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  • Robin R Varghese, PT.

Tail bone pain? Now what exactly is a tail in humans and can a Physical Therapist relieve this pain?

COCCYDYNIA


What is Coccyx?

  • The coccyx is a triangular arrangement of bone that makes up the very bottom portion of the spine below the sacrum. It represents a vestigial tail, hence the common term tailbone.

  • The coccyx is one part of a three-part support for a person in the seated position. Weight is distributed between the bottom portions of the two hip bones (or ischium) and the tailbone, providing balance and stability when a person is seated.

  • The tailbone is the connecting point for many pelvic floor muscles. These muscles help support the anus and aid in defecation and assist in walking, running, and moving the legs.



What is Coccydynia?

  • Coccydynia is the term used to describe the symptoms of pain that occur in the region of the coccyx.

  • It is also referred to as coccydynia, coccalgia, coccygeal neuralgia or tailbone pain.

  • It is commonly triggered in a sitting position, but may also occur when the individual changes from a sitting to standing position

  • It can get chronic, having negative impacts on quality of life.

Risk Factors

Obesity

Rapid weight loss

Pregnancy

Morphological variations of the coccyx


The variations in morphology of the coccyx can be as:

  • Type I: The coccyx is slightly curved forward, with its apex positioned downward and caudally

  • Type II: The forward curvature of the coccyx is more exaggerated, with the apex positioned in a straightforward direction.

  • Type III: Sharp forward angulation of the coccyx forward.

  • Type IV: Subluxation of the coccyx at the sacrococcygeal or intercoccygeal joint.



Classification of Coccydynia

  • post-traumatic (Internal/external trauma)

  • non-traumatic (Degenerative disc disease, hyper and/or hypo-mobility of the sacrococcygeal joint, infectious diseases and different variations in the configuration of the coccyx

  • Idiopathic ( occurs in the absence of any pathology in the coccyx.)

Symptoms of Coccydynia

1. Pain

  • pain in and around the coccyx without any reports of severe low back pain or radiating pain

  • The pain is typically localized to the sacrococcygeal joint and is described as a “pulling” or “cutting” sensation.

  • Individuals will commonly report tenderness on palpation of the coccyx.

  • Pain is usually exacerbated with repeated sitting or with transition from sitting to standing position.

  • Pain is relieved usually with sitting on the legs or buttock.

  • Pain increases with defecation or the frequent need to defecate.

  • Pain increases with coughing and during menstruation in females.

2. Guarding seated posture

  • Patients usually exhibit a guarding seated posture, whereby one buttock will be elevated to take weight off of the coccyx.

3. Low back pain

  • morphological variations in the shape of the coccyx and it’s forward curvature may give rise to low back pain.


Management

Non-operative:

  • 90 percent of patients are successfully treated conservatively.

  • Non-steroidal anti-inflammatory drugs (NSAIDs),

  • Activity modification,

  • Ergonomic adjustments, and

  • Physical therapy

Surgical:

  • Coccygectomy or removal of a section or all of the coccyx, is done only when conservative measures fail.

Physical therapy management

  • Postural awareness

  • Ergonomics

  • Use of cushions may be recommended over a 6–8-week period

- Modified wedge-shaped cushions (relieve the pressure placed on the coccyx during sitting)

- Donut shaped or circular cushions (actually increase pressure over the coccyx, but are more beneficial for rectal pain.)

  • Manual therapy

-stretching

soft tissue manipulation of Levator ani muscle or the coccygeus muscle,

stretching of the piriformis or iliopsoas.


-Joint mobilization

joint mobilization while the coccyx is hyperextended to stretch the Levator ani

repeated mobilizations while the coccyx is rotated

mobilizations of the sacrococcygeal or intercoccygeal joints, posterior mobilizations to the thoracic spine

-Manipulation

manipulations of either the coccyx or sacroiliac joint,

mobilizations of the sacrococcygeal or intercoccygeal joints, posterior mobilizations to the thoracic spine and stretching of the piriformis or iliopsoas.


At Valley Healing Hands, Brownsville, Texas, we provide the best Physical Therapy for Coccydynia or Coccalgia or tail bone pain. Our highly skilled Physical Therapists will be happy to assist you get over your pain. Our patients are very happy with our services. You can check what they have to say and get connected to us here. Our patients love us and you too will!



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