The coccyx (also referred to as the tailbone) is the triangular bony structure at the bottom of the vertebral column that serves as an attachment for our pelvic floor muscles. It is composed of three to five bony segments that are held in place by joints and ligaments. Because it corresponds to the location of an animal’s tail, the coccyx is called the ‘tailbone’.
The coccyx is an important attachment site for tendons, ligaments, and muscles in the pelvis. It bears the body’s weight and acts as a shock absorber when a person sits. Its position under the skin, leveled with the cleft of the buttocks, makes the coccyx likely to get bruised or fractured. Some people have a coccyx that curves too far, instead of pointing straight down, predisposing them to injuries and pain. When injured, it can cause debilitating pain – this pain can be termed as coccygodynia, coccydynia, or coccalgia.
These injuries may result in a bruise, dislocation, or even a coccyx fracture. Although they may be slow to heal, the majority of coccyx fractures can be managed with cautious treatment. In addition, the majority of coccyx fractures occur in women, because the female pelvis is broader and the coccyx is therefore more exposed.
Causes & Symptoms
The injury in the coccyx area may cause a bruise or a fracture of the coccyx. In rare cases, dislocation of the sacrococcygeal joint, which is located in between the top of your sacrum and the base of your coccyx, may occur.
Other common causes specifically linked to coccyx fractures include:
- Repeated trauma – Activities like horseback riding or cycling can increase the risk of a coccyx fracture due to repetitive pressure or friction on the coccyx for long periods of time. Furthermore, simply sitting on a hard surface during a long car ride or airline flight may cause additional tailbone pain.
- Degenerative Joint Disease – Wear and tear from repetitive motion can cause osteoarthritis, a degenerative joint disease that can affect any joint in the body, including the coccyx.
- Nerve Pain – A bundle of nerves called the ganglion impar is located in front of the upper part of the coccyx. Overactivity or irritation of these nerves may cause chronic coccyx pain.
- Coccyx Morphology – There is variability in the number of coccygeal bones a person has. Additionally, some people have a bone spur or spicule located on the lowest tip of the coccyx. This growth can irritate the coccyx area when a person sits. It can pinch the skin and the fatty tissue between the spur and the chair. Besides bony growth, some experts report scoliotic deformity as a potential cause of a coccyx fracture.
- Pelvic Floor Muscle Spasms – Since the tailbone serves as the attachment site for a deep layer of pelvic floor muscles, muscle spasms and irritation can cause levator syndrome, a type of condition that causes a dull, aching pain, often felt in the coccyx and higher up in the rectum.
Other symptoms of coccyx fractures include:
- Severe pain when changing from sitting to standing up.
- Severe pain when sitting for long periods of time.
- Pain during bowel movements.
- Achy or piercing pain in the coccyx area.
Other related symptoms that may occur with coccyx fractures include depression, anxiety, poor sleep, and lower back pain.
Who Gets a Coccyx Fracture?
Risk factors of coccyx fractures include the following:
- Childbirth – Giving birth to a newborn child, especially if the delivery is difficult and forceps are used, can cause coccyx pain due to the pressure placed on the top of the coccyx from the baby’s head. Typically, tailbone pain from childbirth is a result of a bone bruise or ligament strain, although sometimes the coccyx can fracture.
- Obesity – Extra weight applies additional pressure to the coccyx. This can cause the coccyx to lean backwards, therefore, your tailbone will hurt if it is out of position.
- Underweight – If you do not have enough fat in your buttocks to prevent your coccyx from rubbing against the muscles, the rubbing then inflames the soft tissues.
- Heart problem – An individual who is living with a heart problem will increase the risk of weakening bones (osteoporosis) and sudden falls that may lead to weakened muscles. Both these conditions can lead to the development of coccyx fractures.
- Contact sports – Playing contact sports such as hockey, football, basketball, rugby, and soccer can all lead to experiencing coccyx fractures.
How Does It Affect You? How Serious Is It?
Though less common, other severe causes of coccyx fractures can be especially dangerous and require urgent medical attention. In rare instances, a malignant tumor that has metastasized to the tailbone may be the source of tailbone pain. In rare cases, a chordoma, which is a primary bone tumor, may arise on the coccyx or within the coccygeal region. An infection located in the tailbone area, such as a pilonidal cyst, can cause swelling and pain over the coccyx, along with redness, warmth, and puss.
Osteomyelitis, a bone infection, may also rarely cause coccydynia which can also produce signs of an infection, including fever, warmth, and redness near the coccyx.
In most severe cases, a vertebral tumor is a tumor in your spine that affects your bones or vertebrae. Therefore, as it grows, it can also cause severe pain in your coccyx area. Some of these symptoms of a vertebral tumor include:
- Lower back pain during nighttime.
- Pain that moves to other parts of your body.
- Weakness or loss of sensation in your arms or legs.
- Sudden trouble of walking.
- Less sensitivity to cold, heat, and pain.
- Loss of bladder or bowel function.
Recommended Treatment & Rehabilitation
Your doctor will use a physical exam and X-rays to help diagnose your coccyx pain. It is important to know if something other than a traumatic injury is causing the pain.
To find out, a doctor will feel the soft tissue around your coccyx and the lower spine. They may be able to detect a pointy growth of a new bone, known as a bone spicule, which could be the source of the pain. They will also look for other possible causes of the pain, such as a tumor or pelvic muscles spasms.
During a rectal examination, your doctor grasps the coccyx between the forefinger and thumb. By moving it, they can tell if there is too much or too little mobility in the coccyx. Therefore, generally the normal range of motion is about 13 degrees, so if it is too much or too little, there can be a sign of a problem.
X-rays are done in both standing and sitting positions. Comparing the angle of the coccyx in the two positions helps your doctor determine the degree of motion. Though coccydynia normally resolves over weeks to months with supportive care, It is sometimes protracted and debilitating. In order to speed up the recovery period, pelvic floor physiotherapy can help improve coccyx positioning and pelvic floor muscle tone. Biofeedback, manual therapy, therapeutic exercises, and activities are some of the treatment techniques used in physiotherapy for this problem.
For persistent pain that is not alleviated with non-surgical treatment and/or activity modification, surgical removal of all or a portion of the coccyx (coccygectomy) is an option.
Coccygectomy surgery is rarely recommended and performed. Whilst the surgery itself is a relatively straightforward operation, recovery from the surgery can be a long and uncomfortable process for the patient. Surgeons may take slightly different approaches to the operation. Perhaps the biggest difference between surgeons is that some remove only part of the coccyx, while others recommend removing the entire coccyx.
Generally, it may take three months to a year after the surgery before patients start to see any relief from their symptoms and sitting is difficult throughout the healing process.
Fractured coccyx exercises are designed to help you recover quickly and correctly from the injury. While several weeks of inactivity may be required, performing weight-bearing exercises on your coccyx can help expedite new bone growth, reducing the amount of time you are injured. In addition to coccyx exercises, performing exercises on the muscles around your tailbone can help reduce your risk of a future injury. Here are some exercise examples for anyone to perform:
While a fractured tailbone causes the pain directly along the bone, weeks of inactivity due to the injury can result in tight hamstrings that may give you further pain in the same region. To stretch these muscles, stand up straight with your knees slightly bent and your arms at your sides. Bend your right leg at the knee, grabbing your ankle with your right hand and pulling back until your shoe hits your buttocks. Hold this position for 10 seconds before repeating with both legs.
Sitting Relief Exercises
While recovering from a coccyx fracture, it is often difficult to find a comfortable position to sit. As a result, your posture and alignment may be thrown off to compensate for the pain. Sitting relief exercises may help reduce pain while improving your posture. Place a phone book down on a chair. Sit down on the book, allowing your coccyx to hang off the back end of it. Sit in this position with your back straight for as long as you can.
After weeks of inactivity, performing light torso lifts can help you strengthen your tailbone, building new muscle and keeping it strong. Lie down on your back with a medicine ball between your hands. Tighten your abdominal muscles, lifting your upper torso while extending your arms and the ball out and away from your body. When your upper torso is perpendicular to the floor, hold for several seconds before returning to lying down. Repeat this exercise until fatigued.
Alternative & Homeopathic Treatment
Many studies have shown that non-surgical treatments are successful in approximately 90% of coccydynia cases. Treatments for coccydynia are usually non-invasive and include activity modification. Some of these at-home treatments include the following:
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Common NSAIDs, such as ibuprofen or naproxen help reduce inflammation around the coccyx that is normally a cause of the pain.
Applying ice or a cold pack to the area several times a day for the first few days after pain starts can help reduce inflammation, which typically occurs after injury and adds to the pain.
Applying heat to the bottom of the spine after the first few days of pain may help relieve muscle tension, which may accompany or exacerbate coccyx pain. Common heat sources include a hot water bottle, chemical heat pack, or hot bath.
Alterations to everyday activities may help take pressure off the tailbone and alleviate pain. These activity modifications may include using a standing desk to avoid prolonged sitting, using a pillow to take the weight off the coccyx, or adjusting posture so weight is taken off the tailbone when sitting.
A custom pillow that takes the pressure off the coccyx when sitting may be used. Pillows for alleviating coccydynia can include U or V-shaped pillows, or wedge-shaped pillows with a cutout or hole where the tailbone is. Any type of pillow or sitting arrangement that keeps pressure off the coccyx is ideal and largely a matter of personal preference.