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The coccyx, or tailbone, is getting a lot of attention lately most likely due to our sedentary lifestyles. Prolonged sitting impacts our posture and movement, leading to issues such as coccyx pain, also known as coccydynia. Coccyx pain is one of the many presentations of pelvic floor dysfunction that we are going to explore here.

Picture a teepee or tent, with a peak where all the sides come together at the top. The coccyx serves a similar role in the body. Although the joint between the coccyx and sacrum isn’t involved in movement, the coccyx acts as an anchor point for important ligaments. These include the anterior and posterior sacrococcygeal ligaments, the lateral sacrococcygeal ligaments, and fibers of the sacrospinous and sacrotuberous ligaments, which connect to the ischium and ischial tuberosity. Take a look at the pic below to see the intricate network of ligaments that go and are around your coccyx. The coccyx plays a crucial role in supporting the position of the anus and helps with defecation and continence. Coccyx pain is more common in women, but men have coccyx too and I see plenty of men with the problem.

Pelvis ligament

Pelvis ligament courtesy of drlaurenkeller.com

What Causes Coccyx Pain?

Aside from direct trauma like falling on the coccyx, tailbone pain can result from referred pain due to trigger points in muscles such as the Gluteus Medius, Gluteus Minimus, Longissimus, Multifidi, Obturator Internus, Coccygeus, and Levator Ani. These muscles are located in the lower back, sacroiliac, and pelvic regions. Trigger points, which are lactic acid build-ups caused by muscle overuse, can develop from both voluntary and involuntary actions. Poor posture is a common cause of involuntary muscle over-engagement, that leads to pain which may radiate to areas beyond the affected muscle.

Referred pain from the sacroiliac joint can also affect the coccyx, making it easy to overlook this common cause. Lifestyle factor such as prolonged sitting, plays a big role in coccyx pain. Evaluating your work environment and daily habits are simple ways to look into what is ‘feeding’ your tailbone pain.

If there is pain in the tailbone area without the actual coccyx being painful, we want to rule out disc herniation.

Pudendal nerve entrapment is another potential cause which means that tailbone pain can stem from joint, muscle, nerve, or disc issues in surrounding areas.

A rare condition called Tarlov cyst involves a fluid-filled cyst on the nerve root in the sacral region. While the exact cause is unknown, it may be associated with falls, epidural injections, or trauma. Tarlov cyst is a common finding with connective tissue disorders such as Hypermobility Spectrum Disorder (HSD), and Ehlers Danlos Syndrome (EDS)

Is It Safe To Remove The Coccyx? Understanding The Function and Risks Of Coccyx Removal

I’ve been asked this question many times, and it’s important to remember that the coccyx plays a crucial role in the stability of the pelvic girdle, which includes more than just the pelvic floor. Removing the coccyx in hopes of solving the problem is unrealistic. Coccyx removal should only be considered in life-threatening situations. For instance, if your coccyx pain is due to a dysfunctional sacroiliac joint, removing the coccyx won’t address the underlying issue.

How Can You Treat Coccyx Pain?

The first step in addressing coccyx pain is to identify its cause to determine whether conservative or surgical treatment is appropriate. A conservative approach should incorporate Postural Neurology and Developmental Kinesiology to address the source of dysfunction in mobility and posture.

For most musculoskeletal causes of coccyx pain, unless there is direct trauma to the coccyx that needs time to heal, the issue often involves dysfunctional movement patterns. Let me give you an example: If movement was a concert, not only do the musicians need to know their instruments and parts but also they need to know when to chime in and when to phase out. Any glitch, from the brain, the ‘conductor’ reading its ‘notes’ to the musicians, the body parts, playing their parts will lead to a symphony that does not sound right.

If all babies on this planet start as helpless infants and become running toddlers without any weight, bands, gyms, Physical therapists, chiropractors, personal trainers, no guidance or coaching, and we all have gone through the same stages of development, doesn’t it make sense to say that we are hard-wired to move that way?

Then why don’t we use the knowledge we have from studying human babies to fix the problems that have to do with movement and stability? This is why I do Postural Neurology and Developmental Kinesiology as the core of treatment with Biological Breathing as the first step in the right direction.

Although we all breathe, most people do so dysfunctionally due to slouched posture from sitting, often behind computers. This posture compresses the abdomen and increases intra-abdominal pressure, effectively making us sit on our internal organs. These organs press down on the pelvic floor muscles, which are connected to the coccyx. Proper breathing involves the abdominal and pelvic diaphragms working in sync, allowing internal organs to move rhythmically. This process is explained in the video below:

If you need help finding out the cause and treating your coccyx pain, contact my office.

Dr. Shakib

Recommended Reading:

Male Pelvic Floor Dysfunction

The Top Pelvic Floor Exercises For A Healthy Core And Beyond