Sacrum pain: Causes, symptoms, and treatment tips

sacrumSacrum pain can be felt as pain in the lower back or buttocks and is typically sharp and aching. The sacrum is a portion of the lower spine that extends into the tailbone. This bone has many different muscles attached to it that may be the origin of sacrum pain associated with postural strain or muscular issue.

Some of the muscles that attach to the sacrum can cause pressure in the area of the buttocks, leading to a lot of patients describing sacrum pain as pain in the butt. Other muscles that result in pain to this area include the deep lateral rotators, hamstrings, hip flexors, and pelvic floor muscles.


A vertical fracture of the pelvic area may also result in sacrum pain. This fracture typically runs parallel to your spine. However, fractures going horizontally across the sacrum are also a possible cause for sacrum pain.

Sacral anatomy

Located at the bottom of the spine, the sacrum is a triangular-shaped bone in the lower back between the two hip bones. The sacrum itself sits between the fifth segment of the lumbar spine (at the level of L5) and the coccyx (the tail bone). The sacral region is composed of five segments, S1 to S5, that are fused together.

The sacrum is part of the pelvic girdle and contributes to the formation of joints at the hip bone called the sacroiliac joints. The sacral region contains a serious of four openings on each side through which the sacral nerves and blood vessels run. Many of these nerves of the cauda equina at the inferior end of the spinal cord pass through the sacrum.

The sacrum is the key stone of the pelvis and serves several important functions in the skeletal, muscular, nervous, and female reproductive systems. Also, several key muscles such as the gluteus maximus, illacus, and piriformis require their sacrum to aim in moving the leg. The sacrum also helps to form the pelvic cavity which serves to protect delicate organs within the abdominopelvic cavity and even helps to provide space to allow the passage of a fetus during childbirth.

Sacrum pain and low back pain

The lower back has a diverse set of muscles involved in postural stability and other flexor and extension actions. This makes lower back pain or sacrum pain a complicated diagnosis, as many variables are at play. Various connecting muscles may refer the pain away from the actual site of injury, requiring medical professionals to examine all the muscles associated with this area to fully diagnose the problem.

This type of pain has been steadily seeing an increase over the past decade. This may be due to the increase of job-related injuries, as sedentary workplaces may create tension in the lower back due to prolonged sitting, though lower back and sacrum pain may occur due to prolonged standing as well.

It is due to these sedentary professions that people spend most of their day not moving. This lack of movement for extended periods of time causes the muscles to become tighter and hold tension. This creates pressure on the nerves running through the muscle leading to a pain sensation. If this occurs long enough, it may become a chronic condition, leading to a feeling of pain during times where you would like to be more active or flexible.

Symptoms of sacrum pain

Experiencing pain in the buttock area is often the first complaint of sacrum pain patients. However, pain may be felt in the lower back, hips, groin, or pelvis. Pain may present only on one side but can occur on both. Numbness or tingling in the leg or feelings of weakness in the leg may also be appreciated.

Typically, symptoms are worsened by sitting, standing, sleeping, walking, or climbing stairs, with the pain occurring on the affected side. You may notice difficulty performing tasks that require sitting down such as riding a bike or sitting in a car. Transitional movements—going from sitting to standing—may also elicit pain.

What causes pain in the sacrum?

Pain in the area of the sacrum can be due to the ligaments becoming too loose or too tight. This may be caused by a fall injury, work injury, car accident, pregnancy, or hip/spine surgery (laminectomy, lumbar fusion). Many diseases may also lead one to experience pain in this region. The following are some of these causes:

External endometriosis: A gynecological disease that extends to the sacro-uterine ligaments and behind the cervix. Pain experienced by these patients is usually cyclical in nature.

Spinal anomalies: Any deformity during spinal development, usually in the lumbar-sacral vertebrae. Pain is usually experienced suddenly after a load on the spine.

Sustained physical activity: Can lead to strain on the back muscles marked by chronic back parametritis, leading to shrinkage rectal-uterine ligaments.

Traumatic injuries: When forced to take an unusual position of the body, leading to spasm of the sacrococcygeal vertebrate muscles.

Infectious lesions: May result in the intrusion of pyogenic microorganisms.

Metabolic diseases of the bone: Osteoporosis or osteomalacia can cause significant bone loss leading to injury and resulting pain.

Chronic prostatitis: The frequent cause of lower back pain. It may be accompanied by frequency in urination or burning sensation.

Prostate cancer: Often the result of metastasis to the bone, which may lead to sacral pain.

Diagnosis sacrum joint pain

When first going to see the doctor for scrum pain, he will do a thorough physical examination looking for abnormalities in posture, gait, and range of motion. Once your doctor suspects the certain injury or pathology originates from the sacrum region, an MRI or CT test may be ordered and provide a more detailed look at the injury site. Pelvic x-rays may also be utilized, but their usage is often limited. An injury to the sacrum doesn’t necessarily require emergency medical care, but early diagnosis and treatment can help prevent complications such as nerve damage from occurring.

Sacrum pain relief tips

Luckily, treatment for sacrum pain usually does not require surgery, as getting adequate rest, taking pain relieving medication, and staying active is often enough to fully resolve the pain over time. Your doctor may recommend you wear a medical brace or corset to help support the bone structure, but this is seldom needed. Water exercises may help maintain flexibility while limiting tension on the back muscles. In severe cases where a fracture has occurred, a sacroplasty procedure may be required, where bonding material is injected into the joint site for faster fusion of the fracture.


If sacrum pain is due to bone weakness, vitamin D and calcium supplementation may be appropriate.
For those who experience only minor sacrum pain, there are things that can be done at home, such as using ice packs to decrease inflammation. However, it is important to only utilize ice therapy for 15–20 minutes at a time, as prolonged sessions may cause the body to react unfavorably, resulting in more pain and inflammation.

Various stretching techniques may also be useful for relieving chronic lower back pain. Addressing hip flexors, hamstrings, and glutes can ease tension built up from prolonged sitting and standing sessions.

Related: Sacroiliitis: Causes, symptoms, and treatment

Author Bio

Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.


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