Coccydinia

Written by: Physiotherapist Jordan Coffey.

Tailbone pain, otherwise known as coccydinia, occurs in or around the bony structure at the bottom of the spine called the coccyx. The name coccyx derives from the Greek word “Cuckoo” due to its resemblance of a bird’s beak. Coccydinia is a symptom rather than a diagnosis. The coccyx is a triangular bone that resembles a short tail at the base of the spine. It is believed that pain in this region can by caused by local pressure over a prominent coccyx, inflammation of the ligaments that attach to the coccyx, referred pain from the lumbosacral spine secondary to disc prolapse, psychological aspects of pain, trauma to the coccyx, prolonged sitting on a narrow or hard surface, degenerative joint changes, or vaginal childbirth (2). Coccydynia constitutes less than 1% of all non-traumatic complaints of the spine. Apart from direct injuries to the coccyx, the mechanism behind coccydinia is not well understood.

Possible contributing factors to tailbone pain:

1. COCCYX SHAPE

• People’s coccyx curvature may vary. Those with a sharp-forward coccyx angle and a more dramatic forward curvature are more likely to experience pain within the tailbone.

2. OBESITY

• A body mass index (BMI) of 27.4 in females and 29.4 in males increases the risk of having coccydinia.

TRAUMA

• You can experience coccydinia after a hard impact to the base of your spine. The tailbone will only be bruised in benign cases, but may be fractured or dislocated in severe cases.

REPETITIVE STRAIN

• Repetitive strain to the coccyx may be due to continually leaning forwards and stretching the base of the spine, in sports such as rowing or cycling. If done frequently, this can strain and stretch the muscles and ligaments surrounding the coccyx. If this happens, your muscles may no longer be able to maintain the correct resting position of the coccyx, resulting in discomfort and pain.

CHILDBIRTH

• The coccyx becomes more flexible during the third trimester of pregnancy to prepare the body for childbirth. Sometimes childbirth can cause the ligaments and muscles surrounding your coccyx and sacrum to overstretch, which results in coccydynia.

POOR POSTURE

• Sitting in an awkward position while working, driving, or at school for a prolonged period of time can put too much pressure through the coccyx.

INCREASED THORACIC CURVATURE (KYPHOSIS) AND STIFFNESS

• This may lead to increased and abnormal load through the sacrum and coccyx.

SPASM OF LOCAL MUSCLES  

• Coccydinia may result from spasm of the local levator ani muscle (Thiele 1963), which is responsible for supporting and raising the pelvic visceral structures. This muscle helps with proper sexual function, defecation, urination, and allowing various structures to pass through. This muscle is composed of three parts: puborectalis. Pubococcygeus, and the iliococcygeus muscles.

Nonsurgical management remains the gold standard treatment for tailbone pain. Treatment and self-management strategies for treating coccydynia include:

• a specially designed coccyx cushion, which helps to reduce the pressure and load through the tailbone
• Standing up and walking around regularly and avoiding prolonged sitting whenever possible to reduce excess load through the tailbone
• Wearing loose-fitting clothes; tight-fitting clothing that may put pressure on your tailbone should be avoided
• Non-steroidal anti-inflammatories are often recommended to help ease pain and reduce inflammation
• Physiotherapy can help to improve posture, correct movement patterns, incorporate exercises and stretches to help strengthen and relax the muscles surrounding the tailbone, and massage techniques to reduce pain
• Corticosteroid injections
• Manipulation
• Stretching the piriformis and iliopsoas muscle
• Pelvic floor strengthening in treating post-partum coccydinia
• Coccygectomy, or removal of the tailbone, in severe cases when conservative management is unsuccessful

ROLE OF STRETCHING THE PIRIFORMIS AND ILIOPSOAS:

The Piriformis muscle laterally rotates the femur with hip extension and abducts the femur with hip flexion. This muscles anteriorly tilts and rotates the sacrum to the opposing side. Sacral rotation is one of the primary causes of coccydinia, which may be due to tightness of the Piriformis. (Issac and Bookhout, 2006) Iliopsoas is the strongest of the hip flexor muscle group and also rotates the thigh laterally. This muscle is dominated by slow twitch red type-1 fibre, so it is susceptible to shortening, especially in the elderly population and those who live a sedentary lifestyle. Shortening leads to an increased anterior pelvic tilt and lumbar lordosis. Tightness of both of these muscles may lead to abnormal loads on the sacrum and coccyx.

Book a Physiotherapy appointment @ Dunsborough Book a Physiotherapy appointment @ Nannup Get the '4Lane Physio' App - iPhone 

Sources:

1. Wray, C. C., Easom, S., & Hoskinson, J. (1991, March). Coccydynia: Aetiology and Treatment. The Journal of Bone and Joint Surgery, 37-B(2), 335-338. (1)
2. Coccydynia (tailbone pain) (2019, July). In NHS. Retrieved from https://www.nhs.uk/conditions/tailbone-pain-coccydynia/causes/. (2)
3. Mohanty, P., & Pattnaik, M. (2017). Effect of Stretching of Piriformis and Iliopsoas in Coccydinia. Journal of Bodywork and Movement Therapies, 21, 743-746. (3)