Sacral Stress Fracture

(Sacral Stress)
  • 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.
    Sacrum
    Sacrum
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  • Causes

    Sacral stress fractures can be caused by repetitive stress or weakened bones.
  • Risk Factors

    Sacral stress fractures are most common in young athletes and older women with osteoporosis. Other factors that may increase your chance of a sacral stress fracture include:
    • Certain diseases or conditions that result in bone or mineral loss, such as abnormal or absent menstrual cycles
    • Having gone through menopause
    • Adolescents with incomplete bone growth
    • Playing certain sports that may result in collisions or falls, such as gymnastics, football, or other high-impact sports
    • Long-distance running
    • Weight-bearing activities, such as weight lifting or military training
    • Radiation therapy
    • History of Paget’s disease, hyperparathyroidism, osteopenia, or rheumatoid arthritis
  • Symptoms

    The most common symptom of a sacral stress fracture is low back pain. If you have unexplained lower back pain, talk to your doctor. Prompt treatment can prevent the injury from further problems.
    Other symptoms may include:
    • Pain in hip or pelvis
    • Pain to buttocks or groin
    • Increase in pain during your workout
    • Lower back tenderness when touched
    • Swelling at lower back
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a spine specialist or a surgeon who specializes in bone problems.
    Imaging tests evaluate your bones and other structures. These may include:
  • Treatment

    In general, treatment depends on the cause and severity.
    Treatment options for a sacral stress fracture include:
    Intial Care
    Extra support may be needed to protect, support, and keep your back in place while it heals. Supportive steps may include a corset or brace.
    Fractures due to osteoporosis are treated with partial weight bearing. A cane or other device will be used for this.
    Medications
    Medications to treat sacral stress fracture include:
    • Over-the-counter medications to reduce inflammation and pain
    • Prescription pain relievers
    If you have osteoporosis, your doctor will recommend different medications that will increase bone density and reduce your risk of another fracture.
    Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
    Rest and Recovery
    Fractures caused by physical stress need rest, but complete rest is rarely required. Ice may also be recommended to help with discomfort and swelling. Gentle massage, heat, and transcutaneous electrical stimulation (TENS) may also be used to relieve pain.
    As you recover, you may be referred to physical therapy or rehabilitation for strengthening exercises. Do not return to activities or sports until your doctor gives you permission to do so.
    Non-Surgical Procedures
    There are some treatments that are not invasive that may help reduce healing time by stimulating bone growth. These treatments include:
    • 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. The waves stimulate growth factors to increase bone cell formation.
    • Vertebroplasty—Small amounts of bone cement are injected into fracture lines guided by CT scan. It is not known what the long-term side effects of the cement are. Because of this, vertebroplasty is used on a limited basis.
    Surgery
    If other treatment does not work, surgery may be required. Surgery is generally indicated if the break is unstable, there are nerve problems, or the sacrum is not properly aligned. Bones are reconnected and held in place with screws or a plate.
  • Prevention

    To help reduce your chance of a sacral stress fracture, take these steps:
    • Make gradual changes in intensity when exercising
    • Use proper equipment and technique when playing sports
    • Talk to your doctor about how to prevent osteoporosis
    To help reduce falling hazards at work and home, take these steps:
    • Clean spills and slippery areas right away
    • Remove tripping hazards such as loose cords, rugs, and clutter
    • Use non-slip mats in the bathtub and shower
    • Install grab bars next to the toilet and in the shower or tub
    • Put in handrails on both sides of stairways
    • Walk only in well-lit rooms, stairs, and halls
    • Keep flashlights on hand in case of a power outage
  • RESOURCES

    The 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

    The University of British Columbia Department of Orthopaedics http://orthopaedics.med.ubc.ca

    References

    Hosey RG, et al. Evaluation and Management of Stress Fractures of the Pelvis and Sacrum. Orthopedics. 2008; 31:383.

    Lin JT, Lane JM. Sacral stress fractures. Journal of Women’s Health. 2003;12(9):879-888.

    Longhino V, Bonora C. The management of sacral stress fractures: current concepts. Clin Cases Miner Bone Metab. 2011;8(3):19-23.

    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 September 26, 2014. Accessed September 28, 2014.

    Micheli LJ, Curtis C. Stress Fractures in the Spine and Sacrum. Clinics in Sports Medicine. Jan 2006;25(1).

    Spondylolysis and spondylolisthesis. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00053. Updated October 2007. Accessed September 28, 2014.

    Stress fractures. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112. Updated October 2007. Accessed September 28, 2014.

    Zaman FM. Sacral stress fractures. Curr Sports Med Rep. 2006;5(1):37-43.

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