Coccydynia is a term used for tailbone pain.
Pelvic Health physical therapists treat coccydynia with a conservative approach. The top complaints that physical therapists tend to hear are: patients cannot sit especially when reclining their trunk backward, had a baby and their tailbone broke, fell on their tailbone and cannot sit, bent down to pick up something and an edge of a table or another object hit the coccyx. When these situations occur, the majority of the time it causes instability. Pelvic Health physical therapists can get the patient back to sitting without pain. Clinically, on average it takes about 1-4 months of having a multi-faceted approach with a physical therapist and pain management to get back to sitting without pain.
For background on pelvic health: there are three layers of the pelvic floor in females and two in males. The pelvic floor’s function is to support, stabilize, assist breath, contract/relax, and use for sexual function. Pelvic Health PTs can assess the muscles externally and/or internally.
The sacrococcygeal joint can flex and extend by 30-50 degrees. The coccyx has 3-5 segments. If the tailbone becomes too flexed, then it can impede the bowels and cause issues with sitting. This can also cause increased dural tension which can lead to inflammation and pain. On average, the tailbone sits at 20 degrees of flexion at rest. In men, the coccyx angle is longer and more flexed. Typically, the coccyx can be mobilized externally and internally. If a patient is uncomfortable with an internal rectal exam, then we can mobilize the muscles/coccyx externally. It can be sensitive to the touch. The tailbone can move 6 different ways: it rotates right and left, laterally deviates to the right and left, and flexes and extends.
Muscle Actions: Coccygeus muscle: flexes and stabilizes the coccyx, helps levator ani muscles and is the most direct direction connect to the coccyx Iliococcygeus muscle (Levator ani): lifts the pelvic floor when contracting Pubococcygeus muscle: (Levator ani): lifts the pelvic floor and gives support to organs
Pelvic Health physical therapists specialize in the nerves, muscles, joints, and ligaments of the entire body. We are therefore trained to perform visceral mobilization to help improve gut health and relax the nervous system. In treating coccydynia, it’s important to treat the pubococcygeus, iliococcygeus, coccygeus, glut max, and sacrospinous ligament because of the direct correlations to the coccyx. Below are ways to help coccydynia non surgically which still remain to be the gold standard when it comes to tailbone pain.
- Lean forward when sitting
- Use “Cushion Your Assets” seat cushion
- Pull butt cheeks apart in sidelying
- Perform hip opener yoga stretches
- Dry needle the pelvic floor
- Hot baths/ heat pad
- Valium/Baclofen or Diazepam suppositories
- CBD suppositories for pain
- Internal wand to help lengthen and focus on the pubococcygeus, iliococcygeus, and coccygeus muscles
- Standing desk
- Nerve blocks of ganglion impar
For anyone treating coccydynia, I would advise looking up and down the chain at the surrounding joints and tissues such as the SI joint, Hips, abdominals, superficial vaginal tissue, low back, and the cervical and thoracic spine. Everything is connected by the fascia.
Be empowered in education,
OrthoPelvic Physical Therapy
Photo by Otto Norin on Unsplash