The Surprising Cause of Sacrum Pain Most People Miss

“Our bodies communicate to us clearly and specifically, if we are willing to listen.” —Shakti Gawain

Sacrum pain is one of the most overlooked and misunderstood types of lower back pain. Many people suffer for months or even years without realizing the source of their discomfort lies in the sacroiliac (SI) joint—the place where the sacrum meets the pelvic bones. In fact, there is no such thing as sacrum pain unless the sacrum itself is broken, which almost never happens.  

What Are The Sacroiliac Joints?

The pelvic bones, which serve as a foundational support for the upper body attached to the triangular bone at the base of the spine, called the sacrum. The joint where they attach is the sacroiliac (SI) joint. When the SI joint becomes misaligned, it can lead to significant pain and mobility issues.

The Cause Most People—and Providers—Overlook

What often goes unnoticed is that ligament strain, not muscle tension or disc problems, is a primary cause of Sacroiliac joint pain.

Ligaments are tough, fibrous tissues that hold the SI joint in place. These ligaments can become overstretched from pregnancy, repetitive stress, poor posture, or trauma. When that happens, the overstretched nerves inside them start to cause pain that can be sharp, dull, radiating, or persistent.

Unlike muscles, ligaments don’t respond well to stretching or massage. In fact, those treatments can sometimes make the pain worse if they further destabilize the joint.

Symptoms of Sacroiliac Joint Dysfunction:

• Pain at the base of the spine

• Discomfort when sitting or standing for long periods

• Pain that radiates into the hips or thighs

• Sharp pain when rising from a seated position

• Trouble sleeping due to pelvic or lower back pain

Common Triggers:

• Pregnancy and hormonal changes

• Repetitive lifting or twisting

• Sudden trauma or falls

• Poor posture over time

• Prolonged sitting

• One leg shorter than the other

• Hypermobile joints or connective tissue conditions

Even one awkward movement can cause the ligaments to overstretch and lose their supportive function.

What You Can Do to Relieve Sacrum Pain

If ligament strain and joint misalignment are the root causes, the solution must focus on realigning the pelvis, calming irritated nerves, and supporting healing.

1. Realign the Pelvis

A gentle 2-minute technique can help reposition the SI joint and restore balance. This involves using your own body positioning to guide the joint back into place. Detailed instructions are provided in the book Low Back Pain: 3 Steps to Relief in 2 Minutes.

2. Calm the Nerves

Providing that there is not too much distance between the skin and irritated nerves, applying a topical mannitol cream, like QR Cream, can help soothe irritated nerve endings within the ligaments. Ice or heat therapy may also be beneficial in promoting circulation and reducing inflammation.

3. Provide Support

Supportive strategies include:

• Wearing a pelvic support belt

• Avoiding activities that overstretch the ligaments

• Using a donut cushion to minimize pelvic separation

• Engaging in gentle movement like walking or deep belly breathing

These approaches help reduce further strain and create a stable environment for healing.

When to Seek Medical Attention

Seek immediate medical care if you experience:

• Numbness or tingling below the knees

• Loss of bladder or bowel control

• Sudden or severe weakness in the legs

• Fever

These symptoms may indicate a more serious condition that requires urgent evaluation.

Final Thoughts

Sacroiliac joint pain, what you may have thought was sacrum pain, is real, and for many, it's rooted in ligament strain and joint misalignment, not muscle tightness or disc issues. By understanding the anatomy and treating the true cause, it’s possible to find long-term relief without relying on medication or invasive procedures.

Relief starts with knowledge. With the right tools and a gentle approach, you can support your body’s natural healing process and return to pain-free movement.

— Hélène Bertrand, MD (retired)

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Disclaimer: This content is for informational and educational purposes only and does not substitute professional medical advice, diagnosis, or treatment. Always consult your healthcare provider before starting any new treatment or making changes to your health regimen. Although Dr. Bertrand is a retired medical doctor, she is not practicing medicine or providing medical care through this website.