Sacral Stress Injuries

Stress fractures refer to fatigue or insufficiency fractures that are caused due to repetitive stress in healthy bones or a decreased ability of abnormal bone to withstand repetitive stress.

Stress fractures of the sacrum are mainly insufficiency fractures that occur when vertical body forces are dissipated from the spine and concentrated in the sacrum, sacral alae and iliac wings.

As mentioned by Miller et al., such fractures may accompany pubic-related stress injuries because of abnormal shear stresses that are transmitted through the pelvic ring in the presence of symphasis instability.

The authors describe the clinical presentation of sacral stress fractures as involving pain that is diffused across the sacroiliac joint in addition to tenderness in the gluteal area; the patient may experience unilateral pain in the lower back, buttocks or hips.

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In athletes, common predisposing factors are considered to be highly intensive training programmes, rapid changes in training regimen, leg length discrepancy, poor training surface and unsupportive footwear.

Wagner et al. describe fragility fractures of the sacrum as occurring due to primary or secondary osteoporosis with biomechanical factors such as hyperlordotic posture, alteration in the stability of the pelvis ring, weight gain and degenerative spondylolisthesis serving as risk factors.

The authors suggest conservative management as the primary approach for isolated non-displaced sacral fractures with or without an additional non-displaced fracture of the anterior pelvic ring.

Following an early diagnosis, conservative treatment programmes should focus on pain control and early mobilisation through physiotherapy in the form of swimming or cycling to prevent immobility-associated complications.

Once pain-free, light-weighted exercises can be implemented in addition to non-impact loading activities to recover strength and correct any imbalances. This can be followed up with sport-specific activity for athletes.

The efficacy of including MASS4D® customised orthotics in rehabilitative programmes stems from increased functionality in the lower limbs, improvement in gait patterns and enhanced mobility.

MASS4D® foot orthotics are highly customised and built to accommodate specific musculoskeletal changes, acting as supportive devices for the foot to provide protection from fragility fractures that could greatly affect an individual’s quality of life.

A MASS4D® customised orthotic intervention would also help in addressing biomechanical problems of the foot, which need to be treated in order to eradicate compensatory movements that could further exacerbate pressure on the sacroiliac joint.

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Related Links
Managing Stress Fractures with Orthotics
The Biomechanical Implications of Sacroiliac Joint Dysfunction
Orthotic Care for Osteoporosis

References:

1. Wagner, D., Ossendorf, C., Gruszka, D., Hofmann, A., Rommens, P. M. (2015) Fragility Fractures of the Sacrum: How to Identify and When to Treat Surgically? European Journal of Trauma and Emergency Surgery: April 2015, Vol. 41, No. 4, pp. 349-362.  doi: 10.1007/s00068-015-0530-z
2. Tzoanos, G., Tsavalas, N., Manidakis, N., Karantanas, A. (2013) Sacral Fatigue Fracture in an Amateur Soccer Player. Case Reports in Medicine: May 2013, Vol. 2013. doi: 10.1155/2013/985310
3. Miller, C., Major, N., Toth, A. (2003) Pelvic Stress Injuries in the Athlete. Sports Medicine: November 2003, Vol. 33, No. 13, pp. 1003-1012. doi: 10.2165/00007256-200333130-00005

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