Diagnosis
The diagnosis always begins with a specific questioning of the patient. The context in which the pain occurs, how exactly it feels and whether it can be provoked by certain movements are important. If the pain occurs, for example, after a fall from a ladder, bruises and fractures are the main focus of the examination.
The diagnosis of such an injury can be confirmed by means of a radiological image. Injuries to the bone can be easily detected in an X-ray or CT scan. However, if the cause lies in the soft tissues of the spine, an MRI image can provide clues. In addition, if the spinal column is involved, further physical examinations must be performed to determine the extent of the injury. These include, for example, muscle exercises of the legs to rule out nerve damage.
Causes
The causes of pain in the sacrum are numerous. Basically, the pain can have a muscular origin, acute blockages and injuries or be based on chronic diseases and changes. Very often, muscular complaints are in the foreground.
These can be caused by excessive strain, incorrect strain, jerky movements or without any recognizable cause. This can result in cracks, tension and entrapment of the gluteal muscles or the muscles of the lower back.The ISG blockade can also be muscularly caused. This is a very painful blockage of the sacroiliac joint, the joint between the spine and the hip bone.
The muscles of the joint cramp and restrict its function. This is often caused by lifting heavy loads, slight movement of the upper body, accidents or a dislocation described as “kicking into space”. The lumbar spine is a very common site of chronic pain.
Usually these pains are felt as dull pain in the deep hollow back of the back when moving or after sitting for a long time. They can radiate into the sacrum. The causes are weak muscles, lack of movement and incorrect loading, for example heavy lifting.
Muscular hardenings can also often be felt in this area. If the movements are too fast and strong, this can lead to pulled muscles, torn muscle fibers and bleeding, which can also be painful in the sacrum. A painful sacrum can also occur as a result of falls and injuries.
The coccyx and the lower spine have an exposed position and are therefore prone to bruising and fractures. The coccyx, sacrum or vertebrae of the lumbar spine can be affected and cause the pain. Another common cause of pain in the sacrum is a herniated disc in the lumbar spine.
At this point of the spinal column, herniated discs occur preferentially, often triggered by the lifting of heavy loads. Nerves originating from the spinal cord may be involved and transmit the pain into the legs. Especially the lower back and buttocks are exposed to great stress.
Many people today have poor posture, as they often perform predominantly sedentary activities and their muscles are too weak. Poor posture and lack of movement can lead to muscle tension, which can manifest itself as unpleasant back pain, especially after standing for a long time. In this area one often feels hardenings (so-called muscle hard tension).
Incorrect or excessive strain during sporting activity can also cause pain in the sacrum area. This can lead to pulled muscles, torn muscle fibres, sore muscles or signs of fatigue. Athletes who have to perform abrupt movements, such as fast start and stop movements, are particularly at risk.
Bleeding into the gluteal muscle cannot be ruled out in sports injuries and can also be accompanied by pain in the sacrum and buttocks. An abscess is an encapsulated accumulation of pus in the tissue, which can cause severe pain. If the abscess is connected to the body surface or other structures by a small duct, it is called a fistula.
So-called coccyx fistulas can occur on the coccyx, they are very painful and are accompanied by redness and swelling of the corresponding area. Those affected are often unable to sit at all because the inflammation causes them such severe discomfort. The pain can radiate to the area of the sacrum and into the buttocks.
The coccyx fistula (also called pilonidal sinus) often occurs in young, slim men with pronounced body hair. The cause is the ingrowth of hair into the adjacent tissue with subsequent inflammatory reaction and accumulation of pus. The coccyx fistula can weep and bleed and usually has to be surgically removed to allow the tissue to heal.