Sacral and lumbar problems
So, continuing with the Back Pain series, we move up to the sacrum – the large flat bone right at the base of your back and then up to the lumbar vertebrae, the five large flexible bones at the bottom of the spine.
The sacrum consists of five bones that are fused together to form a flat, triangular shape. This is a very important part of the spine as it is a connecting point for the back of the pelvis bones on either side, the base of the spinal column at the top and the coccyx below. There is little movement within the sacrum itself but each of the joints to the other bones are under a huge amount of stress as they form part of the pelvic girdle upon which our whole upper body is supported.
The sacrum is an attachment point for many of the deep muscles in the buttocks, particularly the gluteus group, the piriformis, the core stabiliser muscles of the lower back and the hamstrings of the back of the leg. As you can imagine, if any of these muscles tighten and shorten there will be an effect on the sacrum, often a tilting pattern that then puts the lumbar area under strain.
Pain in the sacrum may be a hot, sharp pain or it may feel more a dull ache. If the pain has been caused by muscular tightness – poor posture or a sedentary lifestyle can be contributors to this – then a physical therapy may be all that is needed to give those muscles a hand in releasing the tight holding pattern they may have got stuck in. Highly effective treatments include Massage, using a TENS machine or a regular exercise and stretching programme to encourage the muscles to release and relax back to ‘normal’ function.
Sacral pain may also be due to damage to the ligaments that hold the structures in place and keep the attachment points strong. The ligaments that connect the sacum to the illium of the pelvis – the sacroilliac joint – can be susceptable to the usual soft tissue injuries of strains, tears and inflammation. Sacroilliac joint pain commonly presents as pain in the very lower back, the buttocks and sometimes radiating down towards the knees. It may also refer as groin pain in the front of the pelvis. These type of injuries may be the result of a trauma such as a fall landing hard on one buttock, jarring or occur over time due to a leg length discrepancy or repeated, long term, poor posture.
The lumbar section of the spine has to be strong enough to support the weight of the body above as well as flexible to act as a shock absorber during movement, so these five lumbar vertebrae are larger than the rest of the bones that make up the spine.
Due to the extreme stresses this section of the spine is exposed to, it is a common area for back pain to occur. Muscularly, the quadratus lumborum and erector spinae take a lot of the strain and these often become extremely tight, or hypertonic. Muscle spasm frequently occurs as a protective reflex and the back ‘locks’ up. Massage is extremely effective at treating by gently helping these muscles to release at a deep level and find a more neutral holding pattern in their own time.
More serious problems of the lumbar spine include slipped (prolapsed) or herniated discs, spinal stenosis, arthritis, degenerative disc disease, infections and tumours.
Prolapsed discs occur when the disc, which acts as a cushion between the vertebrae, gets squeezed out of place - one article I read described it as being like a burger sliding out of the bun!! – and presses against the spinal cord. Herniated discs are similar but the strong outer casing of the disc tears and the soft tissue bulges out. Both can cause severe symptoms – including pain that spreads to the buttocks and legs, tingling or numbness, muscle spasms or weakness – but equally both can present no pain symptoms at all.
The severity of the prolapse or herniation will determine the treatment required – low level prolapse can be manipulated back into place through stretches or physical therapy such as Dorn Method or McTimoney Chiropractic. If more severe, surgical intervention may be required to repair the damage and prevent reoccurance.
As well as disc herniation and prolapse it is possible for the vertebrae themselves to slip, a condition called Isthmic Spondylothesis. We are lucky enough to have a guest blog from Caroline who has kindly written about her experience of this, the initial symptoms, the gruelling treatment that followed and finally the surgical intervention and life afterwards. Caroline has been a massage client of mine for a number of years now as well as receiving regular osteopathy, both of which help manage her pain and mobility. You can read the blog here.
In the next installment we will look closer at other pathologies of the lumber spine including degenerative disc disease, arthritis and spinal stenosis.