Sacral Stress Fractures

The sacrum bone is found in the pelvis. Sacral stress fractures are a lot less common than stress fractures to lower extremities like the metatarsal, but they frequently occur in long distance runners and also military personnel. These sorts of groups have a higher incidence of sacral fractures due to their physical activities.

Symptoms

Lower back pain, which can manifest in sharp, steady attacks or be almost continuous. Any pain of this sort should be examined by a doctor as there are multiple back conditions and injuries that can lead to this aching. The pain of a sacral stress fracture can also mimic the symptoms of sciatica – the shooting leg pain caused by lower back nerve root compression (see our article for more details). Reflexes or motion in the back may be compromised, though this is not always the case.

Causes

There can be several factors involved in the development of sacral stress fractures depending on the specific circumstances. However, there are recurring elements that contribute to such injuries. Repetitive pressure to the pelvis and lower spine, due to the force of the legs hitting the floor and concurrent muscle contractions, can lead to gradual damage in the area. This is why mid- and long distance runners are particularly prone to the condition (and activities like jumping can also lead to the injury).

Another risk factor is failure to maintain suitable fitness prior to such activities, especially aerobic fitness. Stretching, warming up and exercising should all be used appropriately, catering to the difficulty and approximate length of your activities. This is linked to overuse, which is often a problem resulting from poor stretching and from overestimating the amount of sports and exercise one is able to take on.

Prior stress fractures might indicate a propensity towards the injury, and women are typically more prone to stress fractures than men.

Treatment

Consult a doctor, who will assess the cause of your symptoms using a physical examination and relevant scans if necessary. This stage is important because the fracture is sometimes misidentified as sciatica.

The sacral stress fracture mainly requires a period of full rest from activity that causes pain or places strain on the pelvis or spinal column. During this period, anti-inflammatory medication such as ibuprofen can be used to treat pain. When pain has diminished, you may undertake low impact activities such as swimming and cycling to avoid rigidity in the local muscles.

Returning to Activity

Patients generally recover after 4 to 6 weeks of rest, but it is crucial to recommence your regular activities gradually, especially those as strenuous as sprinting. You should only do this when you are pain free, preferably with a doctor's approval, and it will be helpful in the rehabilitation stage to start a training program of strengthening exercises (for the hips and the back) to help support the lower back area.

Prevention

To avoid overuse injuries always make sure to warm up and stretch properly, bearing in mind the intensity of your training regimes and suitable techniques, and never exercise with fatigued or weakened muscles.