Tailbone Pain (Coccydynia) (1)

Tailbone Pain (Coccydynia)

• Coccydynia, also known as coccygodynia, coccalgia, or coccygeal neuralgia, refers to pain in the coccyx region.

• Symptoms often occur while sitting or transitioning from sitting to standing.

• Most cases resolve within weeks to months; however, chronic pain can affect quality of life.

Types of Coccyx Positioning

• Type I: Slight forward curvature, apex downward.

• Type II: Exaggerated forward curvature, apex straightforward.

• Type III: Sharp angulation of the coccyx forward.

• Type IV: Subluxation at sacrococcygeal or intercoccygeal joint.

Etiology of Tailbone Pain

• Falls: Bruising, fractures, or dislocation from falls.

• Repetitive Strain Injuries (RSI): Activities requiring leaning motions (e.g., biking, rowing) may strain tissues.

• Pregnancy/Childbirth: Hormonal changes cause softening, potentially leading to overstretching of surrounding tissues.

• Carrying Extra Weight: Increases pressure on the tailbone, leading to pain.

• Not Carrying Enough Weight: Less cushioning can result in friction against muscles and ligaments.

• Prolonged Sitting: Excess pressure from long sitting, especially on hard surfaces.

Rare Causes of Tailbone Pain Without Injury

• Cancer: Rarely, pain may indicate cancer near the coccyx or metastatic cancer affecting bones.

  • Possible Cancers: Chordoma, prostate cancer, colorectal cancer.

  • Additional Symptoms: Numbness, difficulty urinating or defecating, visible mass around the tailbone.

Symptoms of Coccydynia

• Main symptom: Pain and tenderness near the buttocks.

  • Pain is usually dull and achy, with occasional sharp pains.

  • Worsens with sitting, transitioning positions, standing for long durations, sexual activity, and bowel movements.

  • May disrupt sleep and daily activities, such as driving or bending over.

Physical Examination

• Palpation: Tenderness may be detected over the sacrococcygeal joint. Inspect for swelling, bone fragments, or masses.

• Pain Differentiation: True coccygodynia presents localized pain; pseudo coccygodynia may involve referred pain from other organs.

• Symptoms Indication: Increased pain during straight leg raises; rectal examination may reveal tenderness or internal masses.

Management

• Conservative Treatments: Most effective (~90% success rate); includes NSAIDs, activity modifications, ergonomic adjustments, and physical therapy.

• Surgical Treatments: Considered when conservative measures fail; includes coccygectomy (removal of the coccyx).

  • Recommended Actions:

    • Use NSAIDs to reduce pain.

    • Use a donut pillow or gel cushion when sitting.

    • Take warm baths to relax muscles.

    • Apply hot/cold packs for pain relief.

Nonsurgical Treatments for Tailbone Pain

• Considered when home remedies fail:

  • Coccygeal Nerve Block: Injection of numbing agents to relieve pain.

  • Massage Therapy: Provides temporary relief.

  • Physical Therapy: Improves muscle flexibility and posture.

  • Acupuncture.

  • TENS: Transcutaneous electrical nerve stimulation.

Surgical Treatments for Tailbone Pain

• Rarely recommended:

  • Partial Coccygectomy: Removal of part of the coccyx.

  • Total Coccygectomy: Complete removal of the coccyx.

Manual Therapy

• May include a variety of techniques (massage, stretching, mobilization).

  • Internal Techniques: Involves levator ani or coccygeus muscle massage.

  • External Techniques: Manipulations of sacroiliac and coccygeal joints, stretching of muscles related to coccyx movement.

Prevention of Coccydynia

• Tailbone pain often results from accidents or underlying conditions; prevention may reduce risk:

  • Avoid prolonged sitting on hard surfaces.

  • Exercise caution during activities with fall risks.

  • Maintain clear pathways and well-lit stairs.

  • Avoid distractions (e.g., phone use) while walking.

Tailbone Pain (Coccydynia) Q/A

Q: What is coccydynia?A: Coccydynia, also known as coccygodynia, refers to pain in the coccyx region.

Q: What are common symptoms of coccydynia?A: Symptoms include pain and tenderness near the buttocks, worsening during sitting, transitioning, standing for long periods, sexual activity, and bowel movements.

Q: What types of coccyx positioning exist?A:

• Type I: Slight forward curvature, apex downward.

• Type II: Exaggerated forward curvature, apex straightforward.

• Type III: Sharp angulation of the coccyx forward.

• Type IV: Subluxation at sacrococcygeal or intercoccygeal joint.

Q: What are some common causes of tailbone pain?A: Common causes include falls, repetitive strain injuries (e.g., from biking or rowing), pregnancy/childbirth, carrying extra weight, not carrying enough weight, and prolonged sitting.

Q: What are rare causes of tailbone pain that don't involve injury?A: Rare causes may include cancers such as chordoma, prostate cancer, or colorectal cancer, accompanied by symptoms like numbness and difficulties with urination or defecation.

Q: What is the primary symptom of coccydynia?A: The main symptom is pain and tenderness near the buttocks, typically described as dull and achy, with occasional sharp pain.

Q: How is coccydynia physically examined?A: A physical exam includes palpation of the sacrococcygeal joint to check for tenderness, swelling, or masses, as well as pain differentiation between true coccygodynia and pseudo coccygodynia.

Q: What are the management options for coccydynia?A: Management can be divided into conservative treatments (NSAIDs, ergonomic adjustments, physical therapy) and surgical treatments (coccygectomy when conservative measures fail).

Q: What conservative treatments are recommended?A: Recommended actions include using NSAIDs for pain, using a donut pillow or gel cushion when sitting, taking warm baths, and applying hot/cold packs.

Q: What nonsurgical treatments are available for tailbone pain?A: Non-surgical options include coccygeal nerve block, massage therapy, physical therapy, acupuncture, and TENS.

Q: When are surgical treatments considered for tailbone pain?A: Surgical treatments, such as partial or total coccygectomy, are rarely recommended and are considered only when other treatments fail.

Q: What is included in manual therapy for tailbone pain?A: Manual therapy may include techniques like massage, stretching, and manipulation of sacroiliac and coccygeal joints.

Q: How can coccydynia be prevented?A: Preventive measures include avoiding prolonged sitting on hard surfaces, exercising caution during fall-risk activities, maintaining clear pathways, and avoiding distractions while walking.