Featured Body Part: Coccyx

Commonly referred to as the tailbone, the coccyx is not actually a bone, but three to five bones fused together at the bottom of the spine. The tailbone serves little use apart from acting as the point to which several muscles attach. Even though the coccyx doesn’t have much of a purpose, an injury to the tailbone can be painful, causing inflammation and making it difficult to sit without pain. Interestingly, women are more susceptible to a tailbone injury than men because a woman’s pelvis is wider, exposing the tailbone more.

Common Causes

  • Coccydynia – Often caused by direct trauma, coccydynia leads to inflammation surrounding the tailbone, contributing to pain and discomfort. The pain generally occurs while sitting, but it can be intensified when sitting on hard surfaces or for a prolonged period of time.
  • Idiopathic Coccydynia – Like coccydynia, idiopathic coccydynia is also inflammation surrounding the tailbone, contributing to pain and discomfort; however, idiopathic coccydynia pain begins with no identifiable origin.
  • Chordoma – A rare type of cancer that manifests in the base of the skull and the spine, including the tailbone. It is diagnosed in just one in one million people per year and fewer than one in 100,000 people are living with chordoma at any given time.
  • Pilonidal Cyst – Almost always located near the coccyx at top cleft of the buttocks, a pilonidal cyst is an abnormal pocket in the skin containing hair and skin debris. The cyst can be drained or surgically removed.

Common Conditions

  • Injury – A direct blow to the tailbone or falling onto the tailbone in a seated position (usually on a hard surface) are the most common causes of injury.
  • Childbirth – While uncommon, the tailbone can be bruised, dislocated or even fractured by the pressure of the baby passing through the birth canal.
  • Repetitive Strain/Overuse – Athletes doing a sport such as cycling or rowing can injure their coccyx due to the repetitive straining and/or friction against the tailbone.
  • Muscle Spasm or Tightness – The pelvic floor, gluteus maximus, prirformis or adductor magnus muscles can cause tailbone pain. This cause of pain is distinguished from other causes because the pain eases, rather than intensifies, while sitting.

Prevention Tips
Some tips to help prevent tailbone injuries and pain include:

  • Avoid Slouching – Be sure to sit or stand tall, keeping your head, back and pelvis in ‘neutral.’ Slouching, especially while sitting, will put tension onto the coccyx and its attaching muscles which may lead to improper alignment and resultant pain.
  • Stay Flexible – Stretching the muscles around your hips and pelvis can help keep them in their optimal length, which will help with keeping your coccyx (tailbone) mobile.
  • Be Balanced – Maintain equal weight in your legs with standing or sit bones when sitting. Avoid crossing your legs or feet frequently to prevent abnormal pulling of muscles attached to your pelvis and coccyx.
  • Stay Hydrated – Adequate water intake is vital in prevention of constipation. Frequent pushing or straining with a bowel movement may lead to pain and other issues in the muscles around the rectum and coccyx.

Rehabilitation
If you are experiencing symptoms of coccyx pain, physical therapy can help. Some treatment options include:

  • Core Strengthening – Strengthening your pelvic floor, gluteal, abdominal and back muscles will assist in maintaining ideal pelvic and coccyx positioning throughout your day. With exercising, be sure to not overtrain those muscles that may already be tight or overactive. Think ‘length before strength.’
  • Pelvic ‘Drops’ – Pay attention to the muscles around your rectum, as they are in close proximity to your coccyx. Periodically check during the day if you are tensing these muscles by slowly relaxing around your rectum as if you are gently passing gas.
  • Active Range of Motion – Work on keeping your spine and pelvis mobile through movement exercises (i.e., tailwags, pelvic circles, etc.) that target lengthening of tight muscles and joints.
  • Check Your Chair – Be sure your chair has adequate pelvic and lumbar support. Avoid sitting on harder surfaces if experiencing pain, and consider using a seat cushion designed to take pressure off of the coccyx.

When weighing your treatment options for coccyx pain, consider physical therapy. Physical therapy offers a wide variety of treatment options including strengthening, stretching, and sustainable home exercise programs.

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