The coccyx – aka tailbone – is the bony segment at the very end of the spinal column, right below the sacrococcygeal joint, consisting of 3-5 segments. Coccydynia refers to pain in the coccygeal bone and/or its surrounding tissues. In most cases, tailbone pain has an acute onset due to traumatic injury, and most cases self-resolve over a matter of weeks. However, tailbone pain that lasts longer than two months is defined as chronic coccydynia, marked by a consistent nagging pain that makes sitting uncomfortable.
Learn about the causes of coccydynia, the populations most often affected by it, and advanced therapeutic approaches that successfully resolve chronic coccydynia.
Factors that Cause Tailbone Injury
Tailbone pain arises from the coccygeal plexus – a network of nerves that originates in the lower sacral spinal cord. The nerves carry sensory information and transmit pain signals from the tailbone area to the brain. Coccydynia occurs most often in females of all ages, although it may also arise in men. In most cases the condition is considered mild, and it typically self-resolves in a matter of weeks as the injured tissues heal.
Common causes of coccydynia include:
Obesity – Excess body weight puts pressure on the coccyx bone and its supporting ligaments and muscles. Obesity can cause changes in pelvic alignment, distributing body weight onto the coccyx when sitting. The extra pressure can cause instability in the sacrococcygeal joint, worsening symptoms.
Childbirth – Postpartum coccydynia often occurs due to the stress of labor and delivery. Childbirth can cause ligament strains, bruising, joint dislocation, and changes to the myofascia of the pelvic floor. Specialized postpartum physical therapy can help resolve childbirth-related coccydynia.
Rapid weight loss (often associated with gastric by-pass surgery) – Dramatic fat loss can reduce the natural cushioning provided in your tailbone region, causing it to rub against other structures, and making it uncomfortable to sit on hard surfaces. Weight loss can also change your pelvic alignment and sitting posture, and the muscles of your pelvic floor will need time to adapt to changes in weight distribution.
Tailbone injury from falling – Coccyx fractures are often caused by a backward fall, such as slipping on ice. The tailbone takes a traumatic blow as the full force of your body weight is absorbed by your coccyx.
Repetitive stress – Seated sports like cycling and rowing put extra pressure on your coccyx region, and can result in painful overuse injuries.
Sexual intercourse – Some people experience coccyx pain during intercourse when increased pelvic floor tension is combined with direct pressure on the tailbone, straining the ligaments that support the coccyx.
Previous surgery in the region – Surgery often leaves behind scar tissue and adhesions that can entrap nerves and blood vessels, causing pain in the coccygeal region.
Dysfunctional pelvic floor muscles – The pelvic floor muscles help to stabilize your tailbone and control coccyx movement. An overly tight or overly weak pelvic floor can cause joint instability and force your tailbone out of alignment, causing pain in the coccygeal region.
Compression of the coccygeal nerves – Nerves can become entrapped within the myofascia of the pelvic floor when fascia becomes densified. Fascial manipulation therapy combined with other therapies like shockwaves can help release entrapped nerves and restore fascial integrity.
Advanced Treatment Options for Chronic Tailbone Pain
Persistent tailbone pain lasting two months or longer can be conservatively managed by treating pain symptoms, resulting in spontaneous improvement in about 90% of patients. In the remaining 10 percent of cases, chronic coccydynia can diminish your quality of life, interfering with everyday activities and making it painful to move and sit down.
People with chronic coccydynia may experience pain during intercourse, and some report difficulty defecating. You may experience sharp pain when rising from sitting to standing, and sitting on hard surfaces may be unbearable. When provided by an experienced practitioner, specialized coccydynia physical therapy can help resolve chronic tailbone pain and restore pain-free functional movement.
Treatment options range from sitting on a special cushion to full-blown coccygectomy – a surgical procedure to completely remove the coccyx. If coccygeal pain originates from the pelvic floor, specialized pelvic physical therapy can help to resolve the condition.
To determine the most effective treatment options, one research team conducted a broad systematic review of the various treatment modalities for coccydynia.
Research results revealed:
The largest reductions in pain were achieved with extracorporeal shockwave therapy (ESWT), radiofrequency therapy (RFT), and coccygectomy.
Coccygectomy showed an overall high complication rate, mostly due to infection.
Stretching and manipulation of the pelvic floor achieved the least reduction in pain.
The largest reductions in pain were achieved with extracorporeal shockwave therapy (ESWT), radiofrequency therapy (RFT), and coccygectomy.
The researchers recommended non-invasive treatments like radiofrequency therapy and shockwave therapy for tailbone pain, over riskier, more invasive and irreversible coccygectomy.
Get Advanced Tailbone Therapy in NYC
The team at NYDNRehab has an impressive track record of resolving over 500 cases of coccydynia. Our clinic features the most advanced technologies available for diagnosing and treating a broad spectrum of musculoskeletal conditions and injuries. We conduct a comprehensive exam on your first visit using high-resolution diagnostic ultrasonography, to confirm the exact cause of your tailbone pain and rule out other causative factors.
NYDNRehab is one of only a few private clinics to offer INDIBA radiofrequency therapy, along with a broad range of shockwave technologies, including SoftWave, MyAct, focal and radial shockwaves. Tailbone pain often affects more than one tissue type, and requires a combination of different shockwaves to completely eliminate pain.
Our expertise, technologies, holistic approach, and track record of success make NYDNRehab the clinic of choice for coccydynia physical therapy in MIdtown Manhattan.
Dr. Lev Kalika is a world-recognized expert in musculoskeletal ultrasonography, with 20+ years of clinical experience in advanced rehabilitative medicine. In addition to operating his clinical practice in Manhattan, he regularly publishes peer-reviewed research on ultrasound-guided therapies and procedures.
Dr. Kalika is an esteemed member of the International Society for Medical Shockwave Treatment ((SMST), and the only clinician in New York certified by the ISMST to perform extracorporeal shockwave therapy. He is also an active member of the American Institute of Ultrasound in Medicine (AIUM), and has developed his own unique approach to dynamic functional and fascial ultrasonography.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris with large hematoma (blood)
Separation of muscle ends due to tear elicited on dynamic sonography examination
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