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Question: I have experienced chronic pain in my low back and gluteals, which sometimes travels down into my legs and hips like sciatic pain. I have tried stretching various muscles to see if it would relieve the pain, but nothing seems to work. Someone told me it may be caused by a misalignment of my sacrum. What is this?
Answer: The sacral spine or sacrum refers to the large irregular triangular shaped bone made up of the five fused vertebrae below the lumbar region. The sacral and coccygeal vertebræ consist at an early period of life of nine separate bone segments which are eventually fused as an adult, so as to form two bones, five which then form the sacrum, and the other four form the coccyx (or tailbone). The sacrum is inserted like a wedge (refer to the red wedge in the picture to the right) between the two iliac or pelvis bones and is held together by the two sacroiliac joints. Many back problems occur where the lumbar and sacral region of the spine connect because this region of the spine is subjected to a large amount of stress with certain activities.
 There are three joints associated to the Sacrum; two joints mirror one another on the right and left side of the sacrum where the sacrum "attaches to" the right and left hip bones (these joints are called the sacroilliac joints), and a third joint where the sacrum "attaches to" the upper Lumbar Spine (sacrolumbar joint). These joints bear the weight of the twists and turns of the trunk of the body. You can think of the sacrum as the center-most "shock absorber" of the entire body!
Sacral Nerves: There are many nerves extending from the spine through the area of the sacrum. The first and second sacral nerves are large; the third, fourth, and fifth diminish progressively from above and downward. The first sacral nerve goes to the Quadratus Femoris and Gemellus Inferior and leaves the pelvis through the greater sciatic foramen, travels below the Piriformis, and runs down in front of the sciatic nerve located on the back of the leg. The second sacral nerve goes to the Obturator Internus (found in the groin) and Gemellus Superior, and is made up of a nerve “branch” extending to the Piriformis. If a sacral nerve is pinched (by either misalignment or inflamed muscles) a person may feel pain in any of the muscles associated with the sacral nerves listed here, as well as some level of sciatic nerve pain.
Sacral Muscles: There are many muscles located in and around the pelvic region. The key muscles that impact pelvic function include the back extensors or erector spinae muscles (long muscles extending down the back from the head to the sacrum), the abdominals, the quadratus lumborum (which functions to laterally flex the lumbar spine toward the pelvis), and the iliopsoas (these muscles act collectively to either flex the spine on the trunk or to flex the hip and bring the leg towards the trunk). Due to the relationship between the sacrum and the sacral nerves and muscles surrounding the sacrum, a misaligned sacrum may often be mistaken for muscle tension or strain in any of the muscles listed here.
 Sacral Misalignments: Sacral misalignments are more common than reported. Misalignments can be caused by wrong sitting positions, improper stretching, unnatural movements, trauma at birth (before, during or after), wrong lifting techniques, chronically tensed muscles which pull the sacrum to one side, or by an accident (such as falling down etc.). One of the most common injuries found in female Yoga practitioners is misalignment at the Sacral Iliac joint – often a result in over-stretching the hip. All hip stretching should be done with open legs (legs in a straddle position). The knees should be tilted outwards while stretching the Hip-Joint less than 90°, only then will the Hip-Joint stay in its proper position.
A typical sign of the SI joint being out of alignment is a pain on one side of the sacrum. Although well-pronounced misalignments can often be seen by one hip lifting higher than the other, it is best to have a doctor check it out and give you a diagnosis. The misalignment in the hip joint might be very small and may not always or easily be seen on x-ray. However, the resulting leg length difference caused by the misalignments can be quite large. The imbalance in the hip might even cause discomfort in the joints of the knee and ankle. The following movements have proven to worsen and/or produce misalignments in our Hip-joint and /or Sacrum; sitting with crossed legs (probably the worst of all!), stretching the hip joint(s) less than 90° with the legs/knees straight (Forward Stretching), lifting objects over the side (even light objects), turning in the hip with both feet firm on the floor while standing or while the upper body flat and firm lying on the floor, driving in a car (especially long driving without breaks, bad car seats and bad positioning in the seat), and the wrong way of going in and out of the car.
When you learn more about the sacrum, and the importance of stabilizing the three joints associated with the sacral spine, you will gain a greater respect for this often over-looked area of your body which joins the upper torso to the lower extremeties! Consider joining us for an upcoming Educational Workshop (to be scheduled later this year in 2010) to learn more about the Sacral Spine!
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