Coccyx Pain, also known as tailbone pain, typically involves symptoms related trauma or prolonged pressure on the coccyx bone or associated soft tissues such as the ligaments and joints. Here we will discuss the various causes of this condition, how it is diagnosed, and what treatment options are available. In most cases, the condition can be reasonably managed by treatments that decrease the inflammation in and around the tailbone, and the avoidance of activities that caused the pressure. In rare cases, a combination of severe pain and lack or a response to treatments may necessitate a procedure to remove the tailbone. This treatment is known as a coccygectomy. But before we get into that unlikely scenario, take a look at the anatomy of the coccyx, and its function relative to the other structures at the base of the spine.
Coccyx: together, the sacrum and coccyx have the shape of a downward pointed arrowhead, with a curvature towards the back of the pelvic cavity to allow space for the excretory and reproductive organs. The coccyx is also known as the tailbone (tail bone). This structure exists as 3-5 fused vertebral bones during adulthood, and separated segments when we are born. This fused structure is located at the very bottom of our spine. This structure is attached but not fused to the bottom of the sacrum. The structures and points of attachment for these two structures include the fibrocartilaginous joint and the sacrococcygeal symphysis. The sacrococcygeal symphysis allows for limited movement between the sacrum and coccyx.
Though the muscles in our hips and buttocks do much of the weight-bearing when we are sitting down, the coccyx also does some weight bearing, especially when we are leaning back when we are in a sitting position. Because of this weight-bearing, prolonged periods of sitting may result in pain especially when the coccyx has become injured or inflamed.
In many anatomy texts, the adult coccyx is described as one fused structure. Recently, the newer texts describe separated vertebral bodies separated by thin discs of fibrocartilage.
Injuries to the coccyx may result in a fracture of the vertebral bone, injuries to the ligaments that connect it to the sacrum, and injuries to the joints that connect the structures. The coccyx, being a weight-bearing structure, allows for some movement, but beyond the healthy range of movement, injuries to the involved structure may occur.
Let's take a look at the most common treatments for Coccyx Pain:
- Anti-inflammatories: Medications that reduce injury related inflammation include NSAID such as naproxen and ibuprofen, and Cox-2 inhibitors.
- Cold packs and Ice: Icing and application of cold packs to the area several times a day for the first few days may help to bring down the inflammation around the tailbone.
- Applications of hot packs or heat after the first few days may reduce pain and stimulate healing circulation to the affected areas.
- In the first few days of pain avoid prolonged periods of sitting or any activities that increase symptoms or put pressure on the bottom of the spine.
- Do your symptoms increase when you become constipated or have your bowel movements? If so, then you may want to increase your water intake or take stool softeners.
- If sitting causes an increase in your pain or discomfort, then try a custom pillow that is especially designed to take the pressure off your tailbone. The pillow should have a shape that supports your lumbar spine and healthy sitting posture. This pillow will also have an opening around your tailbone to take the weight-bearing responsibilities off of it. Some pillow designs that redistribute weight away from the tailbone include ones that are donut-hole shaped, V-Shaped, and U-shaped. With these Coccyx pillow designs, the tailbone should not come in contact with the seat or the pillow. Any sitting arrangement or pillow that takes pressure off the tailbone should help with the patient's treatment.
Additional Non-surgical Treatments for Coccyx Pain:
Many of the treatments above are designed to get the pain and inflammation under control, while the patients are in acute pain, in the first few days following the injury or onset of symptoms. Treatments such as these may be prescribed if the symptoms persist:
- Injection: These are the same steroid injections that are done to treat conditions in the cervical and lumbar spine. Typical injection procedures include Lidocaine (numbing agent) and Corticosteroid injections, which may provide relief lasting beyond 1 year.
- Manual Manipulation: Osteopathic and Chiropractic manual manipulation techniques may eliminate symptoms by stabilizing the affected structures.