this context, a visit to a back school is also recommended.

Home remedies and medicinal herbs

There are some herbs that offer great help for low back pain. These include in particular:

  • Arnica,
  • Chili,
  • Elder,
  • Johannis herbs,
  • Chamomile,
  • Mullein,
  • Lavender,
  • Marjoram,
  • Mint,
  • Myrtle,
  • Clove,
  • Oregano,
  • Rosemary,
  • Sage,
  • Star anise,
  • Devil's claw,
  • Juniper.

You can use the herbs for a warming healing envelope, for example, because warmth is generally good for back pain. Because of its warming and pain-relieving properties, chilli in particular is now part of numerous back ointments and heat plasters for back pain (e.g. Finalgon, ABC or horse balm). Furthermore, herbal oils from appropriate medicinal plants can be used for a beneficial massage. However, we advise you to have a massage only by trained specialist personnel, as the wrong actions only worsen the symptoms of low back pain. This is especially true if there is a disease of the spine behind the problem. Here, the wrong massage technique can also increase spinal damage.

Medication and surgery

Of course, spinal column and organ diseases often require medication in the case of 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 pain relievers can be administered.

If there is a severe herniated disc, a massive injury or a degenerative bone or joint disease in the advanced stage, an operation to correct the position or to use implants may be necessary, but this is very rarely the case. (ma)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Jan Hildebrandt, Michael Pfingsten: Back pain and lumbar spine, Urban & Fischer Verlag, Elsevier GmbH, 2nd edition, 2011
  • S. Kroppenstedt, A. Halder: Specific low back pain, German Society for Orthopedics and Orthopedic Surgery (DGOOC), (accessed August 15, 2019), AWMF
  • Nikolaus Wülker et al .: Pocket textbook on orthopedics and trauma surgery, Thieme Verlag, 3rd edition, 2015
  • Federal Chamber of Physicians (BÄK), National Association of Statutory Health Insurance Physicians (KBV), Working Group of Scientific Medical Societies (AWMF): National Care Guideline for Non-Specific Low Back Pain - Long Version, 2nd Edition, Version 1, 2017, (accessed August 15, 2019), AWMF
  • Peter J. Moley: Lower back pain, MSD Manual, (accessed August 15, 2019), MSD

Video: Sacroiliac Joint Diagnosis u0026 Treatment Options - Dr. Raval (May 2022).