Coccydnia, pain on or around the coccyx bone, aka the tailbone, can literally be a big old pain in the bottom. This pain is often exacerbated by prolonged sitting, doing kegels and moving from the sitting to standing position.

Before I get too far ahead of myself, a quick anatomy lesson. The coccyx bone is a small triangular shaped bone that forms a joint with the sacrum and is the very last part of the vertebral column. There is some variety in the coccyx bone, for most it consists of 3-5 separate bones with a joint capsule and fascia connecting them. For others their coccyx bone and the bones that comprise it are fused together. Regardless of the anatomy, a common theme exists. When injured, it is a major site for pain and discomfort

Despite its small size, the coccyx is an important site anatomically for the pelvic floor muscles. All of the deeper pelvic floor muscles directly attach to the coccyx and most of the superficial layer attach directly or indirectly to the coccyx bone. It doesn’t stop there either, the coccyx is also a major attachment site for some ligaments and fascia of the pelvis. It’s hard to believe the coccyx is often dismissed as a vestige of our prehistoric ancestors.

The coccyx bone is considered one of the three legs in the tripod (with the right and left ischial tuberosities aka the sit bones) that provide weight bearing support while in the seated position, along with positional support to the anus. Anyone else with me in thinking this lil old bone is pretty damn cool! And then… it also, in times of evacuation (of feces and a baby during a vaginal birth) extends backwards with the aim of getting out of the way.

Women are thought to be five times more likely to suffer with coccydynia. This has been attributed to childbirth and the width of the female pelvis both increasing weight distribution to the coccyx while seated.

Some common causes of coccyx pain:

  • A direct trauma or fall to the coccyx bone.
  • Vaginal delivery – while in the birth canal the babes head is in contact with the coccyx bone for a portion of time. The pressure created by the birth, plus that from the pushing can injure the coccyx and surrounding tissues. I personally experienced this with the birth of my second daughter. I was unable to breastfeed seated, lucky for me I’m not the only osteopath in the family. One treatment (the same day I gave birth) and I was happily breastfeeding in the seated position. As a side note, in extreme situations during childbirth, fracture of the coccyx can occur.
  • Prolonged or repetitive pressure to the coccyx (prolonged sitting, bike riding and rowing).
  • Hypertonic pelvic floor muscles. As many of the pelvic floor muscles attach directly or indirectly to the coccyx, if they are indeed tight they can put direct pressure on the coccyx bone resulting in local pain.
  • Referred pain from other joints or ligaments of the pelvis.
  • Poor sitting posture or malalignment of the joints of the pelvis or lower back can cause coccyx pain and are a major contributing factor of persisting pain.
  • Infections, bone spurs and tumors can be rare causes of coccydynia.

Many tend to dismiss the original pain “it’ll resolve itself” and yes sometimes it does, unfortunately it is a hard area to avoid and for many it ends up becoming a chronic pain.

With the initial dysfunction pain, inflammation is experienced, the brain senses this and pain is perceived. Muscular guarding occurs causing the pelvic floor muscles to engage and protect the area, which causes more local inflammation and noxious stimulation that the brain responds to by making the pelvic floor tighten again. A vicious loop of muscular dysfunction, inflammation and pain results. Over time the constant guarding of the pelvic floor muscles can result in an overactive pelvic floor. (Want to know more about an overactive pelvic floor and the impact it has on your body – check out this blog)

As an osteopath trained in pelvic floor muscle therapy I see many people with coccyx pain, usually referred by another practitioner or out of pure desperation, a coccyx pain sufferer participating in late night googling, wanting answers and more options for pain relief. A commonly asked question; does treatment involve internal work or do you do internal coccygeal manipulation. The short answer is yes, maybe, no. This depends on

  1. If this type of treatment is indicated or appropriate for the given patient.
  2. If the patient consents for internal work to the pelvic floor muscles and coccyx bone via the vaginal and/or rectum.

Treatment consists of a holistic look at the body. I find poor posture in both standing in sitting position, malalignment of the pelvis, poor breathing strategies and hypertonic pelvic floor muscles can be some of the reasons the coccyx pain persisted in the first place and I believe these issues need to addressed along with the local coccygeal restriction.

Treatment will involve lifestyle advice, education on sitting posture, advice on sleep hygiene, stress management, breathing strategies and movement practices to assist with down regulation of the nervous system and relaxation of the pelvic floor.

For more information feel free to give me a call on 96994004.

Dr. Kathryn Johns (Co-Founder and Director of The Fertile Project)

P.S. For many with coccyx pain, I am specifically sought out for internal coccygeal manipulation. Should you have any questions regarding this type of work please contact the clinic. I understand for some this is a very big decision and one I do not take lightly nor do I insist or put pressure on any patient to have internal work done.

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