Spine Health & Spinal Hygiene

"Various problems with the sacrum make up or contribute to a significant portion of lower back problems. Can understanding the anatomy and function help prevent and treat back injuries?"

The Sacrum

The sacrum is a bone shaped like an upside-down triangle located at the base of the spine that helps support the upper body when sitting or standing and provides pelvic girdle flexibility during childbirth. It comprises five vertebrae that fuse during adulthood and connect to the pelvis. This bone takes and endures all of the body's pressure and stress from everyday activities and movements.

Formation

Humans are born with four to six sacral vertebrae. However, fusion does not take place in all sacral vertebrae simultaneously:

• Fusion starts with the S1 and S2.
• As the individual gets older, the overall shape of the sacrum begins to solidify, and the vertebrae fuse into a single structure.
• The process usually starts in the mid-teens and finishes in the early to mid-twenties.
• It is believed to start earlier in females than males.

The timing of the fusion can be used for estimating the age and sex of skeletal remains. (Laura Tobias Gruss, Daniel Schmitt. et al., 2015)

1. The sacrum in a female is wider and shorter and has a more curved top or the pelvic inlet.
2. The male sacrum is longer, narrower, and flatter.

Structure

The sacrum is an irregular bone that makes up the back/posterior third of the pelvic girdle.  There is a ridge across the front/anterior portion of the S1 vertebra known as the sacral promontory. Small holes/foramen on both sides of the sacrum are left over after the vertebrae fuse together. Depending on the number of vertebrae, there can be three to five foramen on each side, though there are usually four. (E. Nastoulis, et al., 2019)

1. Each anterior foramen is typically wider than the posterior or dorsal/backside foramen.
2. Each sacral foramina/plural of foramen provides a channel for the sacral nerves and blood vessels.

• Small ridges develop between each of the fused vertebrae, known as transverse ridges or lines.
• The top of the sacrum is called the base and is connected to the largest and lowest of the lumbar vertebrae - L5.
• The bottom is connected to the tailbone/coccyx, the apex.
• The sacral canal is hollow, runs from the base to the apex, and serves as a channel at the end of the spinal cord.
• The sides of the sacrum connect to the right and left hip/iliac bones. The attachment point is the auricular surface.
• Right behind the auricular surface is the sacral tuberosity, which serves as an attachment area for the ligaments that hold the pelvic girdle together.

Location

The sacrum is at the level of the lower back, just above the intergluteal cleft or where the buttocks split. The cleft starts at around the level of the tailbone or coccyx. The sacrum is curved forward and ends at the coccyx, with the curvature being more pronounced in females than males. It connects to the L5 lumbar vertebra by way of the lumbosacral joint. The disc between these two vertebrae is a common source of low back pain.

1. On either side of the lumbosacral joint are wing-like structures known as the sacral ala, which connect to the iliac bones and form the top of the sacroiliac joint.
2. These wings provide stability and strength for walking and standing.

Anatomical Variations

The most common anatomical variation applies to the number of vertebrae. The most common is five, but anomalies have been documented, including individuals with four or six sacral vertebrae. (E. Nastoulis, et al., 2019)

• Other variations involve the sacrum's surface and curvature, where the curvature differs widely between individuals.
• In some cases, the first and second vertebrae do not fuse and remain separately articulated.
• Failure of the canal to completely close during formation is a condition known as spina bifida.

Function

Studies on the sacrum are ongoing, but some proven functions include:

• It serves as an anchor point for the spinal column to attach to the pelvis.
• It provides stability for the body's core.
• It acts as a platform for the spinal column to rest on when sitting.
• It facilitates childbirth, providing pelvic girdle flexibility.
• It supports upper body weight when sitting or standing.
• It provides extra stability for walking, balance, and mobility.

Conditions

The sacrum can be a main source or focal point for lower back pain. It is estimated that 28% of men and 31.6% of women aged 18 years or older have experienced low back pain in the past three months. (Centers for Disease Control and Prevention. 2020) Conditions that can cause sacrum pain symptoms include.

Sacroiliitis

• This is a common condition of sacroiliac/SI joint inflammation.
• A doctor only makes the diagnosis when all other possible causes of pain have been ruled out, known as a diagnosis of exclusion.
• Sacroiliac joint dysfunction is thought to account for between 15% and 30% of low back pain cases. (Guilherme Barros, Lynn McGrath, Mikhail Gelfenbeyn. 2019)

Chordoma

• This is a type of primary bone cancer.
• About half of all chordomas form in the sacrum, but the tumors can also develop elsewhere in the vertebral column or at the base of the skull. (National Library of Medicine. 2015)

Spina Bifida

• Individuals can be born with conditions that affect the sacrum.
• Spina bifida is a congenital condition that can arise from the malformation of the sacral canal.

Unlocking the Secrets of Inflammation

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Prolonged standing can cause the pelvis to push backward, increasing the curve of the lower back/lumbar region. This increased pressure on the soft tissues surrounding the spine causes the lower back muscles to tighten and/or spasm, resulting in discomfort in the joints and nerves. Weakened core muscles and unhealthy posture/postural syndrome are the most common causes, but injury, aging, congenital malformations, or a disease/condition can also contribute to the symptoms. Injury Medical Chiropractic and Functional Medicine Clinic has a top team of professional therapists to evaluate the problem, diagnose the cause/s accurately, and develop a customized treatment and rehabilitation plan.

Prolonged Standing Back Discomfort

Back Structure

The lower back is one of the most used areas of the spine, moving around and bending during a normal day. When the body stands, the spine naturally curves both in and outwards.

• The inward curve, called lordosis, curves towards the front of the body at the lower back and neck regions.
• The outward curve, called kyphosis, curves towards the back of the body at the chest.
• When bending over while standing, the five lumbar vertebrae of the lower back change position and shift from lordosis to kyphosis when bent completely.
• When standing up from bending, the lumbar vertebrae change position again and return to the lordosis position.

Causes

The facet joints allow movement between each spine level. The standing spinal curvature can increase contact between the facet joints. As the body ages, the facet joints and discs begin to wear out, which can cause the discs and facet joints to become inflamed. Prolonged standing during normal daily activity combined with inflammation in these joints can aggravate the inflammation and cause symptoms. Regular routines and habits may contribute to low back discomfort during prolonged standing. These include:

• Sleeping on a sinking or unsupportive mattress.
• Practicing unhealthy postures that cause imbalances with proper weight distribution.
• Not wearing proper footwear and/or supportive orthotics forces the lower spine into increased curvature and can compress the facet joints.
• Not getting enough physical activity that strengthens the core.
• Improperly lifting and carrying objects.
• Excess weight makes the body heavier.

Standing Recommendations

Some recommendations may help:

• Stand for shorter periods.
• When symptoms start to present, it is recommended to change position.
• A sitting-to-standing workstation or desk that adjusts could help.
• Move around and stretch out to improve circulation and decrease muscle fatigue.
• Try placing one foot on a step while standing, limiting excessive spine curvature.
• Try back and spine support footwear.

Chiropractic

Chiropractors are experts on the musculoskeletal system. They will:

• Listen to the patient about symptoms, medical history, and occupation.
• A physical examination of muscle tone, strength, and range of motion.
• Therapeutic massage, electric muscle stimulation, and ultrasound therapy can help reduce muscle inflammation and increase circulation to injured soft tissues.
• Chiropractic adjustments will reset joints, removing pressure from the surrounding muscles and nerves.
• Targeted therapeutic strength training is recommended for core and leg muscles to improve hip flexibility.
• Non-surgical decompression or traction, either with a machine or suspension, can reverse the pressure in spinal discs.

Standing Lower Back Relief Exercises

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Hasegawa, Tetsuya, et al. “Association of low back load with low back pain during static standing.” PloS one vol. 13,12 e0208877. 18 Dec. 2018, doi:10.1371/journal.pone.0208877

Jo, Hoon, et al. “Negative Impacts of Prolonged Standing at Work on Musculoskeletal Symptoms and Physical Fatigue: The Fifth Korean Working Conditions Survey.” Yonsei medical journal vol. 62,6 (2021): 510-519. doi:10.3349/ymj.2021.62.6.510

Ognibene GT, Torres W, von Eyben R, Horst KC. Impact of a sit-stand workstation on chronic low back pain: randomized trial results. J Occup Environ Med. 2016;58(3):287-293. Abstract. https://www.ncbi.nlm.nih.gov/pubmed/26735316. Accessed March 2, 2017.

Parry, Sharon P et al. “Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers.” The Cochrane database of systematic reviews vol. 2019,11 CD012487. November 17, 2019, doi:10.1002/14651858.CD012487.pub2

Rodríguez-Romero, Beatriz, et al. “Thirty Minutes Identified as the Threshold for Development of Pain in Low Back and Feet Regions, and Predictors of Pain Intensity During 1-h Laboratory-Based Standing in Office Workers.” International journal of environmental research and public health vol. 19,4 2221. February 16, 2022, doi:10.3390/ijerph19042221

Smith, Michelle D et al. “The Influence of Using a Footstool during a Prolonged Standing Task on Low Back Pain in Office Workers.” International journal of environmental research and public health vol. 16,8 1405. April 18. 2019, doi:10.3390/ijerph16081405

Individuals dealing with or managing chronic back pain should incorporate swimming exercises. Swimming is a low-impact aerobic conditioning exercise that's easy on the back and healthy for the spine. When an individual struggles with back problems, they may be tempted to rest and avoid physical activity/exercise. Total rest is not recommended as it can cause the muscles that support the back to weaken or atrophy. When the muscles weaken, they cannot stabilize the spine or body correctly, which causes conditions to worsen or contribute to new injuries. Starting swimming exercises can expand the spine, relieve painful pressure or strain on the back and strengthen the muscles for spinal health.

Starting Swimming Exercises

Swimming does not impact the spine and other musculoskeletal structures because the water suspends the body.

• Swimming is a full-body, low-impact exercise which is excellent for individuals of all ages and all body shapes and sizes.
• Talk to a healthcare professional about any questions or concerns about how swimming may impact your body.
• Swimming benefits include stress relief, a strengthened musculoskeletal system, and support in heart health.

Swimming for Back Problems

Relaxes The Nervous System

• Tense muscles can cause or contribute to back problems and pain symptoms and aggravate spinal conditions.
• Swimming exercises release endorphins to relax the nervous system and tense muscles.

Relieves Pressure on Joints

• The water lightens the body relieving pressure on the joints and muscles.

Builds Muscle to Support the Spine

• The resistance and movement strengthen the whole body with the joints and spine supported.
• Swimming engages muscles not always used, specifically those needed to improve spinal stability.

Exercises for Back Relief

Checking with a physician before exercising is recommended, especially if starting a new exercise routine. When you meet with the Injury Medical Chiropractic and Functional Medicine Cline team, we can determine if starting swimming exercises would benefit you. Once cleared, here are some swimming exercises that could help bring relief:

Walking

• Walking around the pool means movement that the body needs to heal and build muscle without aggravating symptoms.

Aerobics

• Water aerobics is perfect for working on cardiovascular health needed to build strength.
• Increase mobility and flexibility.

Swimming Laps

• Start slow when swimming laps, maybe only twice a week at first.
• The different types of strokes work various muscles in the hips, chest, and back.
• Treading water is a great way to get the body used to the movements.
• A swim coach can provide tips on the proper technique and form.

Swim Exercise Tools and Accessories

Proper swimming equipment can make the exercise sessions much more enjoyable.

Swim Cap

• Swim caps protect the hair from the water's elements and keep hair from blocking the view.

Goggles

• Goggles protect the eyes and help to see better underwater.
• Look for a comfortable pair that doesn't leak.

Sun protection and clothing

• A day in the sun and water increases the risk of exposure to UV rays.

Waterproof Headphones

• For listening to music or podcasts while swimming.

Kickboard

• Many pools can provide kickboards that swimmers can borrow during their time there.
• Lean the upper body on the board and kick, focusing on lower body movements.

Pull Buoy

• Pull buoys help focus on the upper body and arm work.
• It is placed between the upper thighs to help the legs float as the individual pulls with their arms.

It is recommended to take some lessons to learn how the body moves through the water. Once a basic understanding of balance and buoyancy is met, individuals can propel through the water more efficiently.

Sciatica Secrets Revealed

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Bartels, Else Marie, et al. “Aquatic exercise for the treatment of knee and hip osteoarthritis.” The Cochrane Database of systematic reviews vol. 3,3 CD005523. 23 Mar. 2016, doi:10.1002/14651858.CD005523.pub3

Cole, A J et al. “Spine pain: aquatic rehabilitation strategies.” Journal of Back and musculoskeletal rehabilitation vol. 4,4 (1994): 273-86. doi:10.3233/BMR-1994-4407

Ferrell, M C. “The spine in swimming.” Clinics in sports medicine vol. 18,2 (1999): 389-93, viii. doi:10.1016/s0278-5919(05)70153-8

Su, Yanlin, et al. “Swimming as Treatment for Osteoporosis: A Systematic Review and Meta-analysis.” BioMed research international vol. 2020 6210201. 15 May. 2020, doi:10.1155/2020/6210201

Wirth, Klaus, et al. “Strength Training in Swimming.” International Journal of environmental research and public health vol. 19,9 5369. 28 Apr. 2022, doi:10.3390/ijerph19095369