For older individuals, experiencing frequent low back pain could turn out to be a sacral fracture. They tend to occur in individuals over the age of 60 often because there has been a degree of bone loss. Sacral fractures tend not to be the first thing doctors think of when low back pain symptoms are presenting. They are often not picked up on X-rays and are either not diagnosed early enough to take steps or not diagnosed at all. However, they are common.

Sacrum

The sacrum is shaped like a triangle and comprises five segments fused into one large bone. It sits at the base of the spine,  between the two halves of the pelvis, connecting the spine to the lower half of the body. It stabilizes the body when walking, sitting, or standing. The nerves in the lower spine control the bowels bladder and provide sensation to the region.

• The two dimples that can be seen on individuals’ backs are where the sacrum joins the hipbones or the sacroiliac joint.
• The point where the low back joins the sacrum can develop discomfort, soreness, and pain.
• This area experiences stress from bending, twisting, reaching, lifting, carrying during physical activities or sitting for long periods.

Sacral Fracture

Most sacral fractures result from trauma, like slips, falls, and automobile accidents. Stress fractures that happen without a specific injury are also called insufficiency fractures.

Types of Sacral Fractures

• Low-energy fractures usually happen to older individuals with weak bones due to osteoporosis.
• An individual trips on something, lands hard on their butt, lifts a heavy object awkwardly, or over-exerts themselves from some physical activity.
• Then persistent back or buttock pain begins to present.
• The pain is often centered in the lower back, the hips, and butt.
• It is more than just back achiness.
• The individual goes to the doctor, and X-rays are ordered.
• A lot of the time, these fractures are missed on X-rays.
• The doctor may diagnose a sprain, but the pain symptoms do not improve.
• Sometimes there is no apparent cause for the pain.
• It can be misdiagnosed as a lower back compression fracture or urinary tract infection.

 

• High-energy fractures are due to trauma and are more common among the young.
• The individual sustains injuries from an auto accident, has fallen from a significant height, or suffers a sports injury.
• It results in severe pain.
• A woman who has just had a baby and gone through some bone loss because of the pregnancy can experience a sacral stress fracture.

Diagnosis

The most common causes for low back pain include:

• Frequent improper posture.
• Muscle weakness or tightness.
• Ligament strain.
• Joint inflammation.
• A pilonidal cyst or an anal fissure can also cause pain.

For individuals that have been to a doctor and had an X-ray that reveals no fracture, and there is no improvement after 5 to 7 days, it is recommended to schedule another appointment and ask for a CAT scan or MRI, which is highly effective at finding a sacral fracture.

Treatment

Treatment consists of resting the bone but still being safely active in most cases.

• Medication is prescribed for pain relief.
• Many individuals have been found to do well with anti-inflammatory medications, topical medications, and lidocaine patches.
• Older individuals may be recommended to use a walker during the treatment/healing process.
• Depending on the severity, crutches may be recommended.
• Engaging in regular exercise is not recommended, but too much bed rest is also not recommended.
• Too much rest may not allow the injury to heal correctly, worsen the injury, and/or cause new injuries.
• Chiropractic and physical therapy are not recommended to let the sacrum naturally heal.
• After the pain subsides, chiropractic and physical therapy can be implemented to maintain agility and flexibility and strengthen the pelvic and core muscles.

In some cases, if the bone does not heal correctly or some other issue, sacroplasty could be recommended. This is a minimally invasive procedure that injects bone cement into the fracture. It offers quick and long-lasting pain relief with a low percentage of complications. It is considered low risk and can be done by an interventional radiologist or spine surgeon.

Prevention

To minimize the risk of a sacral fracture, it is highly recommended to maintain bone strength. This consists of:

• Having a balanced diet.
• Eating calcium-rich foods.
• Taking calcium and vitamin D supplements.
• Strength training.
• Regular bone density screenings.

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Body Composition

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Sitting Posture Adjustments

Adjust Sitting

• If allowed, sit on an exercise ball for short periods, or try a sit-stand desk. There are also treadmill desks and bicycle desks.
• If none of these are possible options, try exercises to do at a desk that works out the core muscles.

Change Chair

• Try a solid wooden chair if unable to use a ball or sit-stand desk.
• It will make the body sit up straight and increase proper posture.

Move Around Alarm

• Set a timer every hour for two minutes of movement.
• Try to keep moving with different exercise stretches, or take a lap around the building.

References

Gibbs, Wende Nocton, and Amish Doshi. “Sacral Fractures and Sacroplasty.” Neuroimaging clinics of North America vol. 29,4 (2019): 515-527. doi:10.1016/j.nic.2019.07.003

Holmes, Michael W R, et al. “Evaluating Abdominal and Lower-Back Muscle Activity While Performing Core Exercises on a Stability Ball and a Dynamic Office Chair.” Human factors vol. 57,7 (2015): 1149-61. doi:10.1177/0018720815593184

Santolini, Emmanuele et al. “Sacral fractures: issues, challenges, solutions.” EFORT open reviews vol. 5,5 299-311. 5 May. 2020, doi:10.1302/2058-5241.5.190064