Coccyx Pain: A Huge Pain in the Butt!

Pieter Brueghel the Younger, c. 1616

The term coccydynia was coined in 1659, but coccyx pain, or pain in the tailbone, has likely been afflicting man since the beginning of time. After all, humans have been falling on their behinds for thousands of years.

While there can be many causes of coccyx pain, this post focuses on traumatic injury localized to the coccyx bone.


What is a coccyx?

The coccyx is a small triangular bone that forms the very tip of the spinal column. Though it’s a remnant of the tail, it serves as a crucial attachment site for various tendons, muscles and ligaments that contribute to the pelvic floor. It also is a weight bearing structure for sitting.


A traumatic injury, such as a fall or a difficult vaginal delivery may cause a shift or fracture of your tail bone which can lead to a change in pelvic floor muscle length and give rise to a cascade dysfunction. In addition to tenderness at the tip of the tailbone, injury to this structure can cause pelvic floor muscle spasm or muscle weakness. If left untreated, symptoms can progress, manifesting  as pelvic pain,  difficulty with  urination and defecation, or even urinary and/or fecal incontinence.


Symptoms of true coccydynia include:

  • sitting pain at the tail bone or sitting intolerance
  • pain with moving from a seated position to a standing position (pain usually resolves while standing)
  • pain in both glutes (butt cheeks) and/or both hamstrings


What to expect for evaluation of coccyx at EMH Physical Therapy:


First, the therapist will perform a posture analysis to determine spinal and pelvic alignment. The therapist will observe the pelvis and palpate (feel) the coccyx externally to determine if it is shifted, rotated, curved or extended.


She will then assess the muscles that attach to the coccyx externally to determine if they are painful and tight, or weak and overstretched.


An internal exam will then be performed in order to reach the anterior surface of the coccyx and the full length of the pelvic floor muscles to confirm the diagnosis.


An internal sensor may be used to get objective information with regard to exactly how the pelvic floor muscles are firing.


Based on the results of the evaluation, the therapist will treat your tailbone pain by mobilizing the coccyx, releasing the tight muscles and strengthening the weak ones in order to restore normal alignment and function.


Lastly, the therapist will design an individualized home exercise program to reinforce the techniques used during the physical therapy session that will address both the local coccyx pain and the global, full body strength and alignment.


For best results, research shows that it is best to seek physical therapy treatment within the first six months post injury. So hang up your “donuts”, “butt cushions” and heating pads, and treat yourself in 2016 by making an appointment at EMH physical therapy to kick coccyx pain’s butt!

Six Ways to Help Manage Constipation

Constipation[Photo credit: PracticalCures.com]

Constipation is a common condition that affects up to 42 million Americans which is usually caused by:

  • Dysfunction with the nerves, muscles, or hormones in the body
  • Pelvic floor dysfunction leading to an outlet dysfunction
  • Delayed transit through the colon
  • Lifestyle and dietary habits

Specific factors such as medications, lack of physical activity, dehydration, lack of fiber in the diet, pregnancy, aging, travel, laxative overuse, diseases, and IBS form the majority of reasons a person develops constipation.


Constipation is currently diagnosed through a cluster of symptoms, which include hard stools that are difficult to pass, straining for 25% of defecation, a sensation of incomplete evacuation for at least 25% of bowel movements, and fewer than 3 bowel movements per week.  If your constipation results from a dysfunction of the nerves, muscles, or hormones in the body, you will need to consult your doctor and may need to seek out a physical therapist specializing in pelvic floor dysfunction; they can also assist you in making the necessary changes if your constipation results from lifestyle and dietary habits.


However, here are some simple lifestyle changes to help manage constipation:

 1.) Diet modifications

Certain types of foods can increase constipation (processed foods, cheese, white rice, red meat, bananas, dairy products).

Increasing fiber intake is important for the health of the digestive system and can help alleviate constipation. There are two types of fiber: soluble and insoluble. Soluble fiber helps to soften and bulk stool, while insoluble helps to promote movement through the colon.

  • Soluble fiber examples: fruits, vegetables, legumes, nuts, seeds, oats.
  • Insoluble fiber examples: whole grains, brown rice, oat and corn bran, some vegetables and root vegetable skins.

 2.) Anxiety and stress management

Stress is a common cause of constipation. Increased anxiety and stress triggers the sympathetic nervous system (our “fight or flight” response) and deactivates the parasympathetic nervous system (the “rest and digest” system).  This not only decreases the activity of the digestive system, slowing transit through the colon, but also decreases the body’s ability to relax the muscles of the pelvic floor to allow for defecation.

3.) Daily aerobic exercise

Moderate levels of aerobic exercise increases blood flow to the digestive system and improves function. Any form of exercise is beneficial, and can be as little as a 10-20 minute walk.

 4.) Toilet posture/positioning

Proper toilet posture can help assist in relaxation of pelvic floor muscles to allow for improved ease of bowel movement and decreased straining. Modern toilets typically create a sitting posture that does not allow the anorectal angle to straighten, which may increase difficulty with voiding.

For improved ease of bowel movement, the best toileting position is one that mimics a squatting posture. Placing the feet on a stool to increase the amount of hip flexion while sitting is a simple solution to create a better toilet posture.

 5.) Drink water, plenty of it

Dehydration is a common cause of chronic constipation. Decreased fluid intake can lead to firmer, harder stools that are more difficult to pass. Current recommendations for fluid intake vary depending on activity level, health status, and the environment. Generally, a good rule is to aim for around 2 liters of water intake per day.

 6.) Sleep!

Sleep deprivation can slow the intestinal slowdown and decrease bowel regularity. Sleep recommendations vary based on individual needs, however most resources continue to suggest aiming for 7-9 hours per night.

Intimacy Postpartum Doesn’t Have to Hurt

post baby sexIn complete irony the same activity that gave you your little bundle of joy can be painful, daunting, and scary postpartum. I’ve reached the age where the majority of my friends have one or more babies and our group text is rife with complaints about the post baby “bounce back”. If 100% of my girlfriends have complained of pain or aversion to sex post baby I assumed that most women have some concerns about it.

Why Postpartum Pain during Intimacy Occurs

Well, there’s the obvious:  you just pushed a human out of a place that is normally a whole heck of a lot smaller than a baby. If you had a C-section, your doctor had to surgically create an opening to deliver your baby.  If you had an episiotomy or perineal tearing, residual scar tissue can restrict your abdomen and pelvis making intercourse feel painful. In addition, your life just got a whole lot more complicated. You’re now the caretaker for a little miracle and your mind may be on your fragile new baby instead of getting it on with your hubby. Thoughts and distractions can be a powerful libido killer. Lastly, your body is just not the same as it was pre-baby hormone wise. While breastfeeding, your estrogen plummets, and the hormone level in the vagina may be lowered while your whole body focuses on making enough milk for your baby.

post baby massageHow to Overcome Postpartum Pain during Intimacy

  • Firstly, if you had a c-section or episiotomy, self-massage of the vaginal area can be a helpful tool for breaking up scar tissue that may be causing pain. Tips: be gentle with yourself! Don’t rub over the scar but simply hold pressure on the area of discomfort for 5 seconds and then try to move the skin around the incision. Don’t be shy! You can even have your partner gently massage where the perineal or episotomy scar is located if you’re working on an episiotomy scar.
  • Next , when attempting intercourse, use lubrication. Low estrogen levels lead to a lower libido, which means less arousal and less lubrication in the vaginal tissue, and even thinner, more brittle tissue. If you’re into the natural stuff even coconut oil will do. Otherwise try any over the counter kind you like. Your MD may even prescribe a topical cream with some estrogen to help the vaginal tissue bounce back.
  • So you’re lubed up and ready to go…what next? Try different sexual positions, such as being on top of your partner, so you are better to control the depth and speed of penetration. Remember: everyone heals differently. There’s no rush, and you need to communicate with your partner what feels good and what doesn’t.
  • Last tip: don’t forget that you can still get pregnant during postpartum healing.

If you feel like working through the suggestions in this blog on your own is too daunting or you feel like you need professional help, let your MD or physical therapist know. At EMH physical therapy we can help. We specialize in women’s health including any issues that occur post-partum. You deserve to feel like “you” again, so you can be the best mom for that new baby!

Leaking is More Common Than You Think

Hmmm…. How to put this delicatelyWoman jogging on a track

Do you often find yourself leaking urine while exercising?  Squat… leak a little, overhead press… leak a little more, jump… forget about it, pants are soaked!

If this describes YOU, know that you are not alone. You likely fall into the 25% of women between the ages of 18-44, or the 44% of seniors, or the 33% of female athletes who experience varying levels of incontinence. These astounding statistics represent only those who have come forward to report symptoms. If you are skeptical, just take a look at YouTube (search “girl peeing while lifting weights”). You will find solidarity; everything from women admitting to leaking during exercise, to videos of complete loss of bladder control while executing a heavy lift. Today, there are even T-shirts glorifying urinary leakage during workouts in order to empower women and banish feelings of shame.

It is wonderful that women are finally coming forward to bring this previously taboo topic out into the open.  Just last week, Kate Winslet explained that she no longer jumps on trampolines for this very reason.  Leaking when exercising, sneezing, or coughing is so normal that Winslet’s admission was received with more “it’s nice to know she’s normal” reactions than surprised ones.  Yet, shockingly, statistics show that women will wait, on average, 6.5 years before reporting incontinence, because as normal is it may be, women rarely speak of it, even to their medical providers.  It’s no wonder urinary (and fecal) leakage has generated a $28 Billion dollar industry in the US alone.

If you are leaking while exercising, it is likely that your pelvic floor muscles are just not firing properly in order to withstand the load. We call this Stress Urinary Incontinence (SUI) which describes urinary leakage that occurs particularly with physical activity or exertion. While this issue is extremely common, it is not something you want to leave untreated. Whether you are losing a few drops or outright “peeing your pants”, help is out there, in some cases, right around the corner.

First you must understand that the pelvic floor muscles are just that: muscles. Therefore, you can strengthen them like any other muscle. We spend hours in the gym attempting to perfect every muscle in the body, but somehow forget the pelvic floor, a keystone to our overall health and fitness.

The tricky part is that you can’t easily see these muscles. As a matter of fact, you may not even be able to feel them. That is where Pelvic floor rehabilitation comes to the rescue. At EMH, we teach you how to identify, isolate and strengthen the pelvic floor muscles to restore normal function. We then help you integrate pelvic floor techniques back into your exercise routine so that you can squat, overhead press, and jump “leak free”.

So at your next holiday party, just think to yourself — 1 in 4 of the women in this room are currently peeing in their pants. Luckily, you don’t have to be one of them.

When Kegels Do More Harm Than Good

Sit forward, slight inward curving back to prevent a short pelvic floor

Strength Training for healthy muscle is generally good – it thickens the muscle tissue (hypertrophy), increases motor neurons activity for better awareness and reaction time, and improves muscle tone.  Kegels, a specific exercise for the pelvic floor, may help in reversing incontinence, preventing prolapse, increasing sexual pleasure, and stabilizing our core, but they don’t do the full job by itself and can be harmful.   As a pelvic physical therapist treating men and women with pelvic floor dysfunction and pain for 18+ years, I’ve found that the regular performance of Kegel exercises, especially if self-taught, may aggravate or even lead to dysfunction and pain.

How can Kegels do Harm?

Most people who experience leaking, urgency, prolapse, sexual dysfunction and pain in pelvis/groin/hip have short, or “non-relaxing” pelvic floor muscles. A short pelvic floor means just that – instead of returning to a lengthened state at rest, the muscle stays chronically short. Performing repetitive Kegel exercises to these already shortened muscles can further shorten and weaken those muscles leading to pain.  At EMH Physical Therapy, we advocate learning how to relax and lengthen the pelvic floor while recruiting other external muscles to work more effectively for best outcome.

What is the function of the Pelvic Floor?

The pelvic floor muscles attach from the pubic bone in front of the pelvis to the coccyx bone in back. During pelvic floor contraction, the muscle gently pulls the coccyx slightly forward.  The pelvic floor squeezes the urethra shut when not at the bathroom (no leaking), relaxes during urination (no hesitation) and bowel movement (no constipation), and works with the deep lower abdominal and lower back muscles to stabilize our body in preparation for movement (preventing back/hip pain).

A chronically short pelvic floor keeps the coccyx tucked forward, cannot fully relax during urination and bowel movements and because it is weak, can lead to leaking.   Research shows that pregnancy is not the main cause of pelvic floor issues, as teenaged girls, women athletes who have not been pregnant and men suffer from pelvic floor issues.

How does the Pelvic Floor become Short and How to Reverse this Habit?

Think about how you position and use your body during your day.

At the office: are you placing weight backward on the single small coccyx bone (not good) or on your two larger ischial tuberosities (good)?

Is your lower back rounded or flat (not good) or have an inward curve (good)?

At home: Avoid slouching on couches – use back pillows and support your feet.

Here are some Tips to Reverse a Short Pelvic Floor

  • Sit with your spine against the back of your chair, placing a roll or pillow in the lower back.
  • Stand up regularly.
  • Keep your gluteal muscles toned with regular squats, bridging or hip extensor exercises. Gluteal activation helps to lengthen the pelvic floor to prevent chronic shortening
  • Keep your hamstrings and inner thigh muscles flexible. STRETCH or foam roll these muscles. Tight hamstrings and adductors directly refers tension into the pelvic floor.
  • Check your pelvic floor tension throughout the day- gently squeeze this muscle first and then completely release. Feel this release for a few seconds and see if you can relax a bit further.
  • Take a deep slow inhale – allow your abdomen to expand and think of the pelvic floor widening as you inhale. Exhale as you keep the pelvic floor open.
  • Yoga positions such as Childs Pose, Happy Baby and Pigeon Pose help to open the pelvic floor and hips as you slowly breathe.  Maintain each position for 30 seconds.
  • Consult with a pelvic physical therapist for tailored therapy and home exercise program

Why Use Meditation in Physical Therapy


Photo credit:  giphy.com

Meditation’s Benefits

Many people hear the word meditation and instantly think of trendy yoga girls, cheesy narrated audio guides, and Buddhist monks.  While it may be tempting to write off meditation as part of a new age spiritualism that you’re just not into, meditation does not have to be tied to specific philosophy or religion.  Meditation is really about quieting your mind, listening to your body, and allowing yourself to release thoughts of the past and future, if only for the moment.  The reality is that anyone can meditate, and there are as many varieties of meditation as there benefits.

[Read more…]

Event: Healthy Body After Baby Talk

Parents Feet and Baby Booties

This fall is turning into a busy one for us here at EMH!  Not only do we have Dr. Echenberg joining us this October, but we will be hosting an event at the end of November for new and expectant moms.  In addition to getting to meet other moms, this event will be a talk by our very own therapists, Kirsten Hober and Charissa Morrisroe on the effect pregnancy has on the pelvic floor, how your body changes both during and after pregnancy, and some exercises and posture techniques that are easy to implement while caring for your baby.

[Read more…]

Dr. Echenberg to Join EMH in October 2015

In October of 2015, EMH Physical Therapy and The Echenberg Institute for Pelvic and Sexual Pain will begin a collaborative initiative in New York City for comprehensive assessment and treatment of men and women with chronic pelvic pain.

We are pleased to announce that in October 2015, Robert J. Echenberg, MD, FACOG, world renowned for his expertise in the treatment of chronic pelvic, genital and sexual pain, will be working with Evelyn Hecht PT ATC of EMH Physical Therapy, the premier pelvic specialty practice located on the Upper East Side of New York City.

Together, we will offer our expert services in one place where men and women suffering with chronic pelvic pain/pelvic floor dysfunction can be diagnosed, educated, receive a broad range of treatments and find support.

[Read more…]


An App for Pelvic Floor Dysfunction

The PelvicTrack app helps you gain control over your pelvic pain or pelvic floor dysfunction.

  • Tracks symptoms and pain levels
  • Records data on bladder and bowel activity
  • Provides exercises that a pelvic physical therapist may prescribe for patients
  • Includes daily reminders for pelvic awareness
  • Shows reports of improvements gained over time

PelvicTrack Set Reminder TabPelvicTrack Exercises TabPelvicTrack Reports Tab

PelvicTrack Reports - Pain TabPelvicTrack Maps TabPelvicTrack Symptom Tracking Tab

Take charge of your pelvic floor dysfunction treatment.

The PelvicTrack app was written by a Physical Therapist who has specialized in the treatment of pelvic floor dysfunction for more than 18 years, and is ideal for anyone experiencing:

  • pelvic pain
  • abdominal pain
  • constipation
  • urinary frequency/urgency
  • sexual dysfunction

You can use it as a way to easily look up common pelvic exercises, as a personal symptom log, as a personal assistant reminding you to do your home exercises, or even to find a physical therapist in your area on our “Maps” tab.  With the “Reports” tab, you can rate your symptoms each month to see progress over time.

Always consult with your health care provider before starting an exercise program.


Stay Connected to your Pelvic PT

The best way to use the app is when receiving care by a pelvic physical therapist. Your therapist can recommend exercises, adapting treatment as they measure and monitor your progress. When you use the app on your phone, your therapist can help you find and save home exercises in your favorites eliminating the need for paper handouts that can get lost, ripped, or forgotten.  To keep your therapist up to date with your progress, you can take a screen shot of your reports to email or show him or her during your next visit.

Male Pelvic Pain: 3 Steps for Relief

th-1Do you have any of the following symptoms?

  • Bladder pain
  • Feeling of pressure or heaviness, deep within the groin area
  • Burning or numbness inside the shaft or at the tip of the penis
  • Painful intercourse
  • Erectile dysfunction
  • Pelvic floor muscle tenderness
  • Tail bone pain with sitting
  • Urinary urgency/frequency
  • Urinary incontinence
  • Constipation
  • Testicular pain or heaviness

If you answered “Yes” you may have pelvic floor dysfunction or pelvic pain

How to assess:

1.) Are you a “butt clencher”?

What are your gluteal muscles and the muscles and surround your rectum doing right now? Are they tense? Chronic holding in these muscles could lead to many of the above symptoms. Relax the tension now.

Quick fix: Allow the gluteal and rectal region to soften, lower, and relax. Focus on imagery that is relaxing to you, such as a beach on a beautiful day or laying in a hammock on a breezy spring day.

 2.) Are you a “slouchy sitter”?

Are you sitting with all your weight on the tail bone in a posterior pelvic tilted position?

Quick fix: Have a co-worker take a picture of you at your work desk. This will help you adjust your posture. First, have your feet firmly planted on the floor. Sit up straight on your “Sit bones” you should be able to feel them if you sit on your hands. These bones are made to bear you body weight, not the tiny tail bone that is smaller than your pinky toe bone. In order to maintain this upright position, you may need a small towel roll or lumbar roll placed in the small of your low back for support.

3.) Are you a “chest breather”?

Take a nice deep inhale. Did your chest, neck, and shoulders do most of the work to inhale? If so, you are not breathing as effectively as you could.

 Quick Fix: place your hands on your belly, and take a deep inhale focusing on expanding the rib cage and belly as the air comes into your lungs. Exhale, letting the belly relax back to your resting position. Take 10 of these deep belly breaths once an hour.

Did you find the above self-assessment helpful?

You may be a candidate for a thorough assessment by a pelvic floor physical therapist.  Don’t be afraid to speak up! Tell your MD or Physical therapist what you are feeling in order to get the help you need, and seek an evaluation from a physical therapist trained in pelvic floor PT.  Healing time will vary, but you do NOT need to live with pelvic floor pain!  Your healing journey requires a team approach; your enthusiasm and effort combined with physical therapists, nutritionists, urologists, gastro-intestinal MD’s, acupuncturists, and massage therapists. It’s time to take your health into your own hands.




  1. Anderson, R. U., Wise, D., Sawyer, T., & Chan, C. (2005). Adult Urology: Infection/Inflammation: INTEGRATION OF MYOFASCIAL TRIGGER POINT RELEASE AND PARADOXICAL RELAXATION TRAINING TREATMENT OF CHRONIC PELVIC PAIN IN MEN. [Article]. The Journal of Urology, 174, 155-160. doi: 10.1097/01.ju.0000161609.31185.d5
  1. Bø, K., Berghmans, B., Mørkved, S., & Kampen Van, M. (2007). Evidence-based physical physical therapy for the pelvic floor. Bridging science and clinical practice Evidence-based physical physical therapy for the pelvic floor. Bridging science and clinical practice B2 – Evidence-based physical physical therapy for the pelvic floor. Bridging science and clinical practice. New York: Elsevier Butterworth Heinemann
  1. Dorey, G. (2006). Pelvic Dysfunction in Men: Diagnosis and Treatment of Male Incontinence and Erectile Dysfunction Pelvic Dysfunction in Men: Diagnosis and Treatment of Male Incontinence and Erectile Dysfunction B2 – Pelvic Dysfunction in Men: Diagnosis and Treatment of Male Incontinence and Erectile Dysfunction. Chichester: John Wiley & Sons Ltd.
  1. Tanner, Holly. Introduction to Female and Male Pelvic Pain. com continuing education.