• Sacral stress fractures cause a diffuse constant pain in the buttock with occasional sharp pains on loading
• The injury accrues over several weeks or months but can become suddenly symptomatic, often leading to misdiagnosis as a gluteal muscle strain
• The primary causes of sacral stress fractures are:
  • loss of range into hip extension,
  • sudden increase in loading, particularly with impact loading (like downhill running) or power activities (such as sprinting), and
  • underlying bone density issues

TIPS

• Don’t rush your recovery! This injury isn’t a fast healer and the background causes need to be corrected before a successful return. Expect a return to full training loads by 6-9 months post-diagnosis, depending on your sport and other factors
• Confirm your diagnosis via MRI and undergo a blood test to look at hormonal causes as well as low calcium and/or vitamin D levels
• Single leg, split stance (eg. Lunge) and power (eg. Jumping) exercises expose the injured area to load. Gradual reloading is part of the management plan but these exercises shouldn’t be included until after the injury is symptom-free on walking

MYTHS

• Sacral stress fractures are different from other pelvic fractures – athletes with this injury can still walk, run and lift weights despite the pain
• Anti inflammatory medication will resolve the pain associated with bone stress fractures, so a positive response to medication IS NOT reassurance that the injury is not significant
• You don’t need impact loading to cause a sacral stress fracture – the bone can fracture due to torsional or rotational loading, coming from split leg positions (eg. Lunges) or single leg power exercises (eg. Hopping)

WHAT ELSE COULD IT BE?

• Lower back pain can refer pain into this area
• SIJ pain is one of the most common cause of pain around the sacrum
• Gluteal muscle strain can cause similar pain in the buttock but is quicker to recover
• Deep hip muscle pain causes similar constant deep pain in the buttock and often arises after the same aggravating activities as a sacral