Lumbo-Sacrum pain from muscle tightening

Lumbar Spine and Sacrum



Lower back pain can come from different sources, muscles, joints, ligaments or discs and sometimes the source can be all of the above at the same time.  We need to identify the source and the level of the cause (L1, 2, 3, 4 or 5) and sometimes it could be at the sacrum level, where the sacrum and the pelvis form a joint, the sacroiliac (SI) joint.  In this blog, we are going to talk about the pain at the sacrum level specifically.


Sacroiliac (SI) Joint - marked red at the right side


Pain at the SI joint can be caused by tight muscles along the spine, like the superficial erector spinae or the deep multifidus that can run from the neck down the sacrum.  When the myofascial system becomes so tight from working out or prolonged posture, it can pull so hard on the sacrum and cause a shift of the sacrum position, which cause compression on the nerve root travelling through the SI joint and cause a lot of pain.


Lumbosacral Nerves/Plexus
                 


Sometimes the pain can be caused by the SI joint being stuck regardless of the muscles.  When we release the muscle or myofascial tension, the pain reduces then we know the joint is not at fault.  Sometimes the sacrum position becomes better after the muscles are not tight.  However, sometimes the joint continues to be stuck in a tilted position then we will need to "unstuck" the joint with mobilization techniques.  Some practitioners could also perform manipulation for the joint.

Most of the time, when we release the myofascial tension along the erector spinae and multifidus, sacrum moves away from the position of pain gradually.  If we forcefully mobilize or manipulate the SI joint, it could cause worsened muscle tension and worsened pain afterwards.

Regular stretching and postural re-training could be important too to prevent those spinal muscles from tightening again and pulling on the sacrum repetitively.  Proper length of the hip muscles are also important to ensure the pelvis position is not pulling on the sacrum.  We will look into the hips as well once the pain starts to subside at the sacrum area.

Stretching is the key to get better!  Once you are better, we will need to strengthen to prevent the same pain from returning!  Work with your physiotherapist patiently and diligently!

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