Coccydynia (Tailbone pain)
Coccydynia, or coccygodynia, is pain in the region of the coccyx “tailbone pain.”. Simpson first introduced the term in
1859, but accounts of coccygeal pain date back to the 16th century. Despite the identification of chronic coccygeal pain
hundreds of years ago, its treatment can be difficult and sometimes controversial because of the multifactorial nature of
coccygeal pain. Many physiologic and psychological factors contribute to its etiology.
Most cases of coccydynia resolve within weeks to months with or without conservative treatment, but for a few
patients, the pain can become chronic and debilitating.
Despite its small size, the coccyx has several important functions. Along with being the insertion site for multiple
muscles, ligaments, and tendons, it also serves as one leg of the tripod along with the ischial tuberosities that
provides weight-bearing support to a person in the seated position. Leaning back while in a seated position leads to
increased pressure on the coccyx. The coccyx also provides positional support to the anus.
• The exact incidence of coccydynia has not been reported; however, factors associated with increased risk of developing coccydynia include
obesity and female gender.
• Women are 5 times more likely to develop coccydynia than men.
• Adolescents and adults are more likely to present with coccydynia than children.
• Anecdotally, rapid weight loss can also be a risk factor because of the loss of mechanical cushioning.
• The most common etiology of coccydynia is external or internal trauma. External trauma usually occurs due to a backwards fall, leading to
a bruised, dislocated, or broken coccyx.
• The location of the coccyx makes it particularly susceptible to internal injury during childbirth, especially during a difficult or instrumented
delivery. Minor trauma can also occur from repetitive or prolonged sitting on hard, narrow, or uncomfortable surfaces.
• Nontraumatic coccydynia can result from a number of causes, including degenerative joint or disc disease, hypermobility or hypomobility of the
sacrococcygeal joint, infectious etiology, and variants of coccygeal morphology.
• Coccydynia can also be radicular or referred pain, although this type of pain usually is not associated with the hallmark coccygeal
tenderness on physical examination.
• The classic presentation of coccydynia is localized pain over the coccyx.
• Patients present complaining of “tailbone pain.” The pain will usually be worse with prolonged sitting, leaning back while seated, prolonged standing,
and rising from a seated position.
• Pain may also be present with sexual intercourse or defecation. History may be significant for a recent trauma with an acute onset of pain, or the onset
of pain may have been insidious with no clear inciting factor.
• Physical examination will reveal tenderness over the coccyx. Rectal examination allows the coccyx to be grasped between the forefinger and thumb.
• Manipulation will elicit pain and may reveal hypermobility or hypomobility of the sacrococcygeal joint.
• Normal range of motion should be approximately 13 degrees.Other causes of coccyx pain, such as infection etiologies (eg, pilonidal cyst), masses, and
pelvic floor muscle spasms, should be ruled out.
• Radiographic images can more closely evaluate for the presence of fractures, degenerative changes, or masses. Imaging studies, including dynamic x-ray and
magnetic resonance imaging, can help diagnose sacrococcygeal joint hypermobility or hypomobility.
• Home care is aimed at controlling the pain and avoiding further irritation to the coccyx.
• Avoid prolong standing and sitting on too hard surface.
• Use of cushions or pillow while sitting on hard surfaces.
• A doughnut cushion should be used while sitting.
• Eat high fiber diet.
Role of Physiotherapy
Physiotherapy plays a vast role in coccyx pain on coccydynia treatment. It can save you from surgical procedure or any kind of painful maneuvers. Basically
coccydynia is inflammation of tailbone on coccyx therefore an ice therapy is the first step for the acute pain later hot pack can be applied to reduce muscle
tension a doughnut cushion is been prescribed while sitting to reduce the further risk of injury to the tailbone.
Some exercises will help in relieving the symptoms
1. Kneeling groin stretch can help prevent coccyx pain from occurring after long periods of sitting adductor Magnus is a muscle which contributes to tailbone pain
when it is tight. It gets stretched during this exercise and helps prevent tailbone pain.
2. Piriformis stretch can help prevent coccyx pain from occurring. If the pirifomis muscle is shortened or in tightness will coccyx pain hence during this stretch
a exercise muscle gets stretched & help prevent coccyx pain.
3. Walking should be done at least 15-30 at brisk pace.
(a.) Normally the coccyx gets stuck in a wrong position then it provokes a muscle spasm. The spasm then block the coccyx which gets worse with passage of
time? Sometimes it may lead to never entrapment in the coccygeal area.
( b.) It is necessary to unblock the coccyx and relax the muscles as soon as possible. The best option to achieve is to walk fast for
many hours a day.
( c.) Walking has powerful relaxing effects on the spasms that tend to build up around coccyx.
( d.) Strolling just doesn’t work.
4. Kegel exercises will help in strengthening the pelvic muscles, sphincter muscles.
5. Laser therapy laser therapy is known to be relieving the symptoms & pain.
6. Ultrasonic therapy US therapy will help reducing the tenderness over the tailbone region.
7. Long wave therapy will help reducing the tenderness over the tailbone region.
8. Other exercises such as abdominal strengthening and weightless squats will also help in relieving the symptoms.
9. Hamstring stretch during coccyx pain hamstring is the most commonly tight muscles & stretching it will relieve the symptoms.
10. Spinal extensions should be done.
11. Bridging exercised of spine / back will also relieve the symptoms.