The sacrotuberous ligaments, along with the sacrospinus ligaments, anchor the sacrum to the bones of the pelvis. Although they are thick bands of ligament, they are subject to stress and injury with vigorous or repetitive sports activities and can cause a literal pain in the butt. Physical therapy focuses on reducing initial pain and preventing reinjury.
The ligament starts at the sacrum, the triangular bone at the botton of the spine that fits down into the pelvis. It runs forward from the front of the sacrum and downward to attach to the tubercle of the ischium, a bony prominence on one of the bones that make up the ring of the pelvis. Its job is to prevent the sacrum from tipping forward when downward pressure is applied to the spine. It is stressed with sports that create a lot of arching in the lower back like high jumping, golfing, gymnastics, pitching and volleyball spiking.
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Physical Therapy for Pain
Initial physical therapy goals are to reduce pain by minimizing irritation of an injury and reducing local spasm and inflammation. For a sacrotuberus ligament sprain, use rest by stopping sports activities that produce discomfort, and apply ice for pain relief. Use the ice several times per day for up to 20 minutes per session.
Physical Therapy for Prevention
Therapy exercises to increase strength and stability in the area of the lower back and sacrum will help prevent injury to the sacrotuberous ligaments. Core strengthening exercises combined with stretches to increase flexibility in the hamstrings, hip flexors and gluteal muscles will improve shock absorption in the lower extremity and reduce stress on the ligaments
Other Therapy Approaches
For more persistent problems with the sacrotuberous structures, therapeutic approaches that seek to alter scar tissue in the ligament may be of help. To break down scar tissue and improve flexibility in the ligament, the Graston Technique or other forms of deep tissue massage like cross fiber friction therapy may be used to separate fibers in the ligament. In other cases, the solution may be in strengthening the ligament fibers so that prolotherapy, which uses injections into the ligament to stimulate more scar tissue, may make movement easier. If you have persisting problems, talk with your doctor or therapist about these options.