Tailbone pain (Coccydynia)

Tailbone pain (Coccydynia)

The coccyx or tailbone is the small bone (fused vertebrae) at the very bottom of the spine. It’s surrounded by muscles, tendons and ligaments.

Sometimes that bone can be painful. It’s called coccydynia and is more prevalent in women (5 women for 1 man).

What can cause it?

– TRAUMA:

• Fall on the buttocks
• Childbirth, use of forceps
• Repetitive strain injuries: typically cyclists or rowers

– NON-TRAUMATIC:

• Pregnancy
• Anatomy of the coccyx
• Repetitive sitting on hard surfaces
• Obesity, rapid weight loss, very thin (not much cushioning)
• Hyper or hypo-mobility of the sacrococcygeal joint
• Tumour
• Idiopathic (no reason)

What are the symptoms?

The main symptoms are:

• Pain around the tailbone, not irradiating in the back, glutes or legs
• The pain can be sharp or dull
• Pain increases when sitting, standing up
• Tenderness to palpation

But you could present other symptoms like:

• Pain during defecation or frequency
• Pain when coughing
• Pain during period or intercourse

Differential diagnosis:

Most of the time, we know the cause of the pain. However, we need to exclude other potential causes like:

• A coccyx fracture
• Lumbar disc herniation with irradiation in the tailbone
• Pelvic pain (Levator ani, piriformis, Alcock canal syndrome)
• Cancer: rectum, bowel, coccyx, prostate, chordoma
• Bladder and bowel issues
• Endometriosis
• …

If any doubt subsists, your GP can refer you for an Xray, CT scan, MRI or bone scan.

What can you do?

The first thing to do is to modify your activities. Avoid everything that can trigger the pain.

If the pain is there when you’re sitting for a prolonged period of time, try to stand up and move around regularly.

Sitting in a slumped or slouched position adds more pressure on the tailbone. Prefer sitting on your sitting bones with your back flat

If you’re a cyclist, maybe invest in a good saddle or padded shorts.

Sometimes you will have to sit on a cushion (donut or wedge-shaped) for 6 to 8 weeks to alleviate the pressure.

If it’s a very acute stage and is inflamed, use ice and anti-inflammatories (cream or tablet)

If you tried everything and the pain persists, a corticosteroid injection or surgery is possible.

Can physiotherapy help?

YES! A mix of manual therapy and exercises usually help to relieve the pain.

Hands-on therapy consists off pelvic, sacrum and tailbone mobilisations and tissue release around the area.

Exercises are essential to maintain/improve the results between your sessions. It includes stretches and muscle strengthening.

Here are some exercises you can do at home:

Cat cow:

Wide child’s pose:

Glute stretch:

Piriformis stretch (4-shaped stretch):

Knock knee stretch:

Happy baby pose:

Glute bridge:

Clam:

These are examples only. The exercise program will be adapted to your pain and needs.

What about the pelvic floor?

The tailbone is the attachment point of some of your pelvic floor muscles.

A tight pelvic floor can pull on the tailbone and make it tender.

You could have associated symptoms like: pain during period, intercourse, difficulty to empty your bladder or bowels, constipation, …

Relaxing your pelvic floor is essential. Don’t focus on squeezing your pelvic floor muscles (Kegels) but more on the “letting go” (see exercises above).

Sometimes, an internal examination is needed to release the tension in your pelvic floor muscles. A women’s health physio can also mobilise your coccyx that way. Even more so if the pain started during pregnancy or after a birth.

If you have any questions about coccydynia, contact us and we will be very happy to help.