Pain on the Sacrum
In this episode of Unreal Results, I dive deep into sacral pain talking about its link to your organs, nervous system, and even past pelvic floor issues. I share how sacral pain is often misdiagnosed as low back pain and the surprising (maybe not if you've been following along for some time) connection to gut health. I also talk about how hormones and lymphatic congestion can contribute to sacral pain. Lastly, I share some simple self-massage techniques and how the Swelling Reduction Protocol can help with sacral pain.
Resources mentioned in this episode:
Exercises & Other Solutions I Mention For Sacral Pain
Instagram Post I Mention
Episode 37: Swelling Protocol Update Podcast Episode
MovementRev Swelling Reduction Protocol Freebie
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole-body approach to care, however, it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello. Welcome to another episode of the Unreal results podcast. Um, new background, same podcast. Uh, hopefully okay audio quality. Shout out the, um, podcast editing software called Descript. Um, they really, their studio sound really cleans up some poor audio. Um. Anyways, not what the art, not article, not what the podcast is about this week, but just my thoughts.
Cause I'm more in the kitchen area of our Airbnb versus one of the guest rooms. So it's also why I'm talking a little closer to the mic, um, to ensure good quality sound. And, um, I was thinking about what I wanted to talk about today and I wanted to do, um, another like real visceral based, um, Podcast this time around and I was thinking about it.
I'm not sure this must have come up in conversation recently because I did share an old post I did on it. Um, but talking about pain on the sacrum and I actually was thinking about this today and I was like, you know what? I should start this with sometimes talking Sometimes even clinicians don't appreciate, um, from a topography, anatomy, topography standpoint, where exactly the lumbar spine is and the sacrum is on the backside of the body.
And I always share, actually, I share this story in the LTAP level one course when I teach it, um, because like I am the first to admit I teach it now because I was that person who made a mistake early in my career. I remember looking at I was looking at lumbar side bending and seated and I would look at every patient and I'd be like It looks flat.
All of it looks flat. Flat to the right, flat to the left. And I was just like, what, you know, like, I don't even see this curve people are talking about. And what I realized is the area of the body I was looking at was actually the sacrum. And so when somebody was lateral flexing. I wasn't really moving because it shouldn't really move and, um, I realized, oh, I'm looking at a whole different spot at the back.
Like if I'm really truly looking at the lumbar spine, it's up higher and it's not as long often as the sacral area of people. So, you know, first of all, when I'm talking about pain on the sacrum, It's important to realize that a lot of the times clients are going to point to their low back area and say they have low back pain.
And I want you to pay attention on where that pain really is. Because if it's actually on the sacrum, you can guarantee there's almost always a visceral component to it then. The sacrum and the viscera are intimately connected. And if it's not a It's, if it's not often a visceral component to it, oftentimes there's a central nervous system component to it.
And because the, the sacrum is part of the central nervous system because right, so central nervous system is brain and spinal cord. The spinal cord filum terminale goes through the sacrum and attaches down at the coccyx. It is actually even very superficially exposed in the sacral hiatus and you can palpate the filum terminale.
So it is very much part of the central nervous system as well as the front side of the sacrum is very much invested with the, um, ligaments of the, um, your genital organs. And so that is why it's almost always a visceral thing when somebody has pain on their sacrum. So oftentimes I think people point to their sacrum area and are like, Oh, I have back pain.
And we just, we don't even really look at it. We just assume it is back pain. And don't take the time to palpate and notice that it's the sacrum. So first thing to think about, if it's the sacrum or the low back. If it's below, between or below the iliac crests, chances are it's the sacrum. The iliac crests tend to be at about L4, sometimes L3, but mostly L4.
So anything Um, at that level and below is pretty much sacrum because let's, let's say they are pointing to L5. L5, the L5 S1 facet joint is technically like part of the SI joint, right? Part of the SI mobility tests. And so, um, you know, L5 is a little bit more sacrum y than lumbar. So if it's above the level of the iliac crest, that's more lumbar spine.
So that's the first thing to note. The second thing to note is like, it's always visceral component. And, um, you can imagine this too, if you imagine, or if you just pull up like. Go on the old Google and look at the anatomy there. The organs that sit in the pelvic bowl there are going to be the, um, from the front towards the back, right?
Anterior to posterior is going to be the bladder, the uterus or prostate, and then the rectum. And then, um, The ureters, uh, right, the tubes that go from the kidney to the bladder, and then the ovaries are also in that area. Um, so with around all of those organs are different fascial layers, right? Because, um, the ligaments that hold those organs in place extend from the pubic bone to the sides of the ilium and then back to the sacrum.
And so there's sort of different layers of expanse of ligaments and fascia in the area. And all of that area too has a lot of pockets or space for vasculature. So the other thing that goes through this area is the iliac, artery and vein lymphatics, the um, and then all of the venous return to, to and to, not to, from those organs, uh, from the legs and, um, even to, so on the left and right side, you've got the mesenteric veins and arteries that are within the mesentery that we talked about last week, right?
So it's an area of our body that has a lot of vascular, vascularization. Um, it has a tendency towards congestion. So depending on your own experience, you've probably felt this form of congestion, either as a female, you've felt it, um, every month when your menstrual cycle comes around, we have a general.
increase in congestion and, uh, vascular fluid in that area as we menstruate and, um, also if you've been constipated or just plain bloated, um, it tends to like feel pretty heavy in the lower abdomen and pelvis area. So you've felt this, um, congestion in the area more than likely at least once in your life.
So it's, uh, both. Men and women and, um, also too, then it makes sense too, right? So for women who menstruate, um, or who have menstruated more than likely they've experienced some. pain on their sacrum, uh, during that time. And so we're very familiar, I always tell people, like, it's really easy for people to understand the visceral connections when they think about how it already shows up in our life.
So the most famous one is, right, like left arm and shoulder pain with a heart attack. The other most common one is back pain with period cramps. menstrual cramps. And so it's like, yeah, duh. This is actually, I talked about last week how it's an easy, I end up, I end up having a lot of pelvic floor physical therapists that, um, learn from me and follow me on social media and on YouTube and this podcast because, uh, pelvic pain and understanding the visceral connection is actually like.
not a reach, right? It makes sense to people. And so this is a very visceral referral pattern that we are well aware of and accept. But for some time, for some reason, sometimes when people just present with back pain on its own, it's, we forget, we forget to one, is it, back, like lumbar spine, or is it sacrum?
And then two, like, we forget that that could be a referral for visceral pain. So, um, pain, like I said at the beginning, when it's on the sacrum, it's almost always coming from a visceral connection. So, um, The Helpful like why I want to talk about this It's actually to an area that I feel like can be fairly
I don't want to say easily treated because that's not true. Right if that was true, then a profession like Um, pelvic floor or pelvic physical therapists would probably not exist, but, um, I want to say that it actually can be easier to support this, these organs, um, through movement than one would think.
So I have some of my go tos, which I will share, um, and share my thoughts of like why I think they're helpful, but this is another, like, reason for. Why I think the, um, swelling reduction protocol is so great is because again, like, like I said, that a lot of the, there's a lot of vasculature circulation in that area.
And so whenever we can promote or support good lymphatic flow and vascular flow, the less of a tendency we have to be congested in that space. And when we have less congestion in that space. We have less pain because the congestion tends to sensitize or irritate all of the nerves in that area as well.
And that's sometimes how we get the referral sensations. So um just doing. The Swelling Reduction Protocol movements can be so helpful for people with pain on the sacrum. Um, the other things that can be helpful for pain on the sacrum is, uh, one of my favorites to do, and it's one of those things that people sometimes actually will even intuitively do when they don't feel good, is while you lay on your back, not just laying on your back, but propping up your pelvis, propping up your hips.
So your hips are lower. Or sorry, are higher than your heart to help with that fluid return, right, and counteract gravity and even to, like, I always explain it as almost like unweighting the organs, right? Especially think about the pelvic organs, you know, since they're at the bottom of the barrel, right?
in an upright position, they're at mercy of all the pressure containers above them and gravity pushing down on them. And so one of the best and kindest things you can do for these organs is just unweight them with a declined position. And so a supported like hip bridge position, um, Can be so wonderful to just sit and relax in and breathe into to imagine.
I like to imagine all of those organs sort of sliding up towards my diaphragm, especially on an exhale breath. Um, so that's one of my favorite things. With that said, any rocking motions in that position too. So one of the ways this feels really great is. flipping over like a BOSU ball. So it's on the ball, right?
The flat surface is up and the balls on the ground are flipping over a Pilates arc and laying on the flat surface. And the arc part is down and then rocking back and forth into that declined supported hip bridge. It's very nice because that oscillating motion really gets the fluid and really gets the organs moving a little
bit better and that rocking motion is very relaxing to our nervous system in general. And when we're relaxed When our nervous system is in a more restful state We're going to be have less of a tendency to clench our glutes and clench our pelvic floor That creates so much added tension and pressure in the area as well.
So that rocking is a favorite and I have videos of a lot of these and so I'll make sure to link them in the show notes. Um, with that same kind of like Thought process of the rocking, um, in the area. A more specific pelvic clock. Rocking is really great. I like this because I usually do it with a prop, like a Franklin ball, or one of those like spiky half dome balls flipped over, or even a half foam roller can be good for this, or the gorgeous ball.
If you put that ball under the sacrum and then rock back and forth, not only do you get the nice rocking motion and the relaxation to the nervous system and the widening of the pelvic floor. But you also get a little bit of a sacral float, right, like a pressing of the sacrum up and putting those si joint ligaments on, a little bit on slack, which can be, which can feel, feel very good.
And then what you're also doing is it's like you're taking the sacrum and you're bringing it more forward towards the organs. And so if there is any tension on those ligaments. It tends to sort of like let them melt and like reorganize on their own a little bit. It's sort of the same scenario like you get with like a necklace, right?
If there's a knot in the necklace, you don't want to stretch the ends apart. That increases the tension on it, right? You want to bring the ends together. That loosens the knot. And then sometimes the knot just works itself out. Same exact thing. This having an having a block or a ball or something underneath your sacrum while you're laying on your back floats the sacrum up and sort of puts all those ligaments and tissues on a little bit of slack and allows for a little bit more motion to happen.
Um, I usually match this exercise, this pelvic clock exercise, also with breathing, diaphragmatic breathing, and that can be really good to one, create a rhythm to it, and then also getting the like spinal fluid flowing as well as the lymphatic um, fluids flowing too, given the relationship between the diaphragm and the um, lymphatic system.
Another real easy thing that you can do, um, is, um, some,
you know, you gotta think about it. So the sacrum, we talked about the ligaments are related to the front of the sacrum and the organs and basically like the front of the pelvis, right? That sort of like. those three dimensional layers of all those fascial containers. Um, but then the other one that we maybe don't think as much, right?
When we think of the pelvic floor muscles as having a roll on it, but there is a main sort of tendon, uh, that goes from the tailbone to the And it's that tension, it's almost like the tensioner, I always like the tensioner of the pelvic floor. And so doing some self massage on the pelvic floor and specifically like addressing sort of that mobility of the tailbone and stretching out of that central tendon and actual um, Even doing a gentle self massage with the, um, massage balls on the, the middle part of that central tendon, which is the, uh, perineal body can be super helpful in sort of Giving more space in this area to more sensory information, which tends to decrease some of the pain and improve movement and decrease congestion as well.
So um, those are probably my favorites. So doing things for the. Like swelling reduction protocol decongesting the area and then the sacral float or sacral pelvic clocks and then the supported Decline position or the rocking they're all so wonderful for the visceral organs. I'm gonna link a I'm gonna link like I said, I have videos of a lot of that stuff I'm gonna link and I'm also gonna link to a Instagram posts I did a while back talking about this too, and even on that I shared, um, some bladder breathing exercises and, um, even a direct stretch to the portal vein that's just going to help with the congestion too, so, um, really great stuff.
But, and also, Um, maybe, maybe this was why this, this topic was on my brain. I'm like, it's either on my brain because of the menstrual cycle and pain on my sacrum, or, um, it was on my brain too, because I've been wanting to get, uh, Nicole Cozean on the podcast, uh, to do a guest episode and talk about, um, pelvic floor physical therapy or pelvic physical therapy.
And, um, She's taking the LTAP and just, she has a lot of education classes and a podcast too. And I just think she'd be a great resource. So maybe that's why it's on my brain too. But, um, either way, the sacrum, the lumbar spine get clear on where the pain is. And if it's sacrum. You can almost always assume that there is a visceral component of it and so start doing these things in conjunction to whatever else you were planning to do for your patient's pain and, and see what happens.
Or even if you're feeling this in your own body, explore some of these movement practices and let me know your thoughts. But that's it. That's all I got for you on this week's podcast. It's a quick one, but I felt like it like needed its own podcast. Um, so pain on the sacrum, always visceral. Immediately think that.
There's, there, I always tell people there's like a couple things that I'm like, immediately think viscera and it's right shoulder and sacrum pain. So that's it. Let me know if you have questions. Uh, enjoy the videos and, uh, we'll see you next time.