Definition
A sacral stress fracture is a small break in the sacrum. The sacrum is a large triangular bone at base of the spine. The sacrum connects to the pelvis.
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Risk Factors
This problem is more common in young athletes and older women with osteoporosis. Other things that may raise the risk are:
- Female athlete triad
- Having problems that weaken the bones, such as osteoporosis
- Playing some sports, such as gymnastics or football
- Long-distance running
- Weight-bearing activities, such as weight lifting or military training
- Radiation therapy
- History of Paget disease, hyperparathyroidism, osteopenia, or rheumatoid arthritis
Symptoms
The most common problem is low back pain. Other problems may be:
- Pain in hip or pelvis
- Pain in buttocks or groin
- Lower back tenderness
- Swelling at lower back
- Pain during exercise
Diagnosis
You will be asked about your symptoms and health history. A physical exam will be done. You may need to see a doctor who treats spines or one who treats bone problems.
Images may be taken. This can be done with:
Treatment
It will take several weeks for most people to heal. The goals of treatment are to manage pain and support the bone as it heals. This may include:
- Medicine to ease pain and swelling
- A corset or brace to support the bone as it heals
- A cane or other device to take weight off of the lower back
- Exercises to help with strength and range of motion
Non-Surgical Procedures
These treatments may be done to reduce healing time by stimulating bone growth:
- Electrical stimulation—Electrical and magnetic impulses stimulate enzymes to increase bone cell formation
- Extracorporeal shock wave therapy—High-energy shock waves are passed through body tissues to stimulate growth factors to increase bone cell formation
- Vertebroplasty—Small amounts of bone cement are injected into fracture lines. This is not done often.
Surgery
Some people may need surgery when other methods do not help. Bones are reconnected and held in place with screws or a plate.
Prevention
This problem cannot always be prevented. Starting a new sport slowly may help lower the risk of injury. Healthy bones and muscles may also help. This may be done through diet and exercise.
RESOURCES
American Orthopaedic Society for Sports Medicine http://www.sportsmed.org
Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org
CANADIAN RESOURCES
Canadian Orthopaedic Association http://www.coa-aco.org
University of British Columbia Department of Orthopaedics http://orthopaedics.med.ubc.ca
References
American College of Obstetrics and Gynecology (ACOG) Committee on Adolescent Health Care. Committee Opinion No.702: Female Athlete Triad. Obstet Gynecol. 2017 Jun;129(6):e160-167.
Female athlete triad. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/female-athlete-triad . Updated November 7, 2019. Accessed December 6, 2019.
Low back pain fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/backpain/detail%5Fbackpain.htm. Updated August 13, 2019. Accessed December 6, 2019.
Stress fractures. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112. Updated October 2007. Accessed December 6, 2019.
Revision Information
- Reviewer: EBSCO Medical Review Board Laura Lei-Rivera, PT, DPT, GCS
- Review Date: 09/2019
- Update Date: 07/14/2020