Coccydynia is defined as pain in the coccyx or tailbone. The tailbone is the very end of your spine and has a natural slightly curved shape. This bone is the site of multiple muscle and ligament attachments and serves as a support structure when seated. Because of this function, pain typically occurs with touch to the tailbone, sitting- especially on a hard surface, transitioning from sitting to standing, and during defecation. Common causes include trauma (falls and childbirth), prolonged sitting, degenerative joint disease, or too much/too little joint movement. Pain could also be referred from the lumbar spine, pelvic floor muscles, bony spurs or infections. Usually, pain can be the result of multiple sources, and the skill of a pelvic floor physical therapist can help determine appropriate treatments.
For example, research as shown that stretching of hip muscles, including the piriformis and iliopsoas, has had benefits on decreasing tailbone pain. Furthermore, conjunction of stretches with addressing spinal mobility has shown a decrease in pain and improved sitting tolerance. Additionally, research shows effectiveness of tailbone manipulation and tailbone muscle massage performed rectally. It’s important to note that a single tailbone manipulation or mobilization is not likely to decrease pain immediately. People usually have a false belief that a single movement “back into place” will make the pain go away. This is rarely true. Our muscles and nerves also require time to become less sensitive to whatever changes have occurred since the time of injury or start of pain. It can take weeks or month to have significant pain reduction. In the meantime, it may be helpful to use a donut cushion, take a sitz bath, and apply ice or topical analgesics to help manage pain. If pain continues in severity it may be important to consult your therapist and pain management physician regarding more aggressive treatments such as steroid injections, anesthetic injections or nerve blocks.