Oh coccyx, my coccyx!

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By Britt Van Hees

 

If you don’t know what or where your coccyx is, count yourself lucky.  This little bone can make quite a ruckus when it’s not happy, often called coccydynia.  The coccyx, or tailbone, is our little vestigial tail, after eons of evolution.  It is often ignored and forgotten by most, but to me, it’s one of the most important bones in the body.  Today we’ll go over why the coccyx matters and how it plays a role in pelvic pain, muscle tightness, nerve issues and even your neck movement!

 

#1) The coccyx: small but MIGHTY rudder

 

coccyx-spine

 

The coccyx is a tiny bone that joins with the pelvis at the sacrum to create the sacrococcygeal joint.  Despite popular thought, the sacrococcygeal joint is mobile in many people.  This joint varies from synovial (maximal mobility), to fibrocartilaginous (moderate mobility), to ossified (no mobility).1  Also, it is not unusual to have a small articular disc at the sacrococcygeal joint to help with this movement.  Research has documented normal coccygeal movement is between 5-25° from standing to sitting.2 So, the coccyx can move.  The location of the coccyx, at the base of the spine, and its ability to move can have far reaching implications on the rest of the body. For example: a change at the coccyx changes how the sacrum and pelvis moves. The pelvis is the body’s center of mass, so where the pelvis goes the body goes. Who would think such a little rudder could steer such a big ship?

 

#2) The coccyx: central attachment point of fascia, ligaments and muscles

 

pelvic-floor

 

The coccyx is also a central attachment point of fascia, muscles and ligaments on the inside and the outside of the pelvis.  I mean, just look at all those beautiful muscles.  And check out these ligaments!

 

coccyx-front-and-back

 

So, if you imagine, a coccyx off-axis may create some problems.  Let’s just take the pelvic floor muscles as an example. If, say, the coccyx is pulled over to the left, all the pelvic floor muscles attached to the left side of the coccyx will get short and weak, while the ones on the right will get stretched out and weak.  This could lead to decreased “core” strength (pelvic floor is part of the “core”), incontinence (urinary or bowel) and/or pain (bowel, bladder, sex, exercise). The ligaments that attach to the coccyx also provide passive stability to the pelvis, primarily at the sacroiliac joint.  A shift at the coccyx could create ligamentous tension, leading to the same problems.  Some of these ligaments, like the anterior longitudinal and supraspinal ligament, even run all the way up to the head and neck!  You can imagine how childbirth, a fall or throwing your back out could create a problem, not only locally at the tailbone, but further up or down the chain.

 

#3) The coccyx: base of the nervous system, MAGIC

 

spinal-cord

 

This may be one of the more magical things.  The spine houses the spinal cord.  The spinal cord is the brain’s extension to the rest of the body.  It starts in the skull, runs the whole spine and then attaches to your coccyx.  The filum terminale (pictured above as Terminal filum), is the final thread of spinal cord that secures itself to the first coccygeal vertebra.  Sometimes, if there is stiffness in the spine or at the coccyx itself, it can impact the mobility and health of the nervous system.  When this happens the body may become protective in order to keep the nervous system safe.  Often this protection can create symptoms of numbness and tingling, or a tightness that does not resolve after normal healing time.  Examples of this would be a “hamstring tear” or “adductor strain” that has never fully healed.  Often, the tight “muscle” is actually an unhappy nerve, and stretching it may feel good in the moment, but afterward worsens the symptoms. Treating the tailbone is one aspect, along with a multitude of other rehabilitation techniques, to improve the health and mobility of the nervous system.

 

#4) Oh Coccyx, My Coccyx

 

So, what to do with all this information?  Well, hopefully be a little more thoughtful to your coccyx, it’s a cool little bone.  Nice things you can do for your coccyx include: proper sitting posture, pelvic clocks, or even just going for a gentle walk to get some blood flow.  And, if you’ve got pain down there, be sure to see your local pelvic floor PT or come visit us to get that tail wagging again!

 

 

References:

 

1.Lee DG, Lee L-J, Vleeming A, Jones MA. The pelvic girdle: An integration of clinical expertise and research. 4th ed. Edinburgh: Elsevier/Churchill Livingstone; November 17, 2010:24-25.

2. Fogel G, Cunningham P, Esses S. Coccygodynia: evaluation and management. J Am Acad Orthop Surg.2004;12:49–54.

 

About the Author

Britt Van Hees

Britt spent her early years on the island of Bermuda. She later moved to Tahoe and then the Bay for graduate school. She completed her Doctorate of Physical Therapy at Samuel Merritt University and continues to teach there as an Adjunct Instructor. Britt also is a Pilates trainer and yoga enthusiast. She most enjoys helping her patients learn about their bodies and return to healthy movement. She loves easy hikes among the redwoods, exploring new neighborhoods and a good cup of tea.



6 thoughts on “Oh coccyx, my coccyx!

  1. I have been looking through a lot of the blog posts and found them very helpful. I fell in Jan 2015 and my coccyx took the entire fall. For months I couldn’t even sit. Now the pain with sitting is pretty much gone. But I cannot empty my bowels and have severe abdominal pain and bloating everyday. Even passing gas is almost impossible sometimes. I saw a pelvic therapist for 6 months and we focused on dry needling and manual therapies. In other blog posts, it says that stretching the muscles is beneficial but this on relating to the coccyx says that it can hurt more after with the muscle stretching? So what is the best thing to get my right muscles to calm down? I have numbness always and sometimes burning at the tailbone region and have used my finger to help bowel movements every single time for a year since it is impossible otherwise. Please help!! I am only 24 and can barely function anymore since my stomach pain hasn’t taken over my life.

    • Author Britt Van Hees says:

      “Thank you for asking. It sounds like the pelvic floor therapy that focused on your muscles, via dry needling and manual therapy, was very helpful, especially since you can now sit with pretty much no pain. However, your coccyx itself may be in a dysfunctional position, limiting your ability to have complete bowel movements. Also, since your nervous system attaches to your tailbone, your numbness and burning could be related as well. I would find an osteopath or physical therapist who is trained in assessing, and if appropriate, mobilizing your coccyx to help with these other symptoms. Feel free to give a call for specific referrals or if you live near by, come for treatment. It sounds like there are definitely some additional treatments that would be appropriate for you to address the coccyx itself. Also, you may also want to find a functional nutritionist or naturopath to determine if there is any digestive support to reduce bloating and improve your bowel quality. You can also check out some of these other blogs: http://www.pelvicpainrehab.com/pelvic-pain/403/put-your-constipation-woes-behind-you/ and http://www.pelvicpainrehab.com/constipation/3535/whats-right-way-poop/

  2. Thanks so much for this article. I have taken courses with Liz and Stephanie and continue to use their techniques at my clinic in Mcminnville. I have a patient with significant coccyx pain but more of the other symptoms that are referred from the coccyx’s neural connection. Do you have any PT techniques that have helped you treat coccydynia? Thanks for sharing your information and writing an article that is written so well. Kind regards, Nora

    • Author Britt Van Hees says:

      “You are welcome! Yes, thank you for asking. There are a number of techniques to treat the coccyx that I have found helpful. I primarily work within the Institute of Physical Art paradigm, so that would be a good place to start. I believe the IPA has courses in Oregon, the Visceral course or perhaps the Pelvic Girdle Puzzle class would probably be the easiest way to get started. Osteopathic techniques can also be helpful. Essentially, you are trying to get the coccyx back “on axis” or “in alignment” with both external and internal treatment. Then you can treat the neural aspects with low vigor nerve glides. I would recommend taking a course before trying anything too crazy. Also, be aware, patients with heightening central nervous system response may need to work very slowly. And don’t forget, posture and appropriate biomechanics can do wonders for reducing symptoms- though I’m guessing you’ve already cleared that. Feel free to give our office a call if you have other questions.”

  3. What are your thoughts on coccygectomy? I spent 3-4 years in excruciating pain with inability to sit or basically function at all. I spent a year with a pelvic floor PT and did numerous other treatments to no avail. I was recommended to get a coccygectomy as a last resort and that happened over a year ago. My pain seems to have moved to concentrate in my rectum just inside my anus. 🙁 I was discharged from pelvic floor PT a year after the surgery because of no progress.

    • Author Britt Van Hees says:

      “Hi Megan,

      Thank you for your question. You have gone through a lot with your pain. It sounds like the pain at your coccyx is now just shifted to another nearby location. Coccygectomy is not my first choice of treatment since it is such an important structure and often does not provide much relief of symptoms- like your experiencing. I would be interested in restricted tissue around that area or even dural tension somewhere along the spine causing your anal discomfort. Also, if your nervous system is being a little too hyper-protective it could exacerbate these symptoms. Feel free to give our office a call and we can talk a little more about some additional treatment strategies and if there are any appropriate referrals in your area.”

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