Coccydynia (Tailbone Pain)

Coccydynia! If you have no idea what that word means or even how to pronounce it, you’re in the right place. Today, we’re talking tailbone pain. This type of pain is localized to the tailbone, or coccyx, and often manifests in seated positions. Coccydynia, or tailbone pain, has been around forever, with accounts dating back to the 16th century. Before then, I’m guessing no one bothered to write it down since coccydynia occurs more commonly in females (1).

Let’s start with the basics, as usual. The coccyx, or tailbone, is the very end of the spine. It is comprised of 3-5 small vertebrae and is attached to the sacrum. It is shaped like a triangle with the pointy part down. Curvature of the coccyx is variable from person to person and the bones that make it up may or may not fuse together with aging.

There are five main coccyx shapes/types. Type 1 is a slightly curved tailbone that points downward. Type 2 is more curved so that the tip points forward rather than downward. Type 3 has a sharply angled joint, rather than a gentle curve. Type 4 is a coccyx that is subluxed at the sacrococcygeal joint. This means that at the joint between the sacrum and coccyx, there is a partial dislocation, which isn’t necessarily a bad thing. Type 5 is a coccyx with a retroverted tip, meaning the end of the tailbone points backward rather than forward (2). There are other types, but these five are the most common.

Coccyx Types

Muscles that attach to the coccyx include the gluteus maximus, coccygeus, and levator ani. Since the levator ani attaches to the coccyx, when you contract your pelvic floor muscles (PFMs), your coccyx is pulled forward. If you place your hand or finger along the back of your tailbone and contract your PFMs, you may be able to feel the coccyx being pulled forward. Contrastingly, when you perform PFM lengthening, or bearing down, you can sometimes feel the tailbone moving backwards a bit. The gluteus maximus muscle is responsible for pulling your legs backwards, such as during walking. Extending the leg behind you and contracting the gluteus maximus can move the coccyx backward, as well.

It is often assumed that the coccyx is a static feature, but it actually has quite a bit of movement. It can move forward and backward, as well as side to side. It has important functions including providing support to the pelvic floor, providing a surface for the gluteus maximus to attach to for optimal walking mechanics, acting as one of the three bones used for support during sitting, is an active player in childbirth, acts as an influence on sexual function, and plays a role in bowel elimination. During childbirth, the coccyx ideally moves backward to allow the pelvis to open up a bit more in order to allow baby to exit the birth canal. In the most common American birthing position, dorsal lithotomy (lying on the back with legs raised), the coccyx has a harder time moving, but in other positions it is able to move for improved pelvic space. The coccyx provides support to the anus and has attachments to the PFMs, and therefore influences the mechanics of the PFMs and has an effect on stool elimination and continence.

Okay, finally onto tailbone pain! That was a lot of backstory, but hopefully it gives you a bit of an understanding for the coccyx and why it is so important.

Tailbone pain typically presents in the form of pain localized to the tailbone during sitting or when rising from sitting. You could also experience pain during defecation (pooping) or sexual activity since these activities involve the movement of the pelvic floor muscles, and therefore the tailbone. There are pains in the pelvic/tailbone region that may be mistaken for tailbone pain. These include pains due to things such as hemorrhoids, tumors, cysts, disorders of the rectum, and more. It is important to talk with your medical doctor and/or pelvic health specialist in order to determine the source of your pain and appropriate treatment.

What can cause coccydynia?

Tailbone pain, as mentioned, can occur in people of all genders, but is most common in females. (1). It can be caused by activities that cause repetitive stress to the tailbone, including horseback riding, rowing, or prolonged sitting (3). It can also be the result of a more traumatic event such as childbirth, falls, sexual abuse, or anal intercourse (3, 4, 5). Other causes of coccydynia include obesity, poor posture, disc degeneration, entrapped coccygeal nerve, hormone changes (such as those during breastfeeding or menopause), and fear or stress. It is important to have an x-ray to check for fracture, especially if a traumatic event is what preceded your pain.  

 Can physical therapy impact my symptoms of tailbone pain?

Physical therapy can be a huge help for coccydynia. Your pelvic health physical therapist is an expert at providing you with ergonomic solutions to implement during your typical day to ease your symptoms. These could include specific pillows to use in your car or at your desk at work, seated postures that help to release pressure from the tailbone, and standing postures that can ease symptoms in standing. Your therapist can also help you improve positioning during defecation and stool consistency to eliminate these as a source of your pain. Your plan of care should include exercises that will help to work out any muscle imbalances that might be present. For example, if you are experiencing pelvic floor tension that is causing your coccyx to be pulled into a forward curled position, your therapist will help you work on exercises for relaxing and stretching the pelvic floor muscles. If your tailbone is in a forward flexed position, your treatment plan might also include strengthening of the gluteus maximus muscles. Your therapist may also use some manual therapy techniques on you to work out any tight muscles or myofascial tension, and you might even be provided with release techniques you can use at home, such as rolling a tennis ball on your lower back or sitting on a dilator. Finally, your therapist may use a taping technique to help guide your coccyx into a more comfortable position while you are healing.

What else can I do besides physical therapy?

As with most treatments, you are better off using a multidisciplinary approach. This means you have multiple providers of different specialties working to tackle the same issue. Other treatments include medications, injections, and surgery.

Your tailbone pain isn’t a life sentence and there are so many things you can try to help improve your symptoms.

Happy Tails,

XOXO Your Pelvic Bestie

References:

1.     Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014 Spring;14(1):84-7. PMID: 24688338; PMCID: PMC3963058.

2.    Woon JT, Perumal V, Maigne JY, Stringer MD. CT morphology and morphometry of the normal adult coccyx. Eur Spine J. 2013 Apr;22(4):863-70. doi: 10.1007/s00586-012-2595-2. Epub 2012 Nov 29. PMID: 23192732; PMCID: PMC3631051.

3.     Grgić V. Coccygodynia: etiology, pathogenesis, clinical characteristics, diagnosis and therapy. Lijec Vjesn 2012; 134(1-2): 49-55

4.     Stephenson RG and O’Connor LJ (2000). Obstetric and Gynecologic Care in Physical Therapy. 2e Thorofare, NJ: SLACK Inc.

5.     Dalbayrak S, Yaman O, Yilmaz T, Yilmaz M. Treatment principles for coccygodynia. Turk Neurosurg. 2014;24(4):532-7. doi: 10.5137/1019-5149.JTN.9505-13.0. PMID: 25050678.

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.