The coccyx or tailbone has been getting a lot of notoriety these days more than likely because of our sedentary life which not only requires sitting on our seat bone BUT also dealing with the consequence of sitting on posture and movement in general. Look at this blog as a book titled: Pelvic Floor Dysfunction with multiple chapters representing different symptoms associated with pelvic floor dysfunction and coccyx pain or coccydynia as one of those chapters.
Imagine a teepee/tent with the point at the top where the fabric or material making up the body of the teepee or tent is connected to. The coccyx is that point and while the joint between the coccyx and sacrum is not involved in the movement, the coccyx provides the point where certain ligaments are connected to. These ligaments are the anterior and posterior sacrococcygeal ligaments and the lateral sacrococcygeal ligaments, some fibers of sacrospinous and sacrotuberous ligaments that are attached to the ischium and ischial tuberosity also attach to the coccyx.
The coccyx supports the position of the anus therefore defecation and continence while providing the support for gluteus maximus which is involved in walking. It is more commonly painful in women but men can have them as well.
Pelvis ligament courtesy of drlaurenkeller.com
What Causes Coccyx Pain?
Other than trauma to the coccyx such as falling down on it, pain in the coccyx can be as a result of referred pain from trigger points in the Gluteus Medius, Gluteus Minimus, Longissimus, Multifidi, Obturator Internus, Coccygeous, and Levator ani. These are all muscles of your lower back, sacroiliac, and pelvic area. Trigger points are lactic acid build-up that is formed when the muscle is voluntarily or involuntarily overused. Postural decline is a great example of involuntary over-engagement of muscles, leading to pain shooting to areas that are not necessarily within the muscle in question.
Referred pain from the sacroiliac joint can involve the coccyx so it is easy to look at the coccyx and miss this common cause. Lifestyle plays a role as well; for instance, sitting too long and too many days causes coccyx pain. Therefore, assessing your work environment is an important factor to consider, and let’s not forget that you are entitled to have more than one reason behind your coccyx pain.
Disc herniation can cause pain in the coccyx area, but touching the coccyx itself does not necessarily cause pain (this is a good differentiating sign). Pudendal nerve entrapment may also cause pain in the coccyx, therefore coccyx pain can be caused as a result of joint, muscle, nerve, or disc issues in the areas surrounding the coccyx.
Tarlov cyst is a rare condition where a fluid-filled cyst is formed on the nerve root in the sacral area. The cause of the cyst is not known but it may be associated with falls, epidural injections, and trauma to the area.
Is it Okay to Remove the Coccyx if it Does Not Have Any Function?
That is the question I have been asked many times and I remind everyone that the paragraphs above show how the coccyx plays a big role in the stability of the pelvic girdle which includes but is not limited to the pelvic floor only. Removing the coccyx with the hopes that the problem will go away is simply a fantasy that you should not entertain. The only time I see it justified is in case of something that is life-threatening. Imagine if the cause of your coccyx pain is the dysfunctional sacroiliac joint! How is the removal of the coccyx going to fix the problem?
What is the Treatment for Coccyx Pain?
The first thing that has to happen is to find out the cause of the coccyx pain to rule out conservative vs surgical treatment. The conservative approach should involve postural neurology and developmental kinesiology.
Generally speaking, unless there is a direct insult to the coccyx which will require time to heal, all other musculoskeletal causes of coccyx pain involve the brain and the muscles, so by determining what parts of the brain, with regards to the movement are weak, and what parts of the body in the movement are dysfunctional, we can ‘exercise’ the weak parts to get stronger. This does not involve lifting weights or bands but holding poses that when done correctly will require the weak muscles to get stronger and the tight muscles to get stretched. If this seems to be too good to be true, let me explain!
Your brain controls all functions of your body including your movement; in fact, you are born with the blueprint of movement called homunculus which gets ‘detailed’ the first 2 years of your life. This is the reason why all babies around the world go through the same stages of development in movement. We are all hard-wired to move a specific way and we do that automatically as babies.
If we apply those principles to the dysfunctional movement patterns, we can correct the issue. When it comes to the muscles and ligaments attached to the coccyx that directly or indirectly cause pain in the coccyx, by applying principles of developmental kinesiology, we can make the corrections.
An important factor to consider when it comes to coccyx pain with musculoskeletal contribution is biological breathing. We clearly all breathe but almost everyone breathes dysfunctionally. That is because we tend to live our lives mostly behind computers or in a seated position which means slouched posture. With slouched posture comes a compressed abdomen and excess inter-abdominal pressure. This means we are essentially sitting on our internal organs which press down on the pelvic floor muscles which are in-part are connected to the coccyx. According to the design of our body, we are to breathe with both the abdominal diaphragm and pelvic diaphragm working in synch. allowing the internal organs to rhythmically move up and down between the two diaphragms. This is explained in the video below:
In some instances, internal manual examination of the coccyx through the anus may be warranted. This can be done by a chiropractor or a physical therapist trained in pelvic floor dysfunction. This truly works only if the postural improvement using Postural Neurology, Developmental Kinesiology, and Biological breathing are applied.
If you need help finding out the cause and treat your coccyx pain contact my office.