Abstract
Background:
Sacral stress injuries are a relatively uncommon cause of low back, hip, or buttock pain in athletes, and are likely underdiagnosed. Currently, there is a lack of robust literature describing which athletes are at greatest risk, how many of these athletes have a concomitant diagnosis of Relative Energy Deficiency in Sport (REDs), and how long it takes to return to sport after diagnosis, especially amongst the pediatric population.
Hypothesis:
Sacral stress injuries will be more common in running sports, and 75% of all athletes with sacral stress injuries will have a concomitant diagnosis of REDs. Full return to sport/physical activity will take an average of 12 weeks after diagnosis.
Methods:
This was a retrospective cohort study performed at a single academic institution. We included males and females aged 8-22 years old who were seen at the Sports Medicine clinic between 01/01/2019 and 03/01/2025 and were diagnosed with a sacral stress injury related to sports or physical activity. We excluded those who sustained a sacral fracture due to acute trauma sustained <4 weeks prior to presentation, had a concomitant diagnosis of spondylolysis, or whose sacral stress injury was not primarily managed by Sports Medicine clinic. Chart reviews were performed in Power Chart and Epic, and outcomes collected included primary sport, presence of REDs, and time out of sport from diagnosis to return-to-sport clearance date (days). Descriptive statistics summarized demographics, sport type, presence of REDs, and time to return to sport.
Results:
A total of 61 adolescent athletes met our inclusion criteria (age: 16.8 +/- 2.7 years; 80.3% female). Running and hiking sports (45.9%) were most frequently implicated. Approximately 24.6% of young athletes had a concomitant diagnosis of REDs. In this cohort, an average full return to sport following a diagnosis of sacral stress injury took 103.4 +/- 48.1 days.
Conclusion:
Sacral stress injuries are important to keep on the differential diagnosis for an athlete presenting with low back, hip, or buttock pain. Suspicion should be raised if the patient has a diagnosis of REDs. This injury takes an average of nearly 4 months to return to sport in the adolescent population, requiring significant rest and activity modification during the treatment course.