What is sacrum nutation and counternutation


The sacrum is not a real leg

Back problems are often associated with the lumbar spine and primarily with the sacrum. This zone in the lower back is very stressed by constant stress. This results in an acceleration of the natural processes of wear and tear, which repeatedly cause discomfort to young people and adults. In contrast to the thoracic spine, the sacrum area is therefore affected much more often.

What an adequate therapy can look like and much more detailed information is given in the following text. In the Anatomy & Organs section there is a wealth of information that is immensely enriching for both sick and healthy readers. Above all, when it comes to understanding doctors' Latin, helpful explanatory data can be found here, including on the subject of the sacrum.

Table of Contents

What is the sacrum

If you stand in front of a human bone system or skeleton, which is used as a common visual aid in anatomy, you can clearly see the sacrum between the two halves of the pelvis.

To do this, you just have to look through the pool. From the posterior view, the sacrum appears as a bizarre extension of the spine. In medicine, the term sacral vertebra is therefore very common.

Other terms used for the sacrum are sacrum or os sacrum. The inconspicuous sacrum is considered to be the foundation for the part of the pelvis on the back. The sacrum is directly connected to the iliac joint.

This stable morphological unit (morphology describes the shape of an organ) is the sacrum-iliac joint or the sacroiliac joint. This bony component is a relatively rigid, immobile construct. The mobility includes only a minimal inclination forwards and backwards.

The natural limit for this reduced flexibility is the narrow joint space in the sacrum-iliac joint. The bony coccyx is a short extension of the sacrum that is inclined towards the tail or causally.

Vertebrates & Evolution

Not only humans, but all vertebrates living on land have the sacrum. This is shown by the fact that the sacrum has between three and five vertebrae in various land saw animals. On closer inspection, the former sections between the vertebrae can be replaced by what are known as remaining ones Adhesion lines (Lineae transversae) still understand.

However, this part of the bone has regressed in the course of evolution. There is only a bony rudiment left, or one that is passed through a Synostosis (merger) has arisen from several spinal bones. These vertebrae are still cartilaginous until puberty. They harden increasingly and merge completely from the age of 25 on.

From an anatomical point of view, the sacrum surrounds the posterior part of the vertebral canal. The pelvic girdle is a superordinate structure in which the hipbone and sacrum are involved.

One phenomenon that can be observed in some people is that lack of adhesion of the first upper sacral vertebra with the following vertebrae. This phenomenon is called Lumbarization designated. These people have the impression that there are not just five, but even six complete lumbar vertebrae. This anomaly results in better pelvic mobility. A disadvantage is the reduced stability and resilience of the spine.

In contrast, the fifth lumbar vertebra can be attached to the Sacrum be anchored. This anatomical variant is considered by medical professionals Sacralization known.

Functions & tasks

The sacrum represents a part of the pelvis and the spine. A central task of the sacrum is to create a certain mobility. This ability involves two processes that are considered in medicine Nutation and Counter or contranutation To be defined. Such movements are called diffraction and Elongation respectively as Flexion and Extension perceived.

Nutation is a shift of the base of the sacrum downwards and forwards, which causes flexion. The tip of the sacrum points upwards and towards the back at a slight angle. As a result, an erection of the sacrum is triggered.

The access to the small pelvis is narrowed, creating a flexion effect. In contrast, the pelvic outlet is placed wide. This process continues to lead to a distancing of the Ischial tuberosity (Sciatic tuberosity) from each other and to a rapprochement between the two Iliac scoops (Ala ossis ilii).

The counter-nutation is a sequence of movements of the sacroiliac joint that is directed against the nutation. The contranutation or antinutation requires an extension.

All movements of the sacrum involve shifting the tip of the sacrum. The nutation of the sacrum and the sacroiliac joint is common with the rotation (rotation) of the iliac bone is the physiological basis for walking and the birth process.

The nutation causes an enormous expansion of the pubic symphysis. The entrance of the basin widens under this condition. After a hormonally achieved ligament softening, the child's head can pass through during the birth without great difficulty.

Areas of responsibility

The tasks of the sacrum include in detail:

  • Expansion of the pelvic ring for the birth process
  • upright posture of the person
  • Realization of mobility
  • Stabilization of the skeleton when walking
  • Support of the sitting and standing posture
  • Spring effect to relativize the body weight while running
  • Supply of the pelvis and legs with nerves and blood vessels

If the effects of body weight on other organs resulting from running are not balanced, this could lead to damage to other body systems.

The entire movement processes of the sacrum also affect the behavior of the trunk while running or jogging. This would also result in various incorrect or excessive loads that cause a variety of diseases.

Without the sacrum, the skeleton would be extremely unstable, which would cause the body to collapse. The functioning or the physiology of the sacrum is supported by tight, partially elastic tendons, muscles and ligaments. However, three to four vertebrae of the sacrum are without function.

Anatomy & structure

Although the sacrum forms a unit with various other anatomical elements, the individual vertebrae, including the spinous processes typical of the vertebral bones, clearly show a very specific structure. Therefore it can be said that the morphology of the sacrum is very similar to the structure of the spine.

The ones on top Spinous processes resemble a ridge that is imagined along a Center line (Median planesuperior (toabove) and inferior (downward) is pronounced. Individual extensions of the joint together form a ridge running to the side of the central line.

The contact between the sacrum and the last lumbar vertebra is achieved through a tiny joint surface. This is on both pages (lateral) of the processes in the upper area of ​​the sacrum. In addition to the in Longitudinal direction (caudal) towards the tail Occurring processes are to be felt on the sacrum so-called transverse processes.

They are combined to form a laterally located plate, the front area of ​​which is larger than the rear area. This results in the almost triangular, wedge-like texture of the sacrum.

Another anatomical peculiarity of the sacrum is the Facies auricularis. That is an almost oval shaped one Bone plate. This formation has a bone crest running downwards at the side. Over this plate of bone substance is a articulated transition to the iliac bone created.

Other segments

Other segments also belong to the complex of the sacrum. These are important to ensure the function (physiology) of the sacrum. Circular recesses integrated on the back are important here. These holes create enough space for the posterior (dorsal) spinal cord or spinal nerves to pass through.

Pixabay / jochenpippir

Furthermore, the sacrum has generous openings or foramina, which allow the anterior (ventral) spinal nerve branches to exit.

The sacrum as well as the pelvis and the lower extremities are traversed by a network (plexus) of nerves. This network includes the nerves emerging from the spinal cord as well as parts of nerves that penetrate the region around the lumbar vertebrae.

The sacrum and coccyx are combined as the so-called sacral spine, a lower segment of the spine. It is trapped between the tailbone and the lumbar vertebrae. The tapering portion of the sacrum is the apex of the sacrum or apex ossis sacri.

Intervertebral discs are interposed in the sacrum, which can absorb and dissipate mechanical influences. The opening of the vertebral canal is to be found approximately at the 3rd or 4th sacral vertebra. The sacral spinal nerves appear at this point (hiatus sacralis).

The promontory is the ventrally located, protruding last part of the sacrum. The cross section of the sacrum tapers from the skull (cranial) to the tail (caudal). Therefore, the sacrum tapers a bit towards the end.

Vertebrae & sacrum

Which vertebrae are characteristic of the sacrum?Several vertebrae can be seen in the direction of the back or dorsally:

  • The crista sacralis mediana - has spinous processes with a palpable crest structure, is a rather noticeable bone crest in the median plane.
  • Crista sacralis intermedia - former articular processes
  • Crista sacrais lateralis - are transverse processes placed on both sides of the crista sacralis mediana

The Sacral vertebrae are some of the more than 200 bones that make up the skeleton of an adult human. Like almost all other bones, they have a protective and supportive function. The Sacral vertebrae can also take over the storage of minerals and influence muscle contraction.

Illnesses & ailments

Illnesses, complaints and disorders of the sacrum

The sacrum is a very sensitive bone structure that can withstand extreme loads under certain circumstances. The most diverse internal influences and diverse external factors can cause a multitude of complaints and Symptoms (Signs of illness) trigger.

Since the sacrum to the Sacrum-iliac joint (Sacroiliac joint), also known as ISG for short, special changes also cause damage to this entire bony structure and the entire spine. In addition, there are noticeable anomalies and pathological (morbid) Disturbances of the soft tissues of the sacrum such as muscles, ligaments, nerves and tendons are typical.

In the case of sacrum diseases, therefore, they are often characterized by secondary diseases and accompanying symptoms that radiate into other parts of the body. Unpleasant phenomena on the sacrum, which can have a massive impact on well-being and mobility, are popularly known as lumbago, sciatica or rheumatism. Sometimes it is rather succinct reasons such as a poor sitting posture or overuse of the lower spine areas that can be considered as triggers.

If people are in a monotonous sitting position for a long period of time, this process leads to a stiffening and shortening of the flexor muscles. The continuous tension of the muscles that have grown together in the hip manifests itself in increasing strain on the lumbar vertebrae and sacrum. Spontaneous stooping or bending movements out of the cross, which are carried out with an abrupt twist or a spontaneous bending of the back, also promote sacral pain and nerve blocks.

Symptoms & pain

In the event of pain in the sacrum, the affected patients give an examination and a anamnese (Medical history) always differentiating pain levels. The type of pain is almost always similar. Depending on whether the pain is limited to a delimited area of ​​the back or whether it is pain with a radiating character, this aspect is helpful Collection of the findings (Diagnosis).

The pain can reach into the legs, buttocks, shoulders and neck. One-sided, often extremely severe pain that is felt in the groin area is also common. Other physical pain symptoms in certain internal organs can in turn spread to the vicinity of the sacrum. Causal relationships often exist with supraregional clinical pictures.

Causes & Reasons

What causes diseases of the sacrum?

Dysfunction and pathological abnormalities are not always directly related to the sacrum. Sometimes they come from other organs and organ systems.

Both excruciating symptoms of the sacrum and massive impairment of the sacroiliac joint can be caused by:

  • Diseases such as ankylosing spondylitis or ankylosing spondylosis
  • hormonal dysharmonics during pregnancy and menopause
  • Activation of pain receptors (nozireceptors) in the spinal cord nerves through excessive and incorrect loads (pressure and tension)
  • Broken bones
  • Mental illness
  • stress
  • Muscle tension
  • Overstretched ligaments that have not been strengthened (long jogging, prolonged running)
  • Inflammation of the sacral joint (sacroilitis)
  • Infections (penetration of various pathogens into the organism)
  • malignant growth or carcinoma (cancer or tumors in the spine)
  • benign primary or first-time tumors
  • Thrombophlebitis (acute thrombosis and inflammation) of the pelvic veins or the sacroiliac joint veins
  • Damage to nerves
  • Rheumatism (spondyloarthropathy, spondyloarthritis)
  • lumbar disc herniation or disc prolapse, sciatica, lumboschialgia)


Acute thrombosis is the sudden formation of a clot within a blood vessel.

Sometimes patients suffer from a genetic disposition or a hereditary predisposition for ligaments that are less strongly developed. These people are at high risk of disease of the sacrum and the joints associated with it.

Various gynecological diseases such as:

also play a central role in the diagnosis of sacral problems.

Differential diagnostics

The differential diagnosis with meaningful examinations for the delimitation and identification of similar clinical pictures and for the clear assignment of the symptoms to diseases of musculoskeletal sacral complaints results in some astonishing results.

These can indicate other causes:

  • Deviations in length of the lower extremities (asymmetry)
  • Psoriatic arthritis or psoriasis arthritis as joint inflammation caused by psoriasis)
  • Bulging (protrusion of the intervertebral disc)
  • bruise
  • chronic prostatitis, or the persistent, recurrent inflammation of the prostate gland
  • Tumors (due to metastasis or spread of daughter cells from other organ tumors)
  • Pilonidal cyst (bulge on the edge of the coccyx filled with pus)
  • Fracture (break) of the sacrum

Bad posture

What are unfavorable postures?

A congenital or acquired body malposition can become noticeable over time through classic symptoms on the sacrum.

The decisive factors are:

  • an upper body that is permanently tilted to one side
  • Inappropriate torsion of the body (rotation that exceeds the range of motion)
  • back bent forward for a long time
  • Movement while lying down and sleeping on a hard surface

In this context, phenomena such as obesity and a modification of the gait are noteworthy.

Treatment & Therapy

How can sacral problems be treated (treated)?

A premature one wear of the iliac joint, which usually does not take place without changes to the sacrum, can be caused by constant lifting of heavy objects with weak joint muscles or by excessive body weight. This effort pushes the pelvic blades apart, which is placed on both sides, which is an extreme load.

In addition, there is friction between the surfaces of the iliac blade and sacrum joints. This process also accelerates the wear and tear on the sensitive joint surfaces. The surface structures of the joints are not evenly removed and reduced. That's why in the course of life aPelvic osteoarthritis through a Pelvic inclination can adjust.

Proven treatment methods In these cases, heat and electricity are used to stimulate relaxation and blood flow to the muscles. This results in a better supply of nutrients and oxygen with simultaneous muscle strengthening. Acupuncture, pressure point massage and local pain anesthesia complement this approach.

Furthermore, a reduction in excess weight, suitable physiotherapeutic exercises to optimize mobility and gentle physical activities are useful. As a last resort, an operation can be indicated to reduce the risk of the patient by permanently stiffening the iliac joint (arodesis) Diana method to relieve.

Treatment methods

How can sacral problems be adequately treated?

Depending on the results of the diagnosis, doctors can use different treatment methods. To ensure the success of these therapies, they recommend that patients exercise enough. This variant is expanded to include physiotherapy and physiotherapy sessions. The aim is to achieve increasing relief and a slow strengthening of the sacroiliac joint including the sacrum structures.

If these measures are unsuccessful, acute or chronic pain can be relieved with topical medication (Local anesthetics) are contained. The injections are introduced either in the immediate vicinity of the site of origin or in the joint space. This results in a relieve of pain by interrupting the conduction of stimuli through the nerves in the soft tissues. Alternatively, the anesthetic drug can be applied to the iliac joint. This happens under X-ray control.

Depending on the disorder, a different treatment may be considered
pixabay / qimono

Orally (through the mouthMedicines to be taken such as glucocorticoids are also useful. These are on the one hand pain-relieving and on the other hand anti-inflammatory. Preparations that work in this way can be injected if necessary (injected) become. They disable the function of the nerves in the joint space so that the sensation of pain is switched off.

Licensed physiotherapists and specially trained specialists such as orthopedic surgeons can resolve blockages by manipulating and mobilizing the sacroiliac joint. Mobilization or moving mainly involves stretching.

The manipulation is based on the exertion of impulses through rapid application of force. These interventions are supplemented by heat treatments to relax the muscles and by the administration of non-steroidal anti-inflammatory drugs.

The need for an operation on the sacrum cannot be ruled out if the iliac joint syndrome cannot be cured in the conservative way. However, surgical intervention is contraindicated (Contraindication is contraindication) if you have advanced osteoporosis, inflammation of the sacroiliac joint, or rheumatic disease. In contrast to previous procedures, surgeons today largely use minimally invasive techniques. The usual is here Distraction interference arthrodesis.

Typical diseases

Typical and common diseases of the sacrum at a glance:

  • arthrosis (age-related degradation of cartilage tissue through wear and tear and natural wear processes) of the hip joint
  • osteoporosis (Loss of bone substance)
  • Osteomalacia (softening of the bones accompanied by pain)
  • Sciatica (radiating pain from the sciatic nerve with paresthesia and other symptoms)
  • Blood vessel disorders
  • Strain (Distension) of the muscles and torn muscle fibers
  • inflammatory irritation on the nerve roots
  • Blockage of the sacroiliac joint
  • Kidney disease
  • disc prolapse
  • sitting position too long
  • Lack of exercise
  • untreated misalignments of the feet, knees and hips

This list shows how multifaceted and complex the diseases can be, on which the specialists of the most diverse medical disciplines have to concentrate. In order to clarify the findings, which in some cases have very serious and serious backgrounds, the patients are in numerous cases required to go to several specialists and undergo a variety of diagnostic procedures.

Frequently asked questions and answers

Here you will find moving questions and helpful answers related to the sacrum.

What is a spondylolisthesis?

With this disease, the fifth lumbar vertebra of the sacrum is constantly shifting forward.

What happens to the sacrum if there is a herniated disc?

The term sciatica or the synonymous term lumboschialgie summarizes painful abnormalities that are associated with irritation of the sciatica or the sciatic nerves.

They usually occur in connection with a herniated disc. This results in a crushing of the sensitive nerve root of the sciatic nerve by the cartilaginous intervertebral disc.

In contrast to sciatica, there are lumbago (Herniated disc in the lower spine area) the pain is limited to the lower back only. Lumboischialgia is permanent irritation of the nerve fibers with complete back pain.

If the intervertebral disc slides out of the lower lumbar vertebrae, pressure develops on the nerve roots of the nerve cords emerging from the sacrum. The nerve roots become narrowed and sciatica can develop.

What is sacrum blockage?

A sacrum blockage can be caused by an inflammatory process in the sacrum or an incorrect posture. This disease can be traced back to wear and tear on the spine and incorrect movement sequences. The explanation of the event that occurs during a sacrum blockade includes tension in the muscles including pinching of the nerves of the iliac joint with the involvement of the sacrum.


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