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The Gist: What is coccydynia, or tailbone pain?

Also known as: tailbone pain

Coccydynia typically presents as pinpoint pain at the tailbone that is intense, dull, and achy in nature. Sitting, particularly on hard surfaces, is difficult or impossible due to pain. Standing up after sitting, standing for prolonged periods of time, intercourse, and taking bowel movements are often very painful as well.

The anatomy of Coccydynia

The coccyx is the small triangular bone at the very bottom of your spine also known as your tailbone. It articulates with your sacrum at the sacrococcygeal symphysis and is made up of 3-5 coccygeal vertebrae that are essentially fused today.

Coccydynia occurs when there is increased pressure on or trauma to the coccyx and/or the surrounding muscles and ligaments.

Who gets Coccydynia? When does it occur for women?

Coccydynia can present during pregnancy, delivery, postpartum, or at a different point unrelated to pregnancy at all. During pregnancy, the hormones that affect joint laxity will also affect the sacrococcygeal symphysis. The combination of a less stable tailbone and the increased body mass during pregnancy puts more load through the tailbone, particularly with sitting, leading to pain and inflammation in the area. As a result, the muscles that are attached to the coccyx, including the pelvic floor, will tighten and further progress the symptoms.

The tailbone can also be injured during delivery. Most women deliver in the lithotomy position (on your back with your knees pulled towards your chest), which causes the tailbone to naturally flex under. During delivery, the baby can injure the tailbone on the way out.

Expectant and new moms are not the only ones who can experience tailbone pain. Because there are pelvic floor muscles that attach to the coccyx, other pelvic floor dysfunctions can cause coccydynia including chronic constipation and straining to defecate. Furthermore, trauma to the tailbone (like a fall) can lead to tightening of the surrounding muscle and subsequent pelvic floor conditions like dyspareunia and rectal pain.

The Origin Way: Physical therapy for Coccydynia

We treat coccydynia from the inside out. We assess the pelvic floor, the glutes, and the rest of the muscles of your pelvic girdle to find the root cause of pain. We also look at the way you sit, stand up, and walk. Through a combination of manual therapy, specific strengthening and lengthening exercises, and changes to the way you move, we treat coccydynia comprehensively. Your Physical Therapist may also recommend a pillow to sit on while your tailbone heals.

How long does it take?

Tailbone pain can take weeks to months to heal, but physical therapy will make it heal faster. Early intervention is key! If you have trauma to your tailbone either from childbirth or a fall, see a physical therapist soon so that subsequent pelvic floor issues do not develop

What to expect in the future

Maintaining long term symptom resolution often requires you to keep up with your exercises in some capacity and avoiding situations that may flare it up, like sitting on a wood bench for hours. However, long term success is possible and you will have all the tools and knowledge necessary to maintain it.

Additional Reading and Sources

Lirette, Lesley Smallwood, et al. "Coccydynia: an Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain." The Ochsner Journal, The Academic Division of Ochsner Clinic Foundation, 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3963058/

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