Sacral Bone Stress Injuries in Runners

At Epoch Health, we regularly see runners struggling with persistent lower back or pelvic pain that turns out to be more than just tight muscles or overuse. One of the lesser-known but important diagnoses is a sacral bone stress injury — an issue that, when left unaddressed, can sideline even elite athletes.

What is a Sacral Bone Stress Injury?

The sacrum is the triangular bone at the base of your spine, connecting the lumbar spine to the pelvis. Repeated stress, especially from high-volume or high-intensity running, can overwhelm the bone's ability to repair itself. This leads to microfractures — commonly referred to as sacral stress fractures.

Although these injuries are relatively rare compared to shin or foot stress fractures, they are more common than people think — especially in long-distance runners, females with low energy availability, and those training with poor biomechanics.

Key Risk Factors

At Epoch Health, we take a whole-person approach to identify and address the root causes of sacral stress injuries. Common contributing factors include:

• Sudden increases in training load without adequate recovery

• Biomechanical imbalances, such as poor pelvic control or uneven gait patterns

• Poor running form or improper footwear

• Low energy availability, menstrual dysfunction, or poor nutrition

• Reduced bone density or underlying health conditions

Our team — including chiropractors, massage therapists, and clinical nutritionists — work together to assess these areas during your initial visit.

Signs and Symptoms

Typical symptoms include:

• Deep, aching pain in the lower back or buttock, usually one-sided

• Pain that worsens with running, jumping, or prolonged standing

• Discomfort even during low-impact activities like walking

• Little to no relief from stretching or foam rolling

Many runners mistake this pain for a muscle strain or lumbar issue, which is why accurate diagnosis is critical.

Diagnosis and Imaging

Because sacral stress injuries don’t always show up on standard X-rays, MRI is the gold standard for diagnosis. At Epoch Health, our chiropractors are trained to recognise the red flags and can refer for imaging when necessary to confirm the diagnosis and rule out other causes.

Classifying the Injury

Sacral stress injuries are classified based on location:

• Type I: Lateral to the sacral foramina (sacral ala)

• Type II: Involving the sacral foramina

• Type III: Central sacrum, sometimes with nerve involvement

This classification helps guide treatment, rest duration, and return-to-sport timelines.

Treatment at Epoch Health

We follow an evidence-based, multidisciplinary plan to help you recover safely and completely:

1. Relative Rest

High-impact activity is paused while maintaining fitness through swimming, cycling, or anti-gravity treadmill use (if available).

2. Chiropractic Care

Our chiropractors focus on improving pelvic stability, spinal alignment, and movement mechanics. We use gentle manual techniques and rehab exercises to offload stress on the sacrum and correct asymmetries.

3. Soft Tissue and Massage Therapy

Massage can relieve compensatory tightness in the glutes, hip flexors, and lumbar spine that often develop as a result of altered gait.

4. Nutritional Support

Low energy availability is one of the biggest contributors to stress fractures. Our in-house clinical nutritionist can help optimise calcium, vitamin D, and overall nutrient intake, especially for female athletes.

5. Gradual Return to Running

Once pain subsides and healing is confirmed, we implement a progressive return-to-run program with a focus on load tolerance, strength, and technique.

Prevention Tips for Runners

To reduce your risk of sacral stress injuries:

• Avoid abrupt changes in training volume or intensity

• Ensure proper footwear and running form

• Strengthen your glutes, core, and hips

• Eat to match your training load, especially if you’re increasing mileage

• Get professional assessments if symptoms persist longer than 1–2 weeks

When to See a Chiropractor or Allied Health Professional

If you’re a runner with lingering buttock or lower back pain, don’t ignore it. Early assessment and intervention can drastically reduce time off and prevent further complications.

At Epoch Health, our integrated team can help you diagnose, treat, and prevent injuries like sacral stress fractures. Whether it’s chiropractic care, massage therapy, nutrition support, or tailored rehab programs, we’re here to support your running journey.

📍Book an assessment today at Epoch Health – Telopea or Dundas Valley.