This article is about Coccyx Pain, otherwise known as Coccydynia or Tailbone Pain. It will address the condition and discuss the main causes and treatment options from self-help ideas right through to the interventional treatments and surgery. The information is also provided in video format below.
What is the Coccyx ?
Well the coccyx usually consists of 4 small bones fused together at the very bottom of the spine, although occasionally there can be 3 or even 5 bones present. Its connects to the sacrum above it, which in turn connects to the lumbar spine.
The coccyx really serves no useful purpose in humans and is essentially a vestigial remanent of an evolutionary tail. But it does act a supporting structure when sat down and multiple ligaments and tendons still attach to it. It’s also supplied by lots of nerve endings which is the main reason why it can be so painful when injured.
What’s causes Coccyx Pain ?
In the majority of cases it’s cased by a direct trauma, typically a heavy fall. But it can also be caused by repetitively sitting on a hard surface, and as such, it’s a known problem in cyclists. It’s also common in pregnancy or after birth, and there is a higher risk of developing coccyx pain if you’re very overweight or very underweight. It’s also 5 times more common in women than in men.
What are the Treatments ?
Well we can divide the treatments up into the things you can do yourself and the interventional treatments that a specialist can provide.
Self-Help
The first thing you could do is use some form of pressure relief cushion when sitting. That could be just a nice thick soft cushion but you can buy a specific coccyx cushion which is either a donut type cushion or a C shaped one. And they can undoubtedly be very helpful, particularly when faced with a firm chair and the prospect of a few hours sat down, like in a restaurant or watching a sports game.
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| Donut Cushion (link to product) |
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| ‘C’ Shaped cushion |
Medication
Anti-inflammatories, taken as a course for a few weeks, can be worth a try particularly if your coccyx pain has suddenly flared up or if it’s constantly aching in the background. Just make sure you check with a pharmacist if you can take them, as not everyone can.
And the other medication that people can find helpful are Laxatives. Coccyx pain is enough of a problem on its own but combined with constipation, it can be much worse, so do avoiding foods that can bung you up, and indeed I would also avoid medications with codeine in, because they have the common side effect of causing constipation.
Exercises and Stretches
The other thing worth trying are the exercises and stretches. Now these aren’t going to be a Quick fix but are rather a slow burn which can steadily improve symptoms as the weeks go by.
People with coccyx pain often have quite stiff lumbar spines and quite poor core stability, and so the exercises aim to address these issues.
For stiffness, lumbar flexion stretches are often helpful. Here are 3 of the most useful ones.
1) Lye on your back and pull both knees up towards your chest. Hold for a few seconds and repeat 5-10 times. You should feel a nice stretch in the lower back region.
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| The Knees to Chest Stretch |
2) This is the ‘sad cat - happy cat’ stretch which is done in kneeling. You basically try to arch your back as high as possible and then do opposite movement where you try and maximise the lumbar arch. Again, hold for few seconds in each position and repeat 5-10 times.
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| The ‘sad cat - happy cat’ stretch |
3) The last one can either be done in kneeling or sitting. It basically involves trying to flex your spine fully forwards like this. And again, hold and repeat the same as the other ones.
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| Lumbar Flexion Stretches |
For the stability exercises I think one of the best ones for coccyx pain is the pelvic tilt. You can do this while sitting on your coccyx cushion but perhaps the best way is to use a gym ball. The exercise involves trying to maximise your lumbar curve and then trying to do the opposite movement by flattening your back.
After you’ve done this a few times, try to find the mid position, and then hold there while taking one foot off the floor. Keep this nice posture for 5-10 seconds and then repeat for the other foot. Using a Gym Ball is a good way to progress this exercise.
Stability Exercises
A good stability exercise is the bridge. In its simplest form you just lie on your back and lift your pelvis off the floor. Hold for 5-10 seconds and repeat 5-10 times. If that’s too easy then try taking one foot off the floor like this, and then swapping sides. And if thats too easy then try doing the same but with your hand crossed over your chest.
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| The ‘Bridge’ with Progressions |
Now there are lots of other back exercises you can do but I’ve just tried to show you a couple of basic ones that work well in my experience. If you want to push yourself a bit further, then google exercises like the ‘superman pose’, the ‘plank’ and ‘side plank’, the ‘dead bug’ and the ‘deep squat’.
Address Risk Factors
The last thing to mention in the self-help section is to look at your risk factors. So if you are the overweight, under-fit person who sits for large parts of the day, then if you want to prevent this from becoming a chronic longstanding problem then you’re going to need to loose weight, get fitter and sit less. It’s really not rocket science.
Interventional Treatments
If your coccyx pain has persisted despite trying the self-help treatments then it might be time to see a specialist. And the first thing they might offer you is a coccyx cortisone injection.
This is a fairly straight forward procedure but is usually done in a specialist setting. It usually works well but there is often considerable variation with how long it lasts.
It might work well and never return, which is of course the ideal outcome, but it might only work partially or temporarily. If it works partially, meaning it gets it partially better, usually by just improving the pain on one side of the coccyx but not the not the other side, then it can be worth repeating and trying to target the remaining painful area with a second injection.
If the injection works really well but wears off after 6 months or so then again, it can repeated but I wouldn’t advise that its done time after time as one of the side effects of repeated cortisone injections is that the skin can become thin over the needle site which then carries a risk of the skin eventually breaking down and ulcerating, which is something you really don’t want to happen in the area between your bum cheeks. Not pleasant !
Radiofrequency Ablation
If you’re getting good but only short lived results from cortisone injections then an alternative treatment is something called radio frequency ablation. This procedure involves placing a specialised needle under X-Ray guidance into the region around the coccyx nerves and then heating the tip up to a high temperature.
This essentially destroys the sensory nerves that are responsible for transmitting the pain sensation. It might not be a permanent cure because the nerves have a tendency to grow back over time but the procedure usually lasts at least 12 months and it can be repeated, as it doesn’t cause skin thinning like repeated cortisone injections can.
Coccyx Manipulation
This treatment is really only indicated if the coccyx has been pushed into an abnormal position after a fall. So some form of imaging, usually MRI or CT is needed in order to determine the position of the coccyx. And if the coccyx has been angled inwards then there might be the option of manipulating it back into its correct position.
Ive heard of this being being done by therapists in a clinic room setting but I would recommend that its done under general anaesthesia under image guidance by a Radiologist or an Orthopaedic Spinal Consultant, who will be much better equipped to deal with any complications that might arise.
Surgery
And the final treatment option that might be considered for those patients with chronic debilitating coccydynia despite trying all of the other options, is surgery. Surgical removal of the coccyx is the final treatment resort option, although it has to be said that even this doesn’t always work, as phantom coccyx pain can sometimes persist even after it’s been removed.
Chronic Pain Management
For patients who have to live with chronic coccyx pain and who haven’t responded to the treatments we’ve discussed, or who have declined surgery or maybe not been medically suitable for surgery, then specialist pain clinics are usually the place where this condition is managed for the long term. Here, the emphasis is on managing the problem rather than curing it, and various strategies can be used including different medications, cognitive behavioural therapy, TENS machines, epidural injections and spinal cord stimulation.
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This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only and not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.