Coccyx Pain

Physiotherapy techniques can be successful in the treatment of Coccyx or Tailbone Pain. I have been treating this condition for over 10 years using manual techniques that focus on mobility of the coccyx itself, its connection to the pelvic floor and its connection to the whole spine. 

Coccydynia alos known as Coccyx Pain or Tailbone pain 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, you may 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. 

Because it requires high doses of radiation to show a 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!)


Anatomy of the Coccyx

The coccyx, along with the two ischial tuberosities of the pelvic ( you sit on these bones), 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 its 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 ischococcygeus. Gluteus Maximus has an attachment to the lateral border of the coccyx



Physiotherapy Treatment of Coccyx Pain

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 firstly that the pain you are feeling is actually coming from you coccyx, and to ensure that all investigations are done in case anything strange is going on. Your GP may also prescribe suitable pain relief. If the pain is coming from your coccyx and does not go away after 8-10 weeks this is a good time to think about attending a physiotherapist who is specialised in the area.

Coccyx Pain can be treated successfully by Physiotherapy. 


Risk Factors for developing Coccydinia

Prolonged sitting, poor sitting posture

Difficult labour and delivery

Activity involving a sudden blow to the coccyx such as trauma or a fall, or repetitive loading to the coccyx such as horse riding, bicycle,tractor.

Surgery involving lying on the back with knees flexed may lead to coccyx pain.

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).

Coccyx Pain may be referred from other sources e.g Pelvic Floor Muscles, Pelvic Ligaments, Stiff joints in the Spine or tight muscles.


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