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With evolution, we humans have lost our tail, but there is a vestigial part of the tail in us that can hinder our daily activities if it gets damaged or injured. If you are experiencing pain while sitting, the chances are that you are having tailbone pain or coccydynia.

What is it?

The coccyx is the last part of our vertebral column and is referred to as the tailbone. The tail bone pain or coccydynia is the pain that you feel at the tip of the tailbone, and is caused when the coccyx or the surrounded tissue is injured. The pain usually starts when an individual sits suddenly and/or stands up after being seated for long.

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The condition is also known as coccygodynia, and it can interfere with the quality of life. The patient describes the pain as stabbing, which can radiate down to the buttocks and sometimes up to to the thighs.

To understand the coccydynia, you first need to know more about the final part of the vertebral column that is the coccyx. The vertebrae of the coccyx are all fused together, and it is the attachment site for many muscles and ligaments that control the pelvic floor. The coccyx is also responsible for supporting the anus’s position in an individual. Sometimes when the ligaments or muscles attached to the coccyx are damaged, the coccyx can take an abnormal position resulting in pain.

Major causes

Tailbone pain or coccydynia is common in people who sit for long hours. The pain is such that it makes sitting difficult. Here are the major causes of tailbone pain:

a.    Poor posture – Mostly, the tailbone pain is the result of poor posture. Sitting continuously in the wrong posture may cause unnecessary pressure on the muscles and bones of the coccyx. The tailbone pain caused by poor posture may become chronic unless you don’t correct it. To avoid coccydynia, it is important that you correct your posture.

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b.   Injury – The injury to the coccyx can most likely occur if you experience a slip or a fall. There is a high chance of injuring the coccyx if a person slips or falls on his buttocks. Such injury is more common in sports like football, wrestling, hockey and basketball. Depending on the type of blow, the coccyx may get dislocated or fractured.

c. Underweight or overweight – Your weight is an important factor in determining the pressure on the coccyx that can lead to coccyx pain (Maigne, 2000). A BMI higher than 29.4 in men and BMI higher than 27.4 in women can increase the risk of pain in the coccyx. In addition, it is found that pelvic rotation in obese people is less, which means continually increased stress on the coccyx leading to pain.

However, coccydynia is also common in people who are underweight as they don’t have sufficient fat around the buttocks to prevent the rubbing of the coccyx with the tissue surrounding it. Falling on the buttocks for such people is more painful.

d. Giving birth – Giving birth is also one of the most common causes of coccydynia in women (ÁM et al., 2019). During the last trimester of pregnancy, the coccyx becomes more flexible so that it and the spine above it can bend easily to support the birthing process (J. Maigne, 2012). Sometimes, the pressure of the baby can cause the ligaments and muscles of the coccyx to overstretch. This results in the pain of the coccyx.

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e.    Aging – Aging is another important factor that leads to coccydynia. The main reason behind this is the degeneration of the cartilaginous disc. In severe cases, the bones of the coccyx become fused tightly, causing more stress on the coccyx resulting in pain. To avoid coccydynia in old age, it is important that you keep on exercising and get proper nutrition. 

f.     Cancer or infection – In rare cases, an infection like a pilonidal cyst can also result in coccydynia. This may also cause a pilonidal abscess (pus collection in the anal cleft).

In addition, coccydynia is also caused by cancer which originates from one area and spreads to the coccyx. Chordoma is a type of cancer that commonly affects the spine and can lead to tailbone pain. 

g.  Repetitive injury – Coccyx can also get damaged in the sports like cycling and rowing as such sports needs you to lean forward for a prolonged duration. The repetitive motion in such sports causes the muscles and the ligaments of the coccyx to stretch. There can also be permanent damage which can result in pain and discomfort. To prevent this, one should limit the hours spent on such strenuous activities. 

h.  Referred pain – In some cases, pain can be referred to the coccyx from the pelvis or spine in the conditions like a degenerative lumbar disc or herniated disc.

Anatomical causes

Coccydynia is also caused by few anatomical issues:

a. Hypermobility of coccyx – When coccyx is hypermobile, it puts additional stress on the sacrococcygeal joint and the coccyx. Sometimes hypermobility also pulls the pelvic floor muscles that attach to the coccyx. This also gives rise to tailbone pain.

b.   Hypomobility of coccyx – Hypomobility of the coccyx causes the coccyx to move outwards during sitting, which can raise the pressure on the sacrococcygeal joint and the bones of the coccyx. It also increases the tension of the pelvic floor muscle resulting in discomfort.

c. Dislocation – In very rare cases, the sacrococcygeal joint may get dislocated, resulting in the pain of the coccyx.

How do you know if you have it?

If you want to know whether you have coccydynia or not, there are few signs to look for:

a.    Pain while sitting on the hard surfaces

b. Localized pain around the tailbone increases when any kind of pressure is applied to it.

c. The pain worsens when you stand up from the seating position after a long duration.

d.   Pain during sexual intercourse

e.    Some women complaint of pain during their periods

Physiotherapy treatment options

Your therapist would advise avoiding the factors that might exaggerate the pain. You will be given gel cushions to avoid the pain when you are sitting for a prolonged duration. This will reduce the localized pain while improving the posture. Your therapist will also add progressive stretching of piriformis and iliopsoas (Mohanty, 2017) and muscle strengthening to your treatment protocol. Other physiotherapy treatment options are:

a. Posture correction – One of the most important goals of treatment is to provide postural education. A person should be taught proper sitting posture, which takes away the weight from the coccyx and loads ischial tuberosities instead.

b.  Manual therapy – Manual therapy includes stretching, massage, mobilization, and manipulation. This may involve internal or external contact with the coccyx.

Internal techniques involve massaging the levator ani muscle while the coccyx is hyperextended (Maigne JY,2001).

External techniques include manipulation of the sacroiliac joint (Bergmann TF,1993), mobilization of sacrococcygeal joints (Mennell JB,1952), stretching of iliopsoas or piriformis, and mobilization of the thoracic spine.

One thing to note here is that the type of technique used will depend on the cause of the coccydynia. For example, when the pain is due to the spasm of the pelvic floor, massaging the levator ani should be chosen. Mobilization is the best when there is hypomobility of the coccyx.

c. Physical Modalities – Extracorporeal shockwave therapy is the most effective modality to reduce the pain of the coccyx. A study (Lin SF,2015) found that 70% of patients who took ESWT reported good to excellent satisfaction. Patients were given 2000 shots of ESWT to the coccyx area per session for four sessions. ESWT reduces the inflammation and inflammatory mediators in coccydynia through the induction of neovascularization. Though shortwave diathermy can also reduce the pain, it’s not to the same extent as ESWT.

Conclusion

Almost 90% of the tailbone pain cases can be resolved using conservative treatment like reducing the duration of sitting, seat cushioning, stretching, postural adjustments, etc. Surgical intervention is suitable for patients having advanced coccygeal instability. To have a consultation from experts regarding coccydynia, visit Progressive Care rehabilitation center.

References:

1.   Maigne, J. Y. (2000, December 1). Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. PubMed. 

2.   ÁM, M., E, G., & Mp, A. (2019, March 9). Coccyx pain in women after childbirth. Abstract – Europe PMC. 

3.   Maigne, J. (2012, July 23). Postpartum coccydynia: a case series study of 57 women. PubMed. 

4.   Mohanty, P. P. (2017, July). Effect of stretching of piriformis and iliopsoas in coccydynia. PubMed. 

5.   Maigne JY, Chatellier G, Le Faou M, Archambeau M. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine. 2006 Aug 15;31(18):E621-7.

6.   Bergmann TF, Petersen DH, Lawrence DJ. Chiropractic Technique-Principals and Procedures. New York: Churchill Livingston Inc. 803p. ISBN 0-443-0872-0; 1993.

7. Mennell JB. The science and Art of Joint Manipulation. London: Churchill, 1952

8.   Lin SF, Chen YJ, Tu HP, Lee CL, Hsieh CL, Wu WL, Chen CH. The effects of extracorporeal shock wave therapy in patients with coccydynia: a randomized controlled trial. PloS one. 2015 Nov 10;10(11):e0142475.

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