Coccydynia (Tailbone Pain)

The medical name “coccydynia” (coccyalgia, coccygodynia) is commonly called tailbone, coccyx or coxxygeal pain. It is a fairly rare and relatively poorly understood condition that can cause persistent severe and disabling localized pain at the very bottom of the spine.

The coccyx (tailbone) is a small triangular shaped bone composed of 3-5 fused or semi-fused segments is located at the end of the sacrum, which is part of the pelvis.

Click here for video "Coccydynia: Tailbone Pain"

The various terms are all used to describe a set of symptoms in the tailbone that can be caused by various injuries or conditions. Treatment may vary depending on the underlying cause of the symptoms and the severity and duration of the symptoms.

Coccydynia is often associated with a local trauma such as falling on your behind or other events such as giving birth... but in many cases there are no obvious reasons. Quite often pain is referred from the sacroiliac joints, pelvic muscles and the lower back. It is therefore important to have a proper examination to determine why the pain is there and where it is coming from.

On rare occasions, an infection or tumor can also cause pain in the coccyx. In this instance, a medical referral is appropriate.

Sometimes the pain may be due to an unstable coccyx. You have a joint between the coccyx and the sacrum, which can be sprained. If this joint is unstable you may sprain it every time you sit down, hence recurring and chronic pain. When you have coccydynia it is especially painful to sit down or with any activity that puts pressure on the bottom area of the spine.

Why Do More Coccyx Injuries Occur in Women Than Men?

The majority of coccyx injuries occur in women because:

  • The women's coccyx is rotated, leaving it more exposed to injury
  • Women have a broader pelvis, which means that sitting places pressure on their coccyx (male anatomy causes them to sit without much pressure on the coccyx)
  • Childbirth is a common cause of the condition.

History of Coccydynia

Coccydynia has a long history of being poorly understood. In the early 1900s, coccydynia was a popular diagnosis for all types of lower back pain. A fairly extreme treatment, the surgical removal of the coccyx (coccygectomy), was commonly undertaken to treat low back pain. At best, this operation had variable results.

Then the pendulum swung the other way, and the general opinion was that since the condition was mostly in women it was in some way related to "neurosis". The corollary was that if the operation did not work, it was because the pain was in the individual’s head; therefore the operation fell into disrepute and was no longer commonly performed. Subsequently, little research on the subject has been done.

Both extremes of opinion have long since fallen by the wayside, and it is now known that coccydynia does exist as a medical condition. However, it is fairly uncommon.

The coccyx is the very bottom portion of the spine. It represents a vestigial tail (hence the common term "tailbone") and consists of three or more very small bones fused together. The coccyx is made up of between three and five separate or fused vertebrae.

While it was originally thought that the coccyx is always fused together (with no movement between the coccygeal vertebrae), it is now known that the entire coccyx is not one solid bone but often there is some limited movement between the bones permitted by the fibrous joints and ligaments.

Coccydynia Symptoms

Specifically, coccydynia symptoms may consist of one or all of the following:

  • Pain that is markedly worse when sitting
  • Local pain in the tailbone area that is worse when touched or when any pressure is placed on it
  • Pain that is worse when moving from a sitting to standing position
  • Pain that is worse with constipation and feels better after a bowel movement.

Diagnosis and Investigations

The patient’s history can give a clear indication of what the cause is but that is not the case for every person. The first aim for the chiropractor is to find out if chiropractic treatment is appropriate for you. It is therefore often necessary to take x-rays or even MRI-scans to rule out more sinister causes of pain.

Dynamic x-rays are often very useful in order to rule out a dislocating coccyx, which can account for as many as 50% of the cases of pain from the coccyx.

The chiropractor would also palpate the coccyx and related muscles from the outside to determine if there is any localized tenderness on or around it. In some cases it might be necessary to do this internally.

The chiropractor will also examine related areas such as the pelvic joints and the lumbar spine.

Dynamic X-rays

If the flexion observed in dynamic X-ray examination exceeds 25-30 degrees, it indicates a hypermobile coccyx. Conversely, instability in extension is uncommon, but movement greater than 15-20 degrees is considered a sign of instability.

In approximately 40-50% of cases, dynamic X-ray examination may not reveal any abnormalities. In such instances, the diagnosis is labeled as "idiopathic" coccydynia. In these cases, where normal X-ray films do not show a specific problem, the pain may be attributed to various issues, including:

  • Intradiscal inflammation or chronic joint inflammation: Inflammation within the discs or chronic inflammation in the joints could be contributing to the pain.
  • Bursitis: In cases where the coccyx is rigid, pain at the tip may be indicative of bursitis.
  • Pain referred from sacroiliac joints and the lumbosacral area: Discomfort over the coccyx may be linked to pain referred from other areas such as the sacroiliac joints and the lower back.

Careful palpation becomes essential in such scenarios to determine the source of the pain when X-ray findings are inconclusive. This nuanced approach ensures a more comprehensive understanding of the condition and aids in tailoring an appropriate treatment plan for individuals with idiopathic coccydynia.

Coccydynia Treatment

When coccydynia falls within the scope of chiropractic care, a combination of treatments is often employed to diminish pain, coupled with activity modification to alleviate pressure on the tailbone. This approach is typically effective in controlling or alleviating the pain associated with coccydynia.

However, in exceedingly rare cases where the pain persists and is severe, and several months of non-surgical treatment and activity modification prove ineffective, surgery may be considered. Specifically, a coccygectomy, the surgical removal of the coccyx, might be recommended as a last resort. It's important to note that this surgical intervention is not commonly pursued and is reserved for situations where other treatment options have not provided relief for the severe pain associated with coccydynia.

Treatments for coccydynia are usually non-invasive and local. The first line of treatment typically includes:

  • Non-steroidal anti-inflammatory drugs (NSAIDs). Common NSAIDs, such as ibuprofen, naproxen and COX-2 inhibitors, help reduce the inflammation around the coccyx that is usually a cause of the pain.
  • Applying ice or a cold pack to the area several times a day for the first few days after the pain starts.
  • Applying heat or a hot pack to the area after the first few days.
  • Avoiding sitting for prolonged periods, or placing any pressure on the area, as much as possible.
  • A custom pillow, "Kabooti", to help take pressure off the coccyx when sitting. Some find a donut-shaped pillow works well, and for others it is not the right shape and still puts pressure on the coccyx. Many prefer a foam pillow that is more of a U-shape or V-shape (with the back open so nothing touches the coccyx). Any type of pillow or sitting arrangement that keeps pressure off the coccyx is ideal.
  • If the tailbone pain is caused or increased with bowel movements or constipation, then stool softeners and increased fiber and water intake is recommended.

Additional Non-Surgical Treatments for Coccydynia

If the pain is persistent or severe, additional non-surgical treatment options for coccydynia (tailbone pain) include:

  • Manipulation. Some patients find pain relief through manual manipulation (e.g. chiropractic treatment). Click here for study on chiropractic 'activator instrument' methods adjustment treatment of coccydynia.
  • Stretching. Gently stretching the ligaments attached to the coccyx can be helpful. A chiropractor, physical therapist, physiatrist or another appropriately trained healthcare practitioner can provide instruction on the appropriate stretches.
  • Ultrasound. Physical therapy with ultrasound can also be helpful for pain relief.
  • Low-Level Laser Therapy: (Photo-bio-Stimulation; LLLT) can also be helpful for pain relief.
  • Injection. A local injection of a numbing agent (lidocaine) and steroid (to decrease inflammation in the area) can provide some relief. Fluoroscopic guidance is recommended. Relief can last from 1 week up to several years. No more than 3 injections per year are recommended.

In Summary

Coccydynia is often associated with coccygeal instability, with nearly half of the cases showing evidence of hypermobility, a condition that can be documented through dynamic X-ray films. In many instances, the pain associated with coccydynia is a result of referred pain originating from the lumbar spine, pelvic joints (sacroiliac joints), and related musculature.

Ensuring an accurate diagnosis is crucial for guiding the most appropriate treatment. It is noteworthy that some conditions may not be suitable for chiropractic treatment, emphasizing the necessity for referral to a medical professional for a comprehensive assessment. This collaborative approach ensures that individuals with coccydynia receive the specific care that aligns with their diagnosis and overall health needs.

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