Coccydynia – When Standing becomes Easier than Sitting

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(Last Updated On: November 24, 2016)

Coccydynia in lay man’s terms is persistence pain in the coccyx (tail bone area) usually due to sitting for too long in wrong posture caused by inflammation and injury to Coccyx. It has significant effect on the quality of life. 

Causes of Coccydynia

  • Sitting continuously
  • Direct Trauma (Fall on buttocks)
  • Post pregnancy/delivery
  • Over tension muscles (anal levator)
  • Typically occurs when the bone in the Coccyx moved beyond limit ROM

Anatomy

The Coccyx is a small bone at the bottom of spine. It is made up of 5 rudimentary typically fused vertebras and is the lowest part of spinal column. The anterior aspect of Coccyx serves as attachment site of ligament and muscles (Important for many function of pelvic floor).

Coccyx supports the position of anus posteriorly and gluteus Maximus attached posteriorly. The damage to the muscle or a ligament can cause abnormal position of Coccyx.

Coccydynia Affects

  • Woman more than men (due to anatomical position of bones)
  • Bankers, Software engineers
  • Motor biker
  • Sportsman (Skating, rugby etc.)

The size of Coccyx varies from person to person. In males, hip is align, is more upright and sacrum is rotated inward however in females hip is tilted forward and sacrum is rotated outward. At the time of sitting males primarily bear more weight on lower part of hip called “Ischial tuberosity” and females more likely to bear some weight on Coccyx.

Females are highly at risk of getting impacted of Coccydynia due to increase pressure during pregnancy or delivery.

This typically occurs when the bone in the Coccyx moved beyond limit range of motion which causes the ligament between the bones of Coccyx inflamed. 

Symptoms of Coccydynia

  • Experience pain during sitting
  • Pain when coming out of seated position
  • Tenderness of Coccyx
  • Radiation pain due to lumber disc lesion.

Diagnosis of Coccydynia

Coccydynia can be diagnosed by taking a complete medical history and physical examination of the patient. MRI & X-ray are also commonly recommended in order to rule out other potential causes of pain. The most common finding on examination is local tenderness upon palpation of coccyx.

If there no tenderness or palpation at Coccyx, then pain is triggered from other structures, such as SI joint and Lumber disc lesion.

X-ray of the sacrum and coccyx to rule any fracture & MRI to rule out infection. 

Differential Diagnosis:

  • Preforms syndrome
  • Pudendal Neuralgia
  • Pilonidal Sinus 

Treatment

  • Conservative management/Medical
  • Surgical Management

Conservative Management: The first line of treatment is typically non– steroidal and includes anti-inflammatory drugs, which help to reduce the inflammation around the Coccyx which is the root causes of pain. Initially, patients are advised to avoid aggravating factors such as sitting in wrong posture for longer duration.

Most common treatment is an ergonomic advice such as sitting in the right posture and use a donut shaped pillow or gel cushion to avoid any pressure when sitting for long duration.

Ice pack is recommended in acute condition and hot water bath is advice in chronic conditions. Also exercises are advised by the professional to strengthen the weak muscle.

  • Buttock squeeze
  • Leg extension (In prone position)
  • Cat Camel
  • Strengthen of Piriformis by MET
  • Stretching of Muscle: Piriformis, Hamstrings, Tendo Achilles, Breathing/ relaxation exercises
  • Mobilization can be used to help realign the position coccyx
  • DTF Massage to the affected ligament
  • Ultra Sound therapy/ shortwave diathermy are also commonly advised 

Surgical Management:

This includes surgical removal of all or portion of Coccyx. Surgery is the last resort for the patient with minimal recovery from conservative treatment.

Want to know more about Coccydynia? Download Portea’s Mobile app and chat with a doctor for free. You can also book physiotherapy sessions via our app or through the website; visit: Physiotherapy at Home

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Dr. Rashmi has a master’s degree in physiotherapy from PGIMS Rohtak, Haryana with specialization in musculoskeletal. She holds 7 years of experience in Clinical and has vast exposure to sports injury, neurological and rehab cases. Besides work, she is an avid reader and a passionate traveller.

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