Coccydynia: Tailbone and Pelvic Pain

Tailbone and pelvic pain or coccydynia is a common type of pelvic pain. People with tailbone pain often have increased pain with sitting and with transitioning from sitting to standing. While the tailbone is designed to tolerate about 10% of our weight in sitting, many people tend to sit back on their sacrum, increasing stress and pressure on this small group of bones.

The muscles attached to the tailbone, or coccyx are several groups of muscles that play important roles in pelvic and spinal stability, hip and core strength, and pelvic support..

Muscles that attach to the tailbone: Deep pelvic floor muscles including the puborectalis and the iliococcygeus. Anococcygeal raphe, a deep fascial band that supports the external anal sphincter.

Lateral ligaments and muscles that attach to the tailbone: Coccygeus muscle, another pelvic floor muscle that helps to provide pelvic stability.

· Posterior ligaments and muscles that attach to the tailbone: Gluteus maximus, the largest of our hip muscles. Sacrotuberous ligament, a strong ligament that runs from the sacrum and coccyx to the body of the ischial tuberosity helps provide stability of the sacrum and is an extension of the hamstring tendon to the coccyx.

Through these connections at the base of the spine, the coccyx plays an important role in providing our body a strong foundation to work from. It also has direct connections to our hamstrings, hips, and pelvic floor.

Common causes of coccyx pain include a fall directly on the tailbone or childbirth especially if the delivery is assisted with forceps or vacuum. However, tailbone pain can be caused by stiffness or hypermobility at the this joint. With stiffness, the tailbone doesn’t have the flexibility to move while sitting or with transitional movements. With hypermobility, the coccyx can’t provide stability at the base of the spine for the muscles that attach here to work from. This causes overuse in other muscles and eventually pain.

Pelvic floor physical therapy is a gold standard treatment for coccydynia to relieve pain. The mobility of the sacrococcygeal and sacroiliac joints, mobility of the sacrospinous and sacrotuberous ligaments, and muscle mobility and strength of the attaching muscles must be assessed. With this information, a plan can be established for treatment. This can include manual therapies in helping to get the joint moving, ergonomic changes for sitting posture, and exercises for muscle length or strength.

Pelvic floor physical therapy can also look beyond the tailbone. Because the tailbone has so many muscles that attach to it, changes in the spine, hips, or ankles can contribute to tightness or instability in the coccyx and surrounding tissues at the bottom of the spine..

If you are struggling with tailbone pain or coccydynia, a visit to pelvic floor physical therapy can help you on the road to decreasing your pain. We offer a free, 15-minute phone consultation to answer any questions you may have and to help to find help on your journey toward healing..