Often during my conversations with patients, they will mention an old tailbone injury from a fall, an accident, or a challenging birth of a child. Many times, the injury is blown off with an “It was just my tailbone.” Oh, the little attention the tailbone gets! How is this little bone so often involved with pelvic pain, urinary incontinence, constipation, and pelvic organ prolapse? Let’s take a closer look at this little bone that gets so little respect.
The lack of coccyx support has far reaching consequences, beyond the pelvic floor. Let’s start with the pelvic floor and expand outward. The coccyx (tailbone) is the very end of the spine, attaching to the bottom of the sacrum, and is the anchor for the many of the muscles in the pelvic floor. It is the attachment site for the levator ani muscles which are the muscles that form the bottom of the pelvic bowl connecting the pubic rami to the sacrum. These muscles act as a support system for the sacrum, pelvis, rectum, bladder, and in women, the uterus. When the tailbone has been injured, the angle of attachment for the levator ani muscles changes, causing tightness and spasm in some muscles and weakness in others. This can contribute to hip and back pain with sitting, walking, lifting, bending and squatting.
With decreased muscular support for the sacrum, external support must be provided to decrease the hypermobility and pain. In many cases, this can be provided by a sacral support belt to stabilize the sacral iliac joints and to prevent sacral torsions and innominate rotations. However, even with this external support, some people will continue to have a decrease in balance and proprioception due to the internal decrease of core, hip, and pelvic floor stability and strength. This can lead to an increased risk of falls and injury with everyday activities.
The coccyx and levator ani muscles also play an important role for lymphatic and blood flow to the trunk. Changes in lymphatic and blood flow occur due to decreased or changed pelvic floor muscle activity. In conjunction with the thoracic diaphragm, the pelvic floor muscles act as a pump for the lymphatic system, issuing fluid to the thoracic duct, the main drain for the lymphatic system. A backup of fluid often occurs when there is poor coordination of the diaphragm and the pelvic floor muscles. This will appear as abdominal swelling, bloating, or pelvic heaviness. A pelvic floor physical therapist who also has a strong understanding of the lymph system can work to coordinate both diaphragm activation and relaxation patterns and to pelvic congestion management.
With the changes in the pelvic floor muscles, patients will also have decreased support of the pelvic organs. The weakness of the pelvic floor and core muscles lead to pelvic organ prolapse of the bladder, rectum and/or uterus. Pelvic organ prolapse can contribute to urinary leaking, constipation, and pelvic heaviness. If the prolapse is not advanced, often muscle strengthening and pelvic floor PT is successful in reducing the symptoms.
The coccyx truly is our anchor and is not to be overlooked or taken for granted. Pelvic floor physical therapy can make a world of difference when dealing with issues of the coccyx. A hand’s on approach to treatment can assist in the decreased pain and improved strength of the muscles surrounding the tailbone.
–Jennifer Cumming, PT, MSPT, CLT
This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you. If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts. Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.