A real pain in the backside!

By the time patients with coccydinia present at my clinic they may have suffered for a long time from pain in their tailbone or coccyx. Coccydynia  is a throbbing or aching pain in and around the area of the tailbone ( coccyx). If you have had trauma to,  or pain in your coccyx, chances are you have been advised to rest and take anti-inflammatories. Sometimes this works and the pain goes away, other times the pain persists especially when you sit for a long time and when you rise from the sitting position. In my experience coccyx pain can be treated successfully using specific manual techniques.

Because it requires high doses of radiation to show the small coccyx on X-ray, because all tailbones have a different “normal” position, and because an X-ray rarely changes the course of treatment, X-rays are not used routinely to diagnose coccydinia or abnormalities in the coccyx ( correct me if things have changed if anyone reading this is an Irish medical professional or has had a different experience!)

Risk Factors for Coccydynia include prolonged sitting, poor sitting posture, difficult labour and delivery, and activity involving repeated blows to the coccyx such as horse riding, bicycle,tractor..and surgery involving lying on the back with knees flexed.Up to one third can be idiopathic ie of unknown cause ( Lyons et al 2009)

Coccydyinia occurs 5 times more frequently in women than men, with onset at mean age of 40 years ( Patel et al 2008). The fact that giving birth puts substantial pressure on the coccyx is thought to be a factor in the increased risk for women ( Foye et al 2009)

The coccyx projects distal to the sacrum, curving posteriorly and then anteriorly at the tip

Tailbone coccyx pain spine Anatomy of the Human Body” 1918, by Henry Gray

The coccyx, along with the two ischial tuberosities, bears weight when a person is sitting, with an increased weight load on the coccyx when a person leans back in the sitting position.

The coccyx (tailbone) is a small triangular bone made up of 3 – 5 rudimentary vertebrae. These segments may or may not be fused together.—The coccyx flexes forward during contraction of the pelvic floor muscles,It extends backwards during labour and defaecation and it can also bend to each side and rotate a little on it’s long axis. The degree of movement is very different from tailbone to tailbone so when it comes to treatment it is different to treating other joints that have defined normal ranges of movement to aim for.

Two important pelvic floor muscles attach to the tip of the coccyx; these are the iliococcygeus and the ischococcygeue. Gluteus Maximus has an attachment to the lateral border of the coccyx

—Causes of Coccydinia

  • Trauma
  • Direct blow to the coccyx – can be fractured and bruised – may lead to posterior subluxation
  • Inflammation of the sacro-coccygeal joint.
  • Referred pain from other sources e.g Pelvic Floor Muscles, Sacrospinous / Sacrotuberous Ligaments, Gluteus Maximus

If you have had a recent trauma to your coccyx or have noticed a gradual onset of pain, it is worth visiting your GP first to ensure that all investigations are done in case anything strange is going on and to ensure that you use suitable pain relief. If the paindoes not go away after 8-10 weeks this is a good time to think about attending a physiotherapist who is specialised in the area.

Personally I love treating coccydinia as it generally responds quickly to manual techniques if it is going to be treatable by physiotherapy.

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