A Real Pain In The… Tailbone: Causes & Treatment of Coccydynia

Coccydynia is defined as pain in the coccyx or tailbone area, often brought on by a fall onto the coccyx or by persistent irritation usually from sitting (1). With winter in full swing I thought it was a good time to talk about this type of injury. This is the time of year for falls on ice, falls while snowboarding, skiing, or sleddingor perhaps you are a little clumsy or drank a little too much wine and fell down the stairs. Long story short, this type of injury is very common and can affect both men and women. Unfortunately there is little the medical system can do if you injure your coccyx or tailbone. Often times you are told to take it easy, sit on a special cushion, and just give the injury time to heal. For many people these simple steps work just fine, but for some they continue to experience pain with sitting months or even years later. Let’s take a little more in-depth look at the anatomy of the coccyx (tailbone), some common causes of injury and the available treatment options.

What Is The Coccyx (Tailbone)?

If we take a look at the anatomy of the pelvis we can really start to appreciate how many muscles attach on and around the coccyx. The coccyx is a small but important extension of our spine. It is triangular in shape and consists of 3 to 5 fused segments, the largest of which joins the sacrum. Several of the pelvic floor muscles, ligaments of the pelvis, and fibres of the gluteus maximus muscle insert at the coccyx. These ligaments and muscles help support the pelvic floor and also contribute to voluntary bowel control (2). In addition, the coccyx acts as part of our support tripod when we sit. The coccyx along with our two ischial tuberosities or sitz bones provide weight bearing support when we sit (2).

With this in mind, it’s easy to see how when you lean back or slump in your chair the pressure increases on this little bone. Give it a try. Sit nice and straight in your chair with your weight evenly distributed over your sitz bones. Now slump in your chair allowing your pelvis to rock forward slightly. Do you notice how this changes your weight distribution and where you feel pressure? The ischial tuberosities are called “sitz bones” for a reason!

What Are Common Causes Of Coccydynia?

The most common cause of coccyx pain is from external or internal trauma. External trauma is typically caused by a backwards fall, resulting in a bruised, dislocated, or broken coccyx. Internal trauma can happen during childbirth because of the susceptible location of the coccyx, specifically during a difficult or instrumented delivery (forceps or vacuum). Minor trauma can also occur from repetitive or prolonged sitting on hard, narrow, or uncomfortable surfaces. There are times when no trauma is present but there is still coccyx pain. This tends to be related to degenerative joint or disc disease, hypermobility or hypomobility of the sacrococcygeal joint, infectious etiology, and variations to coccyx anatomy (2).

How Can Coccydynia Be Treated?

The majority of people presenting with coccyx pain report a localized pain over the coccyx. It can be made worse with prolonged sitting, leaning back while seated, prolonged standing, and rising from a seated position. For some people there may also be pain with intercourse or bowel movements. Fortunately for the majority of people, reportedly 90%, conservative treatment is successful in managing this type of injury or pain (2). Many cases resolve without medical treatment. Some of the common conservative treatment options include sitting on a modified wedge-shaped cushion or donut to relieve pressure on the coccyx in sitting. A word of caution, there is some research that suggests the donut cushion may place pressure on the coccyx because of its position on the ischial tuberosities. Additional conservative options include learning proper body mechanics for sitting and correcting poor posture. Finally, the use of heat or cold and NSAIDS (non-steroidal anti-inflammoatory drugs) can also be helpful in easing any discomfort.

If all the above options have been explored and there is still pain, Pelvic Floor Physiotherapy can be very helpful. Pelvic floor physiotherapists are able to perform internal exams (usually rectal in this case) that can assist in decreasing pelvic floor muscle spasms and gently mobilizing the coccyx. As a last resort, after all conservative management has been attempted, surgical procedures are an option but come with their own risks and complications. It is best to discuss this with your doctor to determine the best individualized treatment option for you.

 

References

  1. https://en.wikipedia.org/wiki/Coccydynia
  2. Ochsner J. 2014 Spring; 14(1): 84–87.Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain. Lesley Smallwood Lirette, MD, Gassan Chaiban, MD, Reda Tolba, MD, and Hazem Eissa, MD
  3. Maigne JY, Pigeau I, Aguer N, Doursounian L, Chatellier G. Chronic coccydynia in
    adolescents. A series of 53 patients. Eur J Phys Rehabil Med. 2011 Jun;47(2):245–251.

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