Tailbone Pain Chronic Coccydynia

Acute coccygodynia is most often caused by trauma to the coccyx and its surrounding structures, usually due to falling while in the half-seated position. The coccyx itself is a bony structure attached to the end of the sacrum and is composed of three to five segments. The first and second segments may be separated by an intervertebral disc, but more commonly the segments are fused. The mobility, however, between the first and second segments predisposes this segment of the coccyx to fracture and dislocate.

On the other hand, chronic coccygodynia is most commonly due to faulty posture while sitting, or trauma to the coccyx during childbirth. Sitting in the slouched position puts stress on the coccyx rather than on the ischial tuberosities. Other possible causes for coccygeal pain are chronic infection and dysfunction of the musculature of the pelvic floor.

People without a spinal cord injury, who experience rectal pain, typically elicit a positive “jump sign” when the sacrococcygeal ligament is palpated. Prolotherapy to this ligament is curative in most cases. Some patients may also have laxity in the sacroiliac joint, which requires treatment to resolve the chronic rectal pain.

No standard traditional medical treatment for Coccydynia or tailbone pain has been found to be very effective, and patients and physicians often become rather frustrated during the process of trying. However, some patients may find temporary relief with sitz baths, which involve sitting in a tub of hot water; local anesthetic creams; muscle relaxants; electric stimulation devices; and sometimes anti-depressants.

Although cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, both result in long-term loss of function and even more chronic pain by inhibiting the healing process of soft tissues. See our article when NSAIDs make pain worse.

Non-surgical treatment of  Coccygodynia (Tailbone Pain)

If trauma has been caused to the coccyx and its surrounding structures, as can happen through a fall in the half-seated position or during childbirth, or stress has been put on this area through years of faulty posture while sitting, ligament damage will be the cause of the pain. Prolotherapy to the weakened pelvic ligaments helps the coccyx heal and return to normal strength. Once the sacrococcygeal, iliolumbar and other weakened pelvic ligaments are strong again, the chronic tailbone pain abates.

The connection of soft tissue damage and coccydynia has been made by researchers at the Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center who found positive physical therapy treatment to the pelvic floor muscles provided relief of coccydynia.1

Department of Physical Therapy and Athletic Training, Boston University had also previously made this connection with physical therapy and the one-year success of cortisone injection for coccydynia

The BU doctors reported on the cases of two women, 26 and 31 years of age, who were sent to physical therapy with persistent coccygeal pain that increased with prolonged sitting and intensified when transitioning from sit to stand.

The patient with a traumatic onset of symptoms was referred to physical therapy at the onset of her symptoms, whereas the patient with a nontraumatic onset of symptoms was initially treated with a cortisone injection and, when symptoms returned 1 year later, was referred to physical therapy.

Both individuals underwent manual therapy to the sacrococcygeal joint over 3 treatment sessions. Successful clinical outcomes were achieved in both cases.2

Coccyx Injury

A 46 year-old woman came to Caring Medical with a history of constant tailbone pain for almost six years. The area above the tailbone was tender and swollen. The patient suspected that the injury stemmed from a fall on ice where her tailbone hit the corner of a concrete step. The pain was unbelievable at the time, so she subsequently went to the emergency room where x-rays did not reveal any damage.

The tailbone, or coccyx, attaches to the sacrum via the sacrococcygeal ligaments. When ligaments are injured, as in the case of this woman who fell, the joints they support sustained excessive movement, which put additional strains on the injured ligaments. A swollen joint after trauma typically indicates ligament injury. Ligament injuries do not show up on x-ray. The patient received a series of four Prolotherapy treatments and was completely healed of her pain. Results may not be typical in all cases.

Chronic rectal or tailbone pain can be horribly disabling as this case illustrates. After extensive testing, patients are often given dubious diagnoses such as proctalgia fugax, anorectal neuralgia, levator ani syndrome, coccygodynia, or spastic pelvic floor syndrome.  Typical conservative traditional treatments include pain medicines, sitz baths (sitting in a warm tub), local anesthetic creams, massage, muscle relaxants, electrical stimulation gizmos, or the end-all pain treatment, an anti-depressant medication. Such treatments generally have unsatisfactory results because they do not correct the underlying cause of the chronic rectal pain.

Prolotherapy injections, which strengthen the supporting structures of the sacrococcygeal joint, eliminate chronic rectal pain because they address the root cause of the problem. Chronic rectal pain from coccygodynia occurs because of a weakness in the sacrococcygeal joint or a weakness between one of the coccygeal segments. Prolotherapy to strengthen the ligamentous support of the weakened area cures chronic rectal pain from coccygodynia.

1 Scott KM, Fisher LW, Bernstein IH, Bradley MH. The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy. PM R. 2016 Aug 24. pii: S1934-1482(16)30880-2. doi: 10.1016/j.pmrj.2016.08.007.

2 Marinko LN, Pecci M. Clinical decision making for the evaluation and management of coccydynia: 2 case reports. J Orthop Sports Phys Ther. 2014 Aug;44(8):615-21. doi: 10.2519/jospt.2014.4850. Epub 2014 Jun 23.



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