Introduction
Pain in the gluteal and sacral region can present itself in different ways. Depending on the underlying cause, the affected person may have pain mainly when moving or resting, may have difficulty walking, sitting or lying. The intensity of the pain can also vary greatly. The exact location of the pain and a possible radiation of the pain into the buttocks or back area, as well as into the legs, can provide information about the cause of the pain.
Blocked sacroiliac-iliac joint
The sacroiliac joint (sacroiliac joint) is, as the name suggests, the movable connection between the sacrum and the ilium, which forms part of the pelvic blade. The sacroiliac joint (ISG) is not a conventional joint, such as the shoulder joint, but it does have a low degree of mobility, which is crucial for daily movements. This type of joint is called amphiarthrosis.
It is held by a stable ligamentous apparatus and surrounded by muscles. When lifting too heavy loads or, for example, when stepping on stairs (typically missing steps), the joint can become blocked. This becomes noticeable by a pulling pain that occurs on the affected side at the level of the joint and becomes stronger when bending forward and when turning the leg outwards (e.g. cross-legged).
Associated symptoms
Pain in the sacrum can manifest itself in many forms and with accompanying symptoms. The pain can be described as dull and diffuse, stabbing or pulling. An important indication is also whether the pain can be provoked by touch and pressure from outside or by movement.
In chronic pain, the pain is mainly dull after prolonged immobility in a sitting or standing position. A frequent accompanying symptom when the nerves are involved is the pain radiating through the buttocks into the legs. Initially, there may be a tingling in the toes.
In severe cases, numbness and paralysis are also possible. If there are acute injuries to the sacrum, external symptoms can be detected. Hardenings, break edges and overheating can be felt.
In addition, externally visible bruises can appear as reddening. The sacroiliac joint can also be affected by arthrotic changes that cause similar symptoms. During the aging process, the cartilaginous joint surfaces wear down over time, resulting in a certain incongruity in the joint and increased friction.
This then leads to irritation of surrounding tissue and nerves, and in severe cases to poor posture. In the context of some rheumatic diseases, this joint is also frequently affected by inflammation, e.g. Bechterew’s disease, an inflammatory rheumatic disease. The inflammation of the sacroiliac joints is also known as sacroiliitis.
It usually recedes with treatment of the underlying disease. In addition, Bekhterev’s disease usually causes pronounced morning stiffness in the spine, which lasts at least half an hour and finally improves with movement. Pain that develops in the hip joint can extend into the sacrum and deep spine.
There may be several structures behind it. Especially in older patients, hip arthrosis can be the cause. This is a long-standing sign of wear and tear of the joint head and the acetabulum.
Also complaints of the ISG joint can cause such pain. The most important clinical picture here is the ISG blockage, whereby a muscular blockage of the joint takes place, which is very painful during movement. After falls, especially in elderly people, the fracture of one or more bones must always be considered.
Especially if there is also osteoporosis, even slight falls can lead to fractures of the sacrum, coccyx, neck of femur and hip. Simultaneous pain in the pubic bone and sacrum is often experienced during pregnancy. The pressure and weight load in the pelvis causes not only a displacement of the spine but also a stretching of the pubic symphysis.
This results in a tensile stress on the pubic bone, which can be painful. A rarer cause for this pain can be found in athletes. In the course of long-term exercise, e.g. when playing soccer, small micro fractures occur in the pubic bone, which can cause painful inflammation.
Bending down is a dangerous starting point for acute disc disease and back pain in the sacrum. When bending forward, the spine presses on the intervertebral discs in the front area and squeezes them backwards.After many years of lifting heavy weights from the back, the intervertebral discs can tear and the inner liquid core can leak. This is a herniated disc.
Already in childhood, people must be taught a different way of bending in order to avoid pain and illness in the long term. It is important not to pick up weights such as heavy moving boxes while bending down, but to stand up from the knees with the back stretched. The lumbar spine is a very common source of pain in the sacrum.
With predominant office work and lack of movement nowadays, lumbar spine complaints become more frequent. This is known as “lumbar spine syndrome“. Since the lumbar spine is located directly above the sacrum, the sacrum is also often affected by the pain. Herniated discs also occur excessively often between the lumbar vertebrae. In everyday life, pain can be prevented by movement, muscle building and avoiding lifting heavy loads.
