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“Sit Happens: Conquering Coccyx Pain with the Power of Physical Therapy” 

March 19, 2024 /

This blog was written by our wonderful Stockton physical therapy, Cassidy Hogan. SPT.

Welcome to a blog about pains in the butt, well, coccyx pain. Many people know the coccyx by the name “tailbone”. Coccyx pain, also known as coccydynia, is more than just a passing discomfort, it’s an unwelcome companion that disrupts the ebb and flow of everyday activities. From the seemingly simple act of sitting, to the complex dance of standing and moving around, each moment becomes a strategic negotiation with pain. Tasks that once seemed so simple like working at a desk, exercising, going to the bathroom, having sex, or lounging comfortably all transform into daily challenges. The persistent ache serves as a constant reminder, casting a shadow over the once-effortless activities of life. Have you ever cringed at the thought of sitting through a movie marathon or a long car ride? Well, you’re not alone. Up to 20% of people experience coccyx pain throughout their lives. Stay tuned as we unravel the challenges of coccydynia, and how you can seek solace and solutions. 

So what is it about this little bone that can be so uncomfortable? The coccyx is a tiny, curved, triangular-shaped bone at the very end of your spinal column below the sacrum. It is made up of 3-5 smaller bones fused together and creates the very end of the spinal column. The coccyx has several important jobs such as: bearing our body weight through the pelvis in sitting and moving positions, maintaining proper posture, and serving as an attachment site for many ligaments, tendons, and muscles in the area. It also plays a large role in supporting the body when we sit and with other activities such as standing and walking. Because so many other structures attach to the coccyx, it greatly contributes to the stability of the pelvis and the spine. As you can see, something so small can be so mighty! Many people experience coccydynia in their lifetime due to injuries, falls, pregnancies or childbirths, being over or underweight, sitting for a long time, and weak and/or tight muscles and ligaments. Coccydynia can feel tender, achy, or sharp and can be pinpointed right to the coccyx or refer to other areas like our pelvis or lower back. 

The journey through coccyx pain begins with uncovering its origins and being able to address the cause to reduce the cascade of consequences resulting from the pain. When discomfort lingers in this region, the first step towards relief is a precise diagnosis, a task that often requires the expertise of healthcare professionals, particularly those well-versed in the language of coccyx pain. To uncover the underlying nuisance of coccyx pain, healthcare professionals put on their detective caps to become investigators. They thoroughly explore their patient’s medical history, examining the history of falls, childbirth, and lifestyle habits. This narrative, combined with a thorough physical examination, forms the initial clues in unraveling the complexity of coccydynia and pinpointing the root cause. While the history and physical examination offer valuable insights, the quest for a precise diagnosis may also involve imaging studies. X-rays and other diagnostic tools become the magnifying glass to reveal any fractures, dislocations, or structural abnormalities that might be concealed beneath the surface. These images serve as the roadmap, guiding healthcare professionals to the heart of the matter. 

Now, we have our physical therapist, a seasoned detective in the realm of many musculoskeletal abnormalities. Specializing in detecting and understanding pain and dysfunction, physical therapists use their expertise to assess how the pelvis, spine, and surrounding structures move in our bodies. Through palpation, range of motion tests, and other diagnostic techniques, they can put the pieces of the puzzle together and come up with some comforting solutions. At Practically Perfect Physical Therapy, there are amazing pelvic floor physical therapists with years of experience who have the capabilities to assess coccydynia thoroughly through an orthopedic examination, including the muscles and structures of the pelvic floor. Combining a comprehensive understanding of a patient’s story with insights from imaging studies as well as physical examinations and assessments, healthcare professionals can offer a diagnosis. This diagnosis becomes the foundation for effective treatment strategies, paving the way for a targeted approach to coccyx pain management. This diagnosis allows healthcare providers, including physical therapists, to create a tailored plan that manages coccyx pain and brings back the ease of daily activities once taken for granted. 

Physical therapists are able to implement various treatment strategies to alleviate coccydynia, restore function, and specifically tailor & adapt treatment sessions according to patient tolerance. It is not a one-size-fits-all, cookie-cutter type of treatment: each patient is unique. Joint mobilizations of the lower back, sacrum, and coccyx as well as soft tissue mobilizations to the surrounding soft tissues (muscles, tendons, ligaments, fascia) are beneficial in reducing pain and increasing range of motion. Freeing up any tension that is putting stress on the coccyx can provide tremendous pain relief. Physical therapists can utilize many techniques to access these areas and mobilize or relax them including manual techniques on the outside of the body as well as internally through the vaginal and rectal openings to access those pelvic floor muscles. Sometimes the muscles of our pelvic floor become tight, cranky, and irritated and may require some manual relaxation techniques, just like tight neck or back muscles people so often experience. Once these regions can relax and become more mobile with the help of physical therapy, we will notice decreased pain levels and can begin to hone in on postural exercises, breathing, stretching, and strengthening in combination with skilled manual therapy performed by a physical therapist. 

Strengthening the muscles surrounding the coccyx helps to reduce pain by stabilizing the area and reduces undue pressures on the coccyx that lead to symptoms of pain and discomfort. Our pelvic floor muscles work together with the muscles of our core and lower extremities to support our internal organs, to regulate bowel, bladder, and sexual functions, and support for many other daily functional tasks. Physical therapists can provide patients with exercises that strengthen and/or relax muscles surrounding the coccyx and related structures at the proper times. They are able to teach patients when we should be strengthening versus relaxing muscles and coordinate the timing of each to maintain proper alignment, function and decrease pain. Each patient is unique and their symptoms will change with time. Physical therapists are there to adapt and modify according to how patients are feeling and can provide patients with pain relief, motion, strength, and the tools to maintain their progress through exercises, stretches, and utilization of helpful equipment properly at home. There are many beneficial pieces of equipment a patient can use at home themselves in conjunction with learned exercises and stretches to carry on their progress. 

Posture, often a silent culprit, plays a significant role in coccydynia. Activities impacting posture, like sitting for long hours or bending over frequently, can create a chain reaction of changes in the body. Sitting at a desk for a long day at the office, leaning over to get a closer look at a client’s nails, bending over to see your students’ work at their desk: the possibilities of daily activities that impact our posture are endless. While pain may stem from the coccyx or other areas, addressing overall body posture proves key. This cascade of changes from pain and abnormal postures can result in our body moving differently in attempts consistently trying to avoid the pain. Mindful sitting, standing, walking, and transitioning between movements can make a significant impact on managing coccydynia. Some common ergonomic adjustments physical therapists often employ include proper erect sitting posture, wedge cushions for sitting, or donut-shaped cushions to reduce pain and discomfort. 

As we conclude this exploration of coccyx pain, I hope the various interventions and strategies we have explored can offer some relief and reassurance as you navigate what will best address your body and lifestyle. Although coccydynia is an annoying, uninvited guest disrupting everyday life, being armed with understanding and the expertise of healthcare professionals, particularly physical therapists, can uncover pathways to comfort and relief. The coccyx, though small in size, holds such a significant influence over our well-being. Its role in supporting the body during various activities is nothing short of mighty. Yet, injuries, falls, pregnancies, and other factors can turn this structure into a source of persistent discomfort. The diagnostic journey, led by healthcare professionals, involves unraveling the complexities of coccydynia. Patient narratives, physical examinations, and imaging studies serve to provide answers, guiding us to the heart of the matter. The physical therapist, a skilled detective in the realm of musculoskeletal complexities, takes on the role of crafting unique, tailored plans that manage pain and restore function.

Physical therapy emerges as a symbol of hope, offering a variety of strategies to alleviate coccyx pain. From targeted pain relief and posture correction to personalized exercises and lifestyle adjustments, the approach is holistic and patient-centered. The journey towards comfort is dynamic, with therapists adapting and modifying strategies as needed. So, as we conclude this chapter, remember that coccyx pain may feel like it is taking over, but with the right guidance, it doesn’t have to define the narrative. Armed with knowledge and the support of healthcare professionals, the path to reclaiming comfort becomes easier. Here’s to a future filled with comfort, mobility, and the resilience to face each day, coccydynia-free.

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