If you feel pain and discomfort in the lower back region while sitting and standing, it could be tailbone pain. Here is how to get rid of it.
Do you suffer pain and uneasiness while sitting down? If this happens whenever you sit, this is a warning sign of coccydynia. This is the medical term for tailbone pain that causes acute discomfort for people dealing with it. As per doctors, this condition is caused due to inflammation and can affect everybody irrespective of age and gender. However, women above 40 years are at greater risk as it is found that this condition is highly prevalent in middle-aged women. Onlymyhealth connecting with Dr. Jayashree T. Sonkusale, Physiotherapist from Sancheti Institute of Orthopaedics and Rehabilitation, Pune, to understand the cause, symptoms, diagnosis, treatment and prevention of tailbone pain or coccydynia.
Where is the tailbone situated?
To begin with, let us understand the anatomy of the tailbone. Coccyx or tailbone is a small triangular bone situated at the bottom of the spine. This bone has about 3-5 fused segments and the largest segment connects to the lowest sacral segment. Tailbone is relatively smaller than other bones but it carries many important functions like:
- Attaching the gluteus maximus muscle(situated in the buttocks)
- Attaching anococcygeal ligament and coccygeal muscle
- Provides support during the sitting position along with ischial tuberosities.
- Offers positional support to the anus
The above pointers show the importance of tailbone or coccyx for body functions. Inflammation in the tailbone would not only cause pain and discomfort during sitting but can also hinder other functions that it is associated with.
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Structure and Types of Tailbone
Dr. Jayashree explained that there are four types or structures of the tailbone and these may cause a predisposition to coccydynia(tailbone pain). Based on the configuration of the tailbone, here are its four types:
- Type 1: The tailbone is slightly bent forward and its apex is pointing beneath (70%)
- Type 2: The tailbone is bent more markedly in the front and its high point is directing straight forward (15%)
- Type 3: The tailbone is sharply inclined anteriorly between either the first-second or second-third segments (5%)
- Type 4: The tailbone is subluxated(partially out of the joint) anteriorly. This either occurs at the level of the intercoccygeal joints or the sacrococcygeal joint (10%)
NOTE: People with type 2 and type 4 configurations are highly likely to develop idiopathic tailbone pain as compared to others.
Causes of Tailbone Pain
There are several risk factors or causes linked to tailbone pain or coccydynia that you must know to understand the problem better. Once you know the cause, it would be easier to get it diagnosed. The common causes of tailbone pain are:
- Obesity and Broader Pelvic Structure: Most women have a broader pelvic structure which is why women tend to suffer from tailbone pain more than men. The broader structure reduces pelvic rotation and exposes the tailbone making it prone to injuries. Women tend to suffer increased pain due to pelvic muscle cramps in the premenstrual period.
- Sudden weight loss is also a primary factor as it affects the mechanical cushioning that causes the development of tailbone pain.
- Activities such as horseback riding, bicycling, etc. that involve prolonged sitting pressurises the tailbone area and may trigger tailbone pain.
- When the levator muscles get over-tensed, it can cause a positional change of the tailbone and result in acute pain.
- Minor pain is caused when you sit on uncomfortable, narrow or hard surfaces for long periods.
- Tailbone pain due to external trauma occurs when a person experiences a backward fall that leads to a broken, dislocated or bruised tailbone.
The other non-accidental causes of tailbone pain are disc disease or degenerative joint, infectious etiology and hypomobility or hypermobility of sacrococcygeal joint, to name but a few.
What are the symptoms of Tailbone Pain?
Tailbone pain is experienced when the coccyx bone is suppressed, dislocated or broken. The main symptom is a pain in the lower back part particularly when you sit or try to sit down. This pain would intensify or worsen with prolonged sitting, prolonged standing, leaning back or trying to get up from the seated position. Some people may also suffer pain during defecation and sexual intercourse. Any activity that exercises the tailbone would trigger acute pain and discomfort.
Diagnosis of tailbone pain
Now the question comes, how is tailbone pain diagnosed? The best person to find out about this condition is the patient itself. Experiencing pain while sitting, standing and leaning is a sign of coccydynia or tailbone pain. You need to visit a doctor to get tested for the condition. As told by Dr. Jayashree, these are the tests that doctors or physiotherapist do to find out about the problem:
Palpation: The first thing that an expert would do is to check the local tenderness of the affected area. In the palpation method, the doctor would conduct a physical examination to feel and touch the area around coccyx(tailbone) to examine the location, size, texture, inflammation or swelling, cysts or tumors. This method is also exercised to examine potential bone spurs or coccygeal spicules.
Intrarectal exam and manipulation: To examine the excessive or restrictive mobility of the joint, the expert would manually manipulate the tailbone through the rectum. This process is also called Intrarectal manipulation that helps in examining any muscle tension in the lower part of the body(pelvis) that connects to the tailbone.
Radiographic images: These help to identify any bone fractures, masses or degenerative changes.
Treatment of Tailbone Pain
In most cases, tailbone pain is resolved through supportive care. The symptoms and pain may persist for months or years(in rare cases). However, some patients may have to deal with this the entire life but it is very uncommon. Sadly, patients with intractable tailbone pain or coccydynia have a poor quality of life as they are unable to live life normally.
- The treatment of severe tailbone pain is generally non-surgical or non-invasive. The success rate with these is almost 90%. The only suggestion by the doctors is activity modification that can resolve the condition without requiring medical aid.
- For 10% of cases, Coccygectomy(surgical treatment to remove the tailbone) is performed. This treatment is considered only when other conservative options like rest, painkillers, steroid injections, physiotherapy, etc. fail.
- Anaesthetic steroid injections at the tailbone region where bones join is also given to ease the pain. These are given to patients that do not find relief with rest and physiotherapy.
How Does Physiotherapy Help in Alleviating Tailbone Pain?
Physiotherapy is considered the best solution for tailbone pain. As per physiotherapist Dr. Jayashree T. Sonkusale, physiotherapy aims to:
- Increase the flexibility of iliopsoas, the piriformis muscle
- Reduce pain and inflammation (ice /cold packs or hot bath were as long as weight is kept off the tailbone in bathtub; ultrasound therapy 3 MHZ pulsed mode)
- Increase the strength of pelvic floor muscles. (Anal lock/ anal sphincter exercise)
- Improve the alignment of coccyx through mobilizations and manipulation.
- Release adhesions using deep transverse friction massage.
- Training to adopt proper sitting postures so that weight is taken off the tailbone.
Tailbone pain is common but it should not be neglected. This may aggravate causing severe repercussions. Thus, one should consult a doctor or physiotherapist upon experiencing pain in the lower back region. You can also use supportive pillows (coccygeal cushions) to relieve pressure. Be vigilant and take the necessary steps to ward off the problem at the initial stage.
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