Understanding Sacral Pain and How Pelvic Floor Therapy Can Help

By Dr. Christine Martirez PT, DPT on 10/21/2024

Sacral pain can be debilitating, affecting daily activities and overall quality of life. Located at the base of the spine, the sacrum is a crucial bone in the structure of the pelvis and lower back. Sacral pain often radiates to the lower back, hips, and even the legs, making it challenging to sit, stand, or walk comfortably. In this blog post, we will explore the anatomy of the sacrum, its relationship to surrounding bones and muscles, and how pelvic floor physical therapy can play a key role in treating sacral pain.

Anatomy of the Sacrum

The sacrum is a triangular-shaped bone located at the base of the spine, between the lumbar spine and the tailbone (coccyx). It consists of five fused vertebrae and forms the back part of the pelvic girdle. The sacrum connects to the iliac bones on each side, forming the sacroiliac joints, which are critical for weight-bearing and movement. The sacrum acts as a keystone, providing stability for the pelvis and transferring the weight of the upper body to the lower limbs.Surrounding the sacrum are important muscles and ligaments that support its function, including:

• Gluteal muscles

  The glutes (gluteus maximus, medius, and minimus) are essential for hip movement, stability, and power. They attach to the pelvis and play a role in supporting the sacrum during weight-bearing activities.

• Hip rotators

  Muscles such as the piriformis, obturator internus, and gemellus help rotate and stabilize the hip joint. The piriformis, in particular, originates from the sacrum and can contribute to sacral pain if irritated or tight.

• Pelvic floor muscles

  These muscles form the base of the pelvis, providing support for the pelvic organs and assisting in bladder and bowel control. The pelvic floor muscles include the pubococcygeus, iliococcygeus, puborectalis, coccygeus, and others. These muscles attach to the sacrum and coccyx, playing a direct role in sacral stability and function.

Causes of Sacral Pain

Sacral pain can arise from various factors, including:

• Sacroiliac joint dysfunction

The sacroiliac joints can become irritated or misaligned, causing pain in the lower back, hips, and sacral region.

• Pelvic floor dysfunction

Tight or weak pelvic floor muscles can contribute to imbalances in the pelvis, leading to increased stress on the sacrum and surrounding joints.

• Muscle imbalances

Tension or weakness in the surrounding muscles, such as the glutes or hip rotators, can place excess strain on the sacrum, leading to discomfort.

• Trauma or injury

Falls, accidents, or sports injuries can directly impact the sacrum or sacroiliac joints, causing pain.

• Pregnancy and childbirth

The sacrum and pelvis undergo significant changes during pregnancy and childbirth, which can lead to postural shifts and sacral pain.

• Postural issues

Poor posture or prolonged sitting can put stress on the sacrum, contributing to chronic pain over time.

How Pelvic Floor Therapy Can Help with Sacral Pain

Pelvic floor physical therapy is an effective treatment approach for addressing sacral pain, particularly when it is linked to dysfunction in the pelvic floor, sacroiliac joints, or surrounding muscles. Here are some ways pelvic floor therapy can help:

Comprehensive Assessment

A pelvic floor physical therapist will perform a thorough evaluation of your posture, alignment, muscle strength, and flexibility, focusing on the relationship between the sacrum, pelvis, and surrounding structures. This assessment helps identify any muscle imbalances, joint dysfunction, or postural issues that may be contributing to your sacral pain.

Manual Therapy

Manual therapy techniques such as myofascial release, soft tissue mobilization, and joint mobilization can help release tension in the muscles surrounding the sacrum, including the glutes, hip rotators, and pelvic floor muscles. These techniques can alleviate pain, improve mobility, and restore proper alignment in the pelvis and sacroiliac joints.

Pelvic Floor Muscle Training

If pelvic floor dysfunction is contributing to your sacral pain, pelvic floor therapy can target these muscles with specific exercises. Strengthening or relaxing the pelvic floor muscles can reduce stress on the sacrum and pelvis, helping to restore balance and stability.

Postural and Movement Education

Many people with sacral pain have poor posture or movement patterns that exacerbate their discomfort. A pelvic floor physical therapist can provide guidance on how to improve your posture, particularly while sitting, standing, or moving. They may also teach you body mechanics to avoid putting excess strain on the sacrum during daily activities, such as lifting, bending, or sitting for extended periods.

Neuromuscular Re-Education

Improving coordination and strength between the pelvic floor, glutes, and hip rotators is essential for maintaining sacral and pelvic stability. Neuromuscular re-education techniques can help retrain these muscles to work together efficiently, reducing stress on the sacrum and preventing future pain.

Exercise Prescription

A tailored exercise program can help strengthen and stabilize the muscles surrounding the sacrum, including the core, pelvic floor, and hip muscles. Strengthening these muscles can reduce pressure on the sacrum and sacroiliac joints, alleviating pain and improving function.

Sacral pain can have a profound impact on your ability to move comfortably and engage in daily activities. Given the close relationship between the sacrum, pelvis, and surrounding muscles, including the pelvic floor, treating sacral pain often requires a holistic approach. Pelvic floor therapy offers targeted treatments that address the root causes of sacral pain, helping to restore balance, stability, and mobility in the pelvis and lower back.If you're experiencing sacral pain, consider seeing a pelvic floor therapist to get a personalized treatment plan that addresses your specific needs, helping you return to a pain-free and active lifestyle.

Suffering from sacral pain? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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