Low Back & Pelvis

What It Is

The sacrum is a large, triangular bone at the base of the spine. It connects to the pelvis on each side. The sacrum is a strong bone, and in younger people it usually takes a lot of force, such as a road accident or a fall from a height, to break it (Santolini, Kanakaris and Giannoudis, 2020).

In older people, especially those whose bones have been weakened by osteoporosis (bone thinning), the sacrum can break after only a minor fall or with no clear injury at all (Santolini, Kanakaris and Giannoudis, 2020). These are called sacral insufficiency fractures, a type of stress fracture. They mainly affect older women with osteoporosis, and they are a common but often missed cause of lower back pain (Lyders et al., 2010).

Sacral Fracture Anatomy

The sacrum sits at the base of the spine. Below the sacrum is the coccyx (tailbone), and above the sacrum is the lower back (lumbar spine). To the side of the sacrum is the pelvis. The sacrum connects to the pelvis via a joint on each side known as the sacro-iliac joint. This is a large, strong joint that has only a limited amount of movement.

If a fracture is suspected, you will need imaging. Plain X-rays can miss up to half of sacral fractures, so a CT scan or MRI scan is often used to find the break (Santolini, Kanakaris and Giannoudis, 2020; Lyders et al., 2010).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Sacral Fracture

As you recover, rehabilitation with strengthening exercises helps you get moving again. Working within your medical team's plan, I can help with gentle hands-on work, walking practice and exercises to rebuild your strength. See the My Approach tab for how I work.

1. Initial Care

Stable sacral fractures are usually treated without an operation, with pain relief and getting you moving again early (Santolini, Kanakaris and Giannoudis, 2020). Fractures that are the result of osteoporosis are often managed by cutting down on activity and using a walking aid, such as crutches or a walker, to take some of the load while the bone heals. Long periods of bed rest carry serious risks, such as blood clots, muscle loss and chest infections, so they are best avoided (Lyders et al., 2010). Follow the advice of your medical team about how much weight to put through your legs.

2. Recovery and Rest

You don't have to rest completely, but you do need to give the fracture time to heal. Recovery can be slow: most people with an insufficiency fracture find their symptoms have settled within about a year, although this varies (Lyders et al., 2010).

Some people find an ice pack or heat pack, wrapped in a tea towel, eases back pain (NHS, 2026). Check with your doctor or with me whether this is suitable for you, and never put ice directly on the skin.

3. Rehab

As you go through the recovery process, you might be referred to a physical therapist for rehabilitation with strengthening exercises. I can also guide you through strengthening exercises, as your medical team allows. Avoid returning to any sports or regular activities until you are given permission to do so.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Prescription pain relief: your doctor may prescribe medicine to help control the pain while the bone heals (Lyders et al., 2010).
Bone-strengthening medicines: if you have osteoporosis, your doctor may recommend medicines that strengthen the bones and reduce the risk of another fracture (NHS, 2022).
Surgery: fractures that are unstable may need an operation to hold the bone in place (Santolini, Kanakaris and Giannoudis, 2020).
Sacroplasty: a procedure in which bone cement is injected into the broken sacrum, sometimes used for insufficiency fractures (Lyders et al., 2010).

How I can help (see the My Approach tab)

Easing the areas that work overtime while you heal

Setting up walking aids and practising walking

Gentle strength and balance work, as your team allows

Tips

Make changes slowly when it comes to your exercise routine. It will take some time to recover from a sacral fracture, and doing exercises on the floor may be uncomfortable.
Whenever you are out playing sports, make sure you are using the proper equipment and techniques to prevent injuries from occurring.
Remove any tripping hazards such as rugs, loose cords or clutter to help prevent falls and injuries.
Good nutrition is so important for bone health. Make sure you get enough calcium and vitamin D (NHS, 2022).

Treatment

My Approach

After a sacral fracture, the bone needs time to heal, but staying gently active matters too. Your medical team decides how much weight you can put through your legs, and I work inside those limits. If your fracture was treated with surgery, or it stops you doing your normal daily tasks, I need your team's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

Early On

Easing the low back, hips, shoulders and arms, which work overtime when you use a walking aid, with no pressure over the fracture
Pillows for comfort, and gentle pressure suited to bones weakened by osteoporosis
Warmth or gentle massage near the area only when it suits your stage of healing, and lymphatic drainage for swelling
Setting up your crutches or walker and practising walking safely

As It Heals

Gentle movement for a stiff back and hips, with no forceful joint work
Scar work once any surgical wound has healed
Strength for your hips, legs and trunk, building to balance work and getting up from a chair
Longer walks, and a return to sport once your team agrees

Buttock and hip work is only with your informed consent and a written consent form. If you get new numbness or weakness in your legs, or changes in your bladder or bowels, call 911 (see When to Get Urgent Help).

What to Expect

Typical Course

Typical course: Most people come once or twice a week early on, then weekly, with a reassessment at about 4 to 6 weeks, all fitted around your medical team's plan. Recovery can be slow: most people with an insufficiency fracture find their symptoms have settled within about a year.

What I Focus On

Working Within Your Team's Limits

Compensation Relief

Walking Aids & Gait

Gentle Strength & Balance

Gradual Return to Activity

Please read

When to See a Doctor First

When to Get Urgent Help

Call 911 or go to the emergency room at your nearest hospital if you have back pain and any of the following: pain, tingling, weakness or numbness in both legs; loss of feeling around your genitals or bottom (anus); changes in your bladder or bowels, such as difficulty peeing or not being able to control when you pee or poo; or the pain started after a serious accident, such as a car accident (NHS, 2026).

Sources

References

Lyders, E.M., Whitlow, C.T., Baker, M.D. and Morris, P.P. (2010) 'Imaging and treatment of sacral insufficiency fractures', American Journal of Neuroradiology, 31(2), pp. 201–210. doi: 10.3174/ajnr.A1666
NHS (2022) Osteoporosis – treatment. Available at: https://www.nhs.uk/conditions/osteoporosis/treatment/ (Accessed: 7 October 2026).
NHS (2026) Back pain. Available at: https://www.nhs.uk/conditions/back-pain/ (Accessed: 8 October 2026).
Santolini, E., Kanakaris, N.K. and Giannoudis, P.V. (2020) 'Sacral fractures: issues, challenges, solutions', EFORT Open Reviews, 5(5), pp. 299–311. doi: 10.1302/2058-5241.5.190064

Massage therapy · Kitchener–WaterlooSacral Fracture

What It Is

Sacral Fracture Anatomy

Self-Care & Treatment

How to Treat Sacral Fracture

1. Initial Care

2. Recovery and Rest

3. Rehab

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Early On

As It Heals

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooSacral Fracture

What It Is

Sacral Fracture Anatomy

Self-Care & Treatment

How to Treat Sacral Fracture

1. Initial Care

2. Recovery and Rest

3. Rehab

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Early On

As It Heals

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Ankylosing Spondylitis (AS)

Cervical Spondylotic Myelopathy

Coccydynia

Coccyx Fracture

Book a session