Coccyx Pain:  A Huge Pain in the Butt!

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!