Tailbone (Coccyx) Pain

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Written By Dr. Marcus Yu Bin Pai

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

What Causes Coccyx Pain?

The coccyx is formed by 3 to 5 vertebrae grouped in the final portion of the vertebral spine as a single piece. Thus, pain in the coccyx, also called coccydynia, refers to the painful condition of that region.

Understanding the Coccyx

The coccyx, or tailbone, is located at the very end of the spine and curls underneath our body. It has muscles attached to it, such as the gluteal muscles and the pelvic floor muscles.

These muscles can move the coccyx backward and forward, and when these muscles are tense or in spasm, they can cause pain in the coccyx region.

Causes of Tailbone Pain

Prolonged sitting, particularly in improper positions, can cause pain in the tailbone area. For instance, sitting with legs stretched out or slouched can lead to discomfort. These postures result in static muscle contractions and direct pressure on the trigger points of the gluteus maximus, both of which can exacerbate pain.

It is an increasingly common problem given the time we spend sitting in modern life. Its leading causes are:

Coccyx instability: when there is pressure overload on the coccyx for long periods, the coccygeal vertebrae lose their unity and usual conformation, generating chronic inflammation. The primary example, in this case, is patients who remain seated for long periods in inappropriate positions.

Coccyx Fractures: The coccyx can be fractured, especially after falling on it. Eventually, the bone consolidation process does not occur properly, causing chronic pain.

Cases of coccygeal spurs, coccygeal arthritis, infections, or even tumors are the minority of cases.

When to See a Doctor

While most cases of coccydynia resolve on their own within 2-3 months, it’s important to consult a medical professional if you experience severe pain that interferes with daily activities, such as sitting for extended periods, bowel movements, or sexual intercourse.

A rectal examination may be necessary to determine if the coccyx is the source of the pain and assess its mobility.

How is coccyx pain diagnosed?

The primary way to diagnose coccydynia is through proper medical evaluation after clinical history and detailed physical examination. Thus, imaging tests are complementary tools for diagnosing coccydynia subtypes and therapeutic planning.

In order to assess the stability of the coccyx, dynamic radiography of the coccyx is requested in the sitting and standing position. On the other hand, computed tomography or magnetic resonance imaging of the coccyx is usually required for the evaluation of inflammatory conditions and fractures.

Diagnosing coccydynia (tailbone pain) involves a few steps:

  1. Identifying the cause of pain: A thorough patient history is essential to understand the onset, duration, and possible causes of the pain. Common causes include trauma from a fall, childbirth, extended periods of sitting on a hard surface, or rapid weight loss.
  2. Physical examination: A rectal examination is performed by a medical professional to assess the coccyx. The examiner will hold the coccyx between their thumb and index finger and move it back and forth. If this movement causes pain, it indicates that the source of the pain comes from the coccyx. The examination also helps determine if the coccyx is hypermobile (too much movement) or hypomobile (too little movement).
  3. Imaging: If the rectal examination indicates that the pain is coming from the coccyx, a dynamic x-ray with the patient standing and sitting may be ordered. This helps assess the coccyx’s movement and detect any dislocations or abnormal movement. However, imaging is not necessary if the pain is improving and there are no other symptoms, such as bowel or bladder incontinence, numbness, or tingling in the perineal area.

What is the treatment of coccydynia?

The main treatment in cases of coccyx pain is behavioral change. Thus, it is essential that patients feel properly and avoid staying in this position for long periods. In addition, the use of orthopedic pillows removes excess pressure on the coccyx and is an important therapeutic option.

The use of medications (anti-inflammatories and analgesics) and physical therapy to rehabilitate the pelvic floor muscles complement clinical treatment strategies. For severe and refractory cases, performing infiltrations and even surgical removal of the coccyx (coccygectomy) is possible.

Pharmacological Treatment

Pharmacological treatment options for coccydynia (tailbone pain) can be grouped into two categories:

  1. Over-the-counter (OTC) medications: These are drugs that can be obtained without a prescription and are used to manage pain and inflammation. The main OTC medications recommended for coccydynia are non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. They help reduce inflammation around the coccyx and provide pain relief. It’s important to follow the recommended dosage and consult a healthcare professional if pain persists.
  2. Prescription medications: If OTC medications are not effective in managing the pain, a healthcare provider may prescribe stronger pain relievers. Examples include muscle relaxants to reduce muscle spasms, opioids for severe pain, or antidepressants and anticonvulsants to manage chronic pain. It’s crucial to take these medications as directed by the healthcare provider and discuss any side effects or concerns.

The ideal treatment must be individualized and defined after a careful medical evaluation. Consult a spine specialist.

It’s important to remember that pharmacological treatments for coccydynia should be combined with non-pharmacological approaches, such as physical therapy, ergonomic adjustments, and use of a cushion when sitting, to achieve the best results in managing tailbone pain.

Preventing and Managing Tailbone Pain

  1. Fix your sitting habits:
    • Adjust your lumbar support to the correct height (belt level).
    • Use an anti-slip mat if your chair is slippery.
    • Keep your feet flat on the floor with heels under your knees.
    • Avoid sitting with shoulder blades on the backrest to prevent sliding.
    • Take breaks and stand up every 20-30 minutes.
  2. Perform targeted exercises:
    • Upper Body Reset: Incorporate this exercise into your daily routine (10-15 times per day) to help stretch and relax the lower back muscles. Focus on the bending and turning portions of the exercise to target the multifidi muscles.
    • Modified Cat-Cow/Happy Dog: Perform this mobilization exercise 3-5 times a day, emphasizing lower back movement. This exercise can help relieve tension in the lumbar spine.
    • Safe Stretching: Safely stretch your multifidi and gluteus maximus muscles by lying on your back and holding your knees toward your chest. Hold for 1-2 minutes before switching to the gluteus maximus stretch by bringing one knee toward the opposite shoulder. For a more intense stretch, lean on your side and explore different angles to target the gluteus maximus more effectively.

Stretches and Exercises for Coccyx Pain Relief

Here are four stretches and one exercise designed to relax the muscles around the coccyx bone:

  1. Piriformis Stretch
  • Lie on your back and cross your left leg over your right knee.
  • Bring your knees toward your chest, holding onto the back of your thigh or the front of your shin.
  • Feel the stretch in the middle of your left buttock.
  • Repeat on the opposite side.
  1. Glute Stretch
  • Lie on your back and bend your left knee, turning it outwards.
  • Bring your legs up and hold onto the back of your thigh or front of your shin.
  • Feel the stretch in the middle of your left buttock.
  • Repeat on the opposite side.
  1. Hamstring Stretch
  • Lie on your back with one leg bent and the other straight.
  • Hold onto the back of your thigh or use a towel to bring your leg up, keeping your toe pointed toward the ceiling.
  • Gently guide your leg toward your chest, keeping your lower back on the ground.
  • Feel the stretch through the hamstring, which is connected to the coccyx.
  • Repeat on the opposite side.
  1. Iliopsoas Stretch
  • Kneel in a lunge position, with your right leg forward and your left leg back.
  • Tilt your pelvis forward and down while raising your left arm above your head.
  • Lean slightly to the right, feeling a stretch across the front of your left hip.
  • Repeat on the opposite side.
  1. Pelvic Floor Relaxation
  • Lie down comfortably with your legs slightly apart, and place a pillow under your legs if desired.
  • Breathe deeply into your belly, allowing it to rise and fall.
  • Visualize the area between your sitting bones and think about letting down and out through the anus, as if passing gas.
  • Practice deep breathing and visualization to help relax the pelvic floor muscles, which can pull the coccyx forward.

Frequently asked questions about coccyx pain

What could be coccyx pain?

When the patient has pain in the final region of the spine, the coccyx may be responsible for the condition. The leading causes of pain in the coccyx are inflammation, instability, and sequelae of fractures or trauma to the coccygeal region. Cases of infection or tumors of the coccyx are rare.

What to do to relieve coccyx pain?

The main form of treatment and prevention of coccydynia (pain in the tailbone) is to take pressure off the tailbone. This can be done by sitting properly, avoiding sitting for long periods, especially on hard seats, and using special cushions. Individualized physiotherapy is also essential in the rehabilitation of complex cases. Infiltrations and Surgery are indicated in selected cases.

What is the best medicine for coccyx pain?

The most used drugs are anti-inflammatory drugs, steroids, muscle relaxants, and analgesics. If tailbone pain persists, chronic pain syndrome can develop and require specific treatments.

How to relieve coccyx pain in pregnancy?

During pregnancy, due to the action of pregnancy hormones, the ligaments become more flaccid, and the coccyx can evolve with greater instability. Thus, the chance of inflammation of the coccyx increases precisely in a period of weight gain and restriction of medications, such as anti-inflammatory drugs.

Therefore, strengthening the pelvic floor and postural care when sitting is essential. Certain types of topical pain relievers and anti-inflammatories may also be used.

Seeking medical attention for coccydynia is recommended if the pain interferes with daily activities such as sitting for extended periods, bowel movements, or sexual intercourse. In most cases, coccydynia resolves spontaneously without any medical intervention, and home treatments can be effective in managing the pain.

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

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