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Almost everyone has experienced falling directly on their coccyx or “tailbone” and the surprisingly intense pain that can follow. But very few people understand the role of the coccyx and why it can be involved in several different types of pain and pelvic floor dysfunction. So let’s talk about the anatomy of the coccyx, why it can be a source of pain, and what can be done to alleviate coccyx pain.

Anatomy of the Coccyx

The coccyx is a small bone located at the very bottom of the spine. It is formed by 3-5 vertebrae and attaches directly to the sacrum.

While the coccyx is small, it serves a very important role as an attachment point and passage for many different muscles and ligaments in the pelvic spine illustration

anatomy

Since all these nerves and soft tissues are located in such a small space, injury or pain in any one component will affect how the rest of the structures function….and the pain they perceive!

Over time, if left unaddressed, tailbone pain can intensify and create dysfunction or compensation in the surrounding tissue.

Who Suffers from Coccyx Pain?

Women are 5 times more likely to experience coccyx pain than men, though men do have risk factors that can increase their chances of developing coccyx pain. A portion of the increased rate of coccyx pain in females can be attributed to childbirth. Other risk factors for both males and females are being overweight or underweight, having a job or participating in an activity that requires you to sit for long periods of time, or participating in athletic events like bicycling or rowing.

Why Does the Coccyx Hurt?

Trauma is the most common cause of injury, and trauma to the coccyx is typically categorized as “internal” or “external”. The most common causes of internal trauma are childbirth and degenerative joint changes. External trauma usually involves a force being applied to the coccyx, either repetitively over time, or with a single significant impact. Some examples include falling onto the tailbone, getting hit in the buttock, or participating in long-distance biking or rowing activities with prolonged and repeated pressure on the coccyx. When pain is specific to the coccyx or the surrounding region, it is called “coccydynia”.

skateboard fall

Descriptors for coccyx pain can vary depending on the individual and how the injury occurred. Some people will describe their pain as being dull or aching. This is typically more constant and does not vary significantly with activity. Others will describe their pain as sharp and piercing, changing based on position or movement. In either case, this pain can (and usually does) significantly impact daily life. Seated activities, changing positions from sitting<->standing, walking longer distances, defecation, and intercourse are just some of the daily activities and tasks that coccyx pain can impact. For some women, menstruation can also increase coccyx pain.

How Is Coccyx Pain Treated?

Fortunately, there are many different strategies you can use on your own at home to help alleviate coccyx pain.

  1. If the injury is acute (within the last week or so), try using ice! This can help reduce inflammation and pain immediately after the injury has occurred.
  2. Use cushions, pillows, and/or towels to reduce or prevent pressure on the coccyx. Purchasing a donut cushion or arranging two rolled towels under each “sit bone” can prevent pain because these can prevent pressure or contact with the coccyx while sitting.Sitting illustration
  3. Change your posture while sitting or reduce the amount of time you spend sitting. Changing the alignment of your pelvis can help prevent pressure from being placed on the coccyx.  Tilting your pelvis backward will typically put additional pressure on the coccyx while rotating the pelvis forward can provide some (temporary) relief. Additionally, lying on your, standing up at more regular intervals, or walking intermittently may help prevent pain.
  4. Work on regulating your bowel movements. As noted above, some of the deep pelvic floor muscles attach to the coccyx. These same muscles also help to support the rectum and any stool waiting to be voided. As a result, a full rectum means increased tension in pelvic floor muscles and on the coccyx, which can cause additional coccyx pain. Regular bowel movements will prevent pain by decreasing muscle tension in the pelvic floor and on the coccyx.
What Can a Pelvic Health Physical Therapist Do to Help with Coccyx Pain?

While those simple tips may be helpful for reducing pain, they may not be sufficient for completely eliminating coccyx pain in some cases. Pelvic health physical therapists (PHPT) are an excellent resource for eliminating coccyx pain because they can assess the position and mobility of the coccyx and the surrounding soft tissue (muscles, ligaments, nerves). An assessment can be performed externally or internally (either through the vagina or rectum) depending on what you and your therapist are most comfortable with. Once an assessment of the soft tissue and coccyx position has been determined, your PHPT can perform techniques that will relieve tension on muscles and nerves to help ease the coccyx into a different position or perform a gentle coccyx manipulation to realign the coccyx. Your PHPT can also provide stretches and exercises, to help maintain the decreased tension surrounding the coccyx to prevent a recurrence of pain due to poor positioning or alignment.

child pose yoga

If you or someone you know is suffering from coccyx or “tailbone” pain, please reach out via our contact form below to schedule an assessment with one of our pelvic health physical therapists!