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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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:
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:
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:
In general, treatment depends on the cause and severity.
Treatment options for a sacral stress fracture include:
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 to treat sacral stress fracture include:
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.
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.
There are some treatments that are not invasive that may help reduce healing time by stimulating bone growth. These treatments include:
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.
To help reduce your chance of a sacral stress fracture, take these steps:
To help reduce falling hazards at work and home, take these steps:
The American Orthopaedic Society for Sports Medicine
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
The University of British Columbia Department of Orthopaedics
Hosey RG, et al. Evaluation and Management of Stress Fractures of the Pelvis and Sacrum. Orthopedics. 2008; 31:383.
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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_backpain.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.
Last reviewed August 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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