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  • Deborah Thomas BPT MCSP MAPPI Chartered Physio

Understanding and Managing Tailbone Pain (Coccydynia)

Updated: May 8

Do you have pain in your coccyx or tailbone? You're not alone. Coccydynia, or tailbone pain, can range from uncomfortable to unbearable, affecting everyday activities like sitting, lying down, and transitioning between positions.

Fortunately, there are various management strategies and exercises that can help alleviate the discomfort. Here, I will outline information, tips, and advice to help you understand what is happening, how you can help ease the symptoms, and who to seek help from when you are in pain.


Tailbone pain is a common problem, and in most cases, this pain will resolve with home-based treatment like ice packs, ergonomic changes, or over-the-counter medication within a few days. If changes to sitting, movement, and activity are introduced, this can prevent the symptoms from becoming an ongoing, persistent problem.

Many people aren’t aware of the structures and tissues in that area of our body, and in treatment, they are surprised to learn the intimate relationship between our breathing, back and abdominal muscle function, pelvic floor muscles, bowel and bladder functions, and their symptoms.

So, Let's explore a bit more about the structure of the coccyx to help us understand its function, and this will help us appreciate the problems that may arise when there is pain in the area. 


What is coccydynia

Coccydynia is the medical term for tailbone pain. Coccyx: tailbone; the bone at the base of our spine. Dynia is pain.The coccyx consists of 3-5 small bones (termed vertebrae) at the bottom of the spine, supporting various muscles and ligaments. This is the remainder of the long tail that vertebrate animals have, and we had it when we were embryos in our first weeks of life.This is a palpable structure and feels like a hard, boney area, just above the back passage. The shape of the coccyx differs slightly between males and females; this is to allow easier passage of the baby during childbirth.

Function of the tailbone 

Although this is a small structure, it has several important roles.


  • The coccyx acts as an anchor point for muscles, ligaments, and connective tissues around the gluteal and pelvic floor areas and as a scaffolding structure for the back passage tissues. It’s position and health play a role in pelvic floor function.

  • Support sitting - The tailbone is like a small back leg in a stool, helping the two sitting bones (ischial tuberosities) support your position; however, in a slumped position, lots of weight goes through this bone, putting more pressure on its structures.

So now that we know a little more about the structure and role of the tailbone, let’s understand more about how and why some people experience pain.


Symptoms of coccydynia

 People who suffer from coccyx pain may feel one or more of the following symptoms:

  • Local pain in the area of the tailbone

  • Sensitivity to touch in the area 

  • Pain during sitting that worsens when slumping or leaning back

  • Pain on moving from sitting to standing

  • Prolonged standing, or distance walking can irritate the area

  • Bowel movements and sexual function may be affected

  • Pain when lying on the back or moving from lying in this position

This pain can greatly affect everyday activities because many of them involve putting a strain on your abdomen, pelvis, lower back, and pelvic organs. Whether it's sitting to eat, driving, or working, these actions can worsen the pain. Since avoiding these activities is nearly impossible, the pain can become constant and impact every aspect of life.Several factors can influence your symptoms. That’s why it is always important to have a thorough examination and assessment, as understanding the original issue and problem will be the key to effective treatment.


Common causes of tailbone pain

Trauma: falls, intensive cycling, horseback riding, childbirth, or pregnancy-related factors. Musculoskeletal issues: include incorrect seating, prolonged sitting, pelvic floor conditions, and rheumatology conditions. Chronic constipation and straining can affect the area too.These reasons can cause a mechanical problem like a bruise, sprain, dislocation, or fracture of the coccyx.

Referred pain: our pelvic area is like the heart of a bustling city, with all sorts of functions going on: digestion, elimination, reproduction, movement, and more. And there's a whole network of blood vessels, nerves, and other systems there, making it a real hotspot. Plus, our brain treats our pelvis like ‘VIP territory’—The Very Important Pelvis. So, when things go awry, like pain getting referred to your coccyx and back passage, it can complicate other functions down there too.

Infections & cysts: in the area of the back passage and rectum, sacrum and tailbone.


When to seek medical advice?

listen to your body. If you're feeling some changes related to bowel and bladder function, digestion, or your monthly cycle, or if the pain is sticking around no matter what you do, it is advisable to seek a medical opinion or a pelvic health physiotherapist that will help you understand the source of the pain and mechanism behind it.


As this area is packed with organs, there can be problems that do not come from the coccyx directly, relating to your digestive system and back passage for example, hemorrhoids, fissures, or infections.


Managing tailbone pain Initially, when symptoms begin, it may be helpful to address some basic day to day habits, improve activity and mobility, and consider conservative management (anything that doesn’t involve an injection or operation), such as physiotherapy.


What can you do right now if you experience tailbone pain

The main aim is to reduce the load and pressure on the tailbone to allow it time to heal.

1.  Prevention is best: The most important thing is to avoid prolonged sitting: Don’t let your symptoms build up or worsen before you take action. The moment you are slightly uncomfortable, move, change position, and offload.

2.  Motion is lotion: even if you are not in pain, it’s recommended that if you need to sit for a length of time, you get up and move every 20–30 minutes and walk for 3–4 minutes. This improves circulation to all the tissues and offloads pressure.

3.  Tools you can use: A coccyx pillow: Before you go ahead and buy these, take note of these points: What do you feel more comfortable on, a hard or soft surface?

Try this seating position in this video: https://youtu.be/VuAxwNBI-Hk?si=bPmvDWGwDvbFyvYD using a towel or ball; this will help you understand what feels best for you. Do you find supporting your lower back with a ball or rolled towel helpful? Or maybe changing the pelvic angle releases direct pressure on the coccyx? After experimenting with these, you'll be able to have a more informed shopping experience. Many people find that a wedge cushion works best for them as it transfers more weight forward and away from the coccyx.For example: https://amzn.eu/d/3ZfBShW Or this can also be suitable to address lower back seating issues: https://amzn.eu/d/9QmgG1jA donut cushion is less helpful as it can compress and load the coccyx too much and is more suitable for fissures and hemorrhoids.

4.  Heat or cold? It is worth trying both to see what helps you most. Please be sure to use warm rather than boiling water if using a water bottle.

5.  Movement exercises: movement of the hips, lower back, and pelvis can help relieve symptoms and be a reason to take a break from sitting. Try these exercises on my video:

 

Physiotherapy assessment and treatment for tailbone pain

In physiotherapy, you’ll have the opportunity to be listened to and have the time to go through a thorough history-taking process. Following an understanding of all your symptoms and pain and how this affects your day-to-day life and activities, followed by a physical examination of all the structures and tissues that directly and indirectly affect the coccyx, like the back, hips, legs, and abdomen, to name a few. You may benefit from an internal examination of your pelvic floor muscles and coccyx, and this will be discussed with you in more detail. Some information about what to expect can be found here: https://www.deborahthomasphysio.co.uk/faq 

Treatment is aimed at relieving symptoms, optimizing movement, and improving daily function and is tailored specifically to your needs:

  • Education: to help you understand what and why is happening, to reduce fear, and to motivate you

  • It likely will include some exercises; these will be taught, practiced, and then emailed to you.

  • Manual therapy for soft tissues and joints, either external or internal to the pelvis

  • Acupuncture or dry needling: for more information, see my section about acupuncture on my website: https://www.deborahthomasphysio.co.uk/acupuncture

  • Ergonomic advice

  • Taping, silicone cups, and more as required.

 It is much easier and faster to treat tailbone pain when it is relatively new, and chronic symptoms often take longer to resolve; however, they still respond really well to physiotherapy treatment. 


In conclusion Tailbone pain doesn't have to dictate your life. With the right understanding and management strategies, you can find relief and regain control over your daily activities. If you're experiencing coccydynia, don't hesitate to reach out for professional assistance.  You can find out more about what I do, and book your appointment via this link:


References:

  1. Effects of stretching of piriformis and iliopsoas on coccydynia 2017: Mohanty et all. Journal of Bodywork & Movement Therapies 21 (207) 743-746

  2. Coccydynia: Tailbone pain, Foye P.M. 2017: Phys Med Rehabil Clin Am 28 (2017) 539-549

  3. Coccydynia-could age, trauma and body mass index be independent prognostic factors for outcomes of intervention? Kodumuri P et al 2018: Ann R Coll Surg Engl 2018: 100:12-15

  4. Coccydynia: A Literature Review of Its Anatomy, Etiology, Presentation, Diagnosis, and Treatment. Mahmood S, et al. Int J Musculoskelet Disord: IJMD-109

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