The discomfort that brings pain in the lumbosacral spine can be temporary or permanent, weak and aggravated by any external factors, etc. Pain in the lower back is not an independent disease, but is a sign of some kind of disorder in the body. This disorder may be associated with the musculoskeletal system or problems with internal organs. If you ignore the signal that your body sends, in addition to discomfort, this can also lead to a deterioration in your health in general and impaired motor functions in particular.
Pathogenesis of pain in the sacral region
The lumbosacral spine bears the main load when walking. And if your back hurts specifically in the sacral spine, then this can be explained by any reason - from diseases of the spine itself and neurological disorders to the presence of neoplasms in the body. Discomfort can manifest itself as sudden sharp pain, intensify when bending over or doing any physical activity, or when staying in one position for a long time. Sometimes pain in the lumbosacral spine prevents you from even just straightening up, which affects your lifestyle and quality of life. If the sacrum begins to hurt even when sitting, this may indicate the severity of the disease and pose a threat to health. Don't delay your visit to the doctor! Sign up for a consultation at the first painful sensation.
Diagnosis of pain in the lower abdomen and lower back
When contacting a gynecologist at a multidisciplinary CELT clinic, to make a correct diagnosis you will need:
- collecting information about the frequency and duration of pain in the lower abdomen and lower back
, clarifying the nature of pain and their relationship with the monthly cycle; - conducting an initial medical examination;
- conducting general and special laboratory tests;
- Ultrasound of the pelvic organs;
- if indicated, consultations with related specialists (urologist, gastroenterologist, surgeon, neurologist) to exclude diseases not related to the genital organs;
- if indicated, diagnostic laparoscopic examination.
Causes of pain in the sacral area
Pain in the sacral region is a consequence and sign of an emerging, developing or worsening pathology in the human body. This discomfort may indicate a variety of problems - the initial stage of radiculitis, acquired or congenital anomalies, displacement of the lumbar vertebra, pathological processes in tissues and muscles, etc. If pain in the sacrum occurs in women (usually on the left), then this is often a symptom of a gynecological disease. Another cause of pain in the sacral spine may be problems with the genitourinary system. Age-related changes, various metabolic problems, etc. also lead to painful discomfort. Only a doctor (for example, a neurologist)
) after a thorough examination and diagnosis.
Injuries
Pain in the sacrum does not just happen. There are always reasons for this. One of the most common are injuries that bring even greater discomfort when a person takes a certain position. Injury can be caused accidentally due to an accident, a car accident, a fall, or caused to a person intentionally. If you are injured, you should see a doctor immediately to begin treatment and minimize the risk of serious consequences. Very often, trauma leads to displacement of the sacral and pelvic bones, which causes problems with the functioning of nerves and blood vessels. There are two types of displacement, each of which has its own characteristics:
- when the right pelvic bones are displaced, severe pain and disruption of the right leg are observed, as well as problems with the gastrointestinal tract, the person loses weight and often feels unwell;
- when the left pelvic bones are displaced, a person has problems with the functioning of the left leg and additionally has symptoms such as frequent constipation, colds, impaired functioning of the lungs and heart, as well as excess weight.
If after an injury or bruise the pain does not go away, but only intensifies, contact a specialist immediately.
Osteochondrosis
Osteochondrosis in the lumbosacral region, as one of the common diseases, occurs in many people due to an unhealthy lifestyle, poor nutrition, constant stress, as well as due to injuries and age-related changes. The disease can also develop due to inflammation of the joints of the spine, ankylosing spondylitis and arthritis. How to recognize osteochondrosis in the sacrum? The following symptoms may indicate this disease:
- regular occurrence of pain in the lumbosacral spine, that is, the lower back constantly hurts for no apparent reason, even at rest. Sometimes the pain may radiate to the legs and buttocks;
- in advanced cases, pain occurs even when a person coughs or sneezes and with the slightest physical activity;
- the mobility of the lower back is impaired, and it becomes painful to even bend over a little;
- to this is added general irritability, weakness, sleep disturbances, since it is difficult for a person to find a comfortable position.
Chronic prostatitis
If in women pain in the spine in the sacral region can be associated with gynecological diseases, then in men the discomfort is often caused by chronic prostatitis. In this case, the pain is often aching in nature, radiating to the leg or spreading either along the right or left side. Such signs already indicate that the disease is in an advanced stage. With chronic prostatitis, pain can appear not only in the sacral area, but also in the lower abdomen, in the rectum and anus, in the genitals and radiate to the legs.
Diagnosis of pain in the spine (lower back, lower back)
It all starts with a neurological and orthopedic examination by a doctor. During this examination, the patient’s neurological status is assessed, and possible disorders in the biomechanics of the spine are identified, with a mandatory assessment of the condition of the back muscles and gluteal region. Already at this stage of the study, a patient with spinal osteochondrosis and back and lower back pain can be diagnosed and treatment selected.
Normally, during examination of a healthy spine, thoracic kyphosis and lumbar lordosis are detected. In some people, these spinal curvatures can be significant, forming a so-called “round back.” In diseases of the spine, the presence of excessive curvature or, conversely, smoothing of the normal lumbar lordosis is carefully assessed. A hump is formed with an acute kyphotic angle, which may be the result of a fracture or anomaly in the development of the thoracic spine, an inclined position or curvature of the pelvis, or a difference in the tone of the paravertebral or gluteal muscles. In case of acute pain along the inflamed sciatic nerve (sciatica), a forced position of the lower back can be detected due to muscle tension. This antalgic scoliosis slightly reduces the severity of pain from nerve tension in the patient.
Normally, a person has natural curves of the spinal column (kyphosis and lordosis), which is associated with his upright posture.
Asking a patient about his old injuries does not always help identify the causes of pain in the lower back (lower back). Clarifying the time of occurrence and the circumstances of the onset of pain gives the neurologist or neurosurgeon much more necessary information to make an accurate diagnosis.
Also, when examining a patient, a doctor examines his biomechanics. The spine, hip joints and legs are assessed as the patient performs certain active movements. Restrictions in the patient's movement may be noted when undressing, lying down, or getting up from the examination couch or chair during the consultation. When the torso bends forward from a standing position, a person normally experiences a smoothing of the lumbar lordosis and an increase in the curvature of the thoracic spine (thoracic kyphosis). When there is pain in the lower back, when the posterior ligaments or sacrospinous muscles are tense, the articular surfaces of the intervertebral joints are inflamed, or when the intervertebral discs of the lumbar spine are ruptured, protective reflexes prevent the stretching of these spinal structures. As a result, the sacrospinous muscles remain tense and limit movement in the lumbar spine. Forward bending for pain in the lower back (lower back) will occur through the hip joints and thoracolumbar junction. In case of inflammation of the lumbosacral joints (sacroiliitis) and compression of the spinal nerve roots, the patient bends forward so as to avoid tension in the muscles of the tendons that limit the popliteal fossa on the sides, shifting the main load to the pelvis. With unilateral sciatica, the curvature will increase towards the source of pain in the lower back. Movements in the patient's lower back will be accompanied by muscle tension and pain. The patient will try to tilt the body forward using the hip joints. The knee on the affected side may be flexed to relieve hamstring spasm and the pelvis tilted posteriorly to relieve tension on the spinal nerve root and the sciatic nerve as a whole.
Normally, a person has natural curves of the spinal column (kyphosis and lordosis), which is associated with his upright posture.
If the patient's ligaments or muscles are tense, bending in the opposite direction will increase the pain due to tension on the soft tissues of the spine. With lateral and paramedian hernias and protrusions of intervertebral discs, tilting in the direction of damage will be impossible or severely limited due to increased pain. For pain in the lower back (lower back), bending while sitting with the patient's hips and knees bent can usually be easily done until the knees touch the chest. The reason is that bending the knee releases tension in the patient's hamstrings and also releases tension on the sciatic nerve.
For low back pain and sciatica, passive flexion of the lower back in the patient while lying on his back causes mild pain. If the patient's knees are bent (tension of the sciatic nerve is reduced), movement occurs freely. In case of disease of the lumbosacral and lumbar spine (for example, with arthritis), passive flexion of the hip joints occurs freely or with minor nagging pain in the lower back due to the gluteal muscles. Passive straight leg raising, which in most healthy people occurs without pain up to 80-90° (except for people with poor stretching of the muscles of the back of the leg), leads to tension on the sciatic nerve and its roots, causing pain. Lower back pain can occur when the pelvis rotates around the transverse axis. This movement increases the load on the joints of the lumbosacral spine. If they have arthritis or arthrosis, the patient will complain of pain when moving. With diseases of the intervertebral joints of the lumbosacral spine and compression of the spinal nerve roots, this movement is limited on the affected side compared to the opposite side of the body.
Round back with increased kyphosis of the thoracic spine.
Lasegue's sign (pain and limited range of motion when flexing the hip joint with the knee straight) can help diagnose low back pain. Raising the straight leg on the contralateral side may also cause localized pain. This pain will be weaker than on the side of the disease, but it may be a sign of a more serious destruction of a fragment of the intervertebral disc, and not just its loss (herniation) or protrusion (bulging). The pain caused by this test in the patient will always radiate to the affected side of the lower back, regardless of which leg was raised.
Bending the body back is most easily performed with the patient in a standing position or lying on his stomach. If the disease worsens, it may be difficult for the patient to straighten the spine in a standing position. A person with low back strain or a bulging or herniated disc can usually straighten or bend the spine backward without increasing pain. If the damage is localized in the upper lumbar segments of the spine or there is an active inflammatory process or fracture (crack) of the vertebral body or posterior vertebral structures, then due to increasing bending back can be significantly difficult.
Inflammation of the sacroiliac joint (sacroiliitis) in the acute stage causes pain in the sacrum (sacrodynia).
Palpation and tapping in the projection of the spine are carried out at the end of the examination of the patient. It is advisable to begin palpation from an area that cannot initially serve as a source of pain, so that the patient can relax tense back muscles without fear of increased pain during an examination by a neurologist or neurosurgeon. The neurologist or neurosurgeon conducting the examination should always know what structures may be accessible to the patient when palpating the lower back. Local pain when pressing with a finger in the lumbar region of a patient is rarely detected in cases of spinal disease. The structures of the spine in the case of a disease at the lumbar level are located so deeply that they can rarely cause pain on superficial palpation. Weak pain on the surface or poorly localized pain on palpation of the lower back can only indicate a pathological process within the affected segment on the surface of the body in the area of skin innervation by this particular nerve.
Pain when pressing in the projection of the costovertebral angle can be due to disease of the kidneys, adrenal glands, or damage to the transverse processes of the LI or LII vertebrae. Increased sensitivity during palpation of the transverse processes of the remaining lumbar vertebrae and the sacrospinous muscles passing above them may indicate a fracture of the transverse process of the vertebra or muscle tension at the points of their attachment to the spine. Pain on palpation of the spinous process of the vertebra or increased pain due to tapping on it is a nonspecific sign. This pain may indicate damage to the intervertebral disc in its central part, inflammation (discitis) or a fracture. Pain from pressure in the projection of the articular surfaces between the LV and SI vertebrae can occur with damage to the intervertebral discs. Pain in this area often occurs with rheumatoid arthritis (infectious, nonspecific, progressive, deforming inflammation of the joint).
Straining the ligaments, fascia, and muscles in the lower back (lower back) causes pain or chronic discomfort.
During palpation of the spinous process, the neuropathologist or neurosurgeon notes any deviation from the central line to the side or up and down, because this may indicate a fracture or arthritis of the intervertebral joint. If the spinous process is displaced forward (“sinks” relative to the surface), the patient may have spinal instability with anterior displacement of the vertebra relative to the underlying vertebra (spondylolisthesis).
Examination of the abdominal cavity, rectum and pelvic organs with assessment of the condition of the peripheral vessels in the legs are also important components of the examination of a patient with complaints of pain in the lower back (lower back), which should not be neglected. Without them, you can miss diseases of blood vessels, internal organs, the presence of a tumor or inflammation, which can extend to the spine or cause pain that is reflected in this area.
During a neurological examination of the patient, changes in movement disorders, impaired reflexes and sensitivity in the legs are carefully examined.
Based on the results of a neurological and orthopedic examination of a patient with a pain symptom due to spinal osteochondrosis, the following additional diagnostic procedures may be prescribed:
- X-ray of the lumbosacral spine with functional tests
- lumbosacral spine
- MRI of the lumbosacral spine
Magnetic resonance imaging (MRI) of the lumbosacral spine, intervertebral disc herniation L5–S1.
The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by a fibrous ring consisting of fibrocartilaginous and connective tissue. You can read more about this in the article about the anatomy of the human spine and spinal cord.
The thickness of the discs decreases, the vertebral bodies move closer to each other, reducing the intervertebral foramina and endangering the nerves and vessels located in them (osteochondrosis).
Protrusion of discs (protrusion or prolapse of the intervertebral disc) with their further prolapse into the lumen of the spinal canal (hernia or extrusion of the intervertebral disc) most often lead to compression of the nerve roots, causing pain along the compressed nerve (pain radiating to the leg, arm, back of the head, neck , intercostal spaces depending on the level of nerve compression) with a weakening of muscle strength in the areas of their innervation and impaired sensitivity.
Scoliosis of the spine with protective spasm of the back muscles against the background of exacerbation of lumbago.
Often, a protrusion or herniation of an intervertebral disc is accompanied by a symptom of muscle pain or radicular pain along the nerve in the leg. With this radicular compression symptom, one nerve root or two nerves are compressed at once.
In addition to the symptom of nerve compression by a herniated or protruded intervertebral disc in the lumbar spine, the stability of the spinal motion segment may also be disrupted. When the spine is unstable, the vertebra becomes displaced:
- forward displacement of the vertebra (anterolisthesis)
- backward displacement of the vertebra (retrolisthesis)
To clarify the diagnosis of spinal instability, it may be necessary to conduct x-rays of the lumbosacral spine with functional tests.
Most often, the symptom of compression due to herniation or protrusion of the intervertebral disc is formed by the nerve bundles that make up the sciatic nerve. The sciatic nerve consists of fibers L5, S1, S2, SZ - spinal nerves.
Spinal stenosis with compression of the spinal cord.
A focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (spinal stenosis) and compression of the nerves and spinal cord passing through it. That is why, in case of spinal canal stenosis, it is always necessary to carry out a full course of treatment using a whole arsenal of different treatment methods, and if it is not effective, surgical treatment.
Characteristics of pain in the sacrum
The nature of the pain is one of the signs that the doctor takes into account when searching for the root cause.
Pain in the sacrum combined with pain in the lower back
Pain in the sacrum may appear due to a violation of the bone structure of this part of the musculoskeletal system, or be caused by any disease. If the latter is established, then all diseases that lead to pain in the sacrum are combined with the word sacrodynia. In this case, the pain can often radiate to other parts of the spine and lower torso, and then the patient says that either the lower back, or the tailbone, or the sacrum hurts. If you have pain in the sacrum and lower back at the same time, the source of this pain can be any reason. One of the main causes of pain in both cases is osteochondrosis. But only a doctor can say exactly where this source is and for what reason it arose. This will require a careful and thoughtful diagnosis.
Pain in the sacrum on the right and left
Pain may appear on the right or left if the sacral vertebrae are displaced, for example, due to injuries or bruises. Soreness on both sides often occurs due to inflammation and infection in the area, and may be accompanied by limping or leg cramps. If pain in the lumbosacral spine appears on the right and left even while sitting, then it is necessary to urgently consult a doctor for competent treatment.
Aching pain in the sacrum
Acute and aching pain in the lumbosacral spine often occurs due to the appearance and development of pathologies of internal organs - kidneys, prostate, intestines, appendages, etc. If the pain is aching in nature and does not subside even during a period of rest (for example, in a lying position), then perhaps we are talking about an oncological disease in which metastases have already penetrated into the sacrum. Also, aching pain is characteristic of lumbosacral radiculitis, with displacement of the sacroiliac joint. The pain may radiate to the knee or the back of the thigh.
Symptoms
Pain in the lower abdomen and lower back
can be of different types:
- pain of a pulling or aching nature, localized in the lower abdomen, sometimes radiating to the lumbar area, anus or thigh;
- pain that increases with increased physical activity, hypothermia or sexual contact;
- pain accompanied by nausea, dizziness, tachycardia;
- long-term pain that intensifies with the onset of menstruation, but does not disappear after its end.
In any of these cases, you must immediately visit a gynecologist who can determine the exact cause of the pain.
How to treat pain in the sacrum?
Any independent actions are excluded. In order to know how and with what to remove and treat the lumbosacral spine if it hurts, you need to know the cause of pain in it and have a medical education. Therefore, at the first signs, consult a doctor.
Pain relief (anesthesia)
Treatment is tailored to the cause and individual patient's situation. But most people are prescribed painkillers to relieve pain - these can be either tablets and ointments, or drugs for intramuscular and intravenous administration. If the pain is very severe, the patient may be prescribed a blockade (analgesic complex) of the painful area. The blockade is introduced into the spinal canal in the sacroiliac region or in those areas of the muscles where the main pain syndrome is concentrated.
Manual therapy, acupuncture, massage
If the lumbosacral spine hurts, how to treat it is known to an experienced specialist who, in addition to medications, can prescribe to the patient such methods of influencing the pain syndrome as acupuncture, manual therapy and massage. These methods are useful when it is necessary to correct existing bone misalignments in the pelvic area, relieve tension and swelling from the muscles, improve blood flow and oxygen supply to the muscles, joints and nearby organs, and also align the position of internal organs if they are misaligned.
Physiotherapy
Physiotherapeutic procedures for pain in the sacrum involve the use of UHF and SMT (impact on painful areas with sinusoidal currents). They help relieve swelling and inflammation in the sacrum and lower back and improve joint mobility.
Treatment
Very common pain in the lower abdomen and lower back
turn out to be a symptom of a serious disease that requires long-term and scrupulous treatment.
The sooner the doctor can determine their cause and make an accurate diagnosis, the less long and expensive the treatment process will be. Qualified gynecologists at the CELT clinic have modern equipment for diagnosis and therapy at the highest level, meeting the requirements of modern medicine. Make an appointment through the application or by calling +7 +7 We work every day:
- Monday—Friday: 8.00—20.00
- Saturday: 8.00–18.00
- Sunday is a day off
The nearest metro and MCC stations to the clinic:
- Highway of Enthusiasts or Perovo
- Partisan
- Enthusiast Highway
Driving directions
