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Coccydynia – a real pain in the tailbone

Coccydynia, or tailbone pain, is a fairly poorly understood condition that can cause persistent low back pain. It is felt as a localized pain at the very bottom of the spine (the coccyx) and will generally feel worse when sitting.

The condition is much more common in women than men. It is usually caused by local trauma (a fall) or giving birth. On rare occasions, an infection or tumor can also cause pain in the coccyx.

Local conservative treatments usually suffice to control or alleviate the pain. Rarely, surgical removal of the coccyx may be necessary if local conservative treatments are not effective in relieving the pain.

Causes of coccydynia

The coccyx is the very bottom portion of the spine. It represents a vestigial tail (hence the common term "tailbone") and consists of four or more very small bones fused together. The coccyx articulates with the sacrum through a vestigial disc, and is also connected to the sacrum with ligaments

It is not clearly understood which portions of the anatomy can cause coccyx pain. Either the ligaments or the vestigial disc may be a cause of pain and, rarely, a primary bone tumor or soft tissue tumor can cause pain.

It is thought that the condition is more common in women because:

  • In women the coccyx is rotated and faces backward, which makes it more susceptible to trauma.
  • Women have a broader pelvis, which means that sitting places pressure not only on their ischial tuberosities ("butt bone") but also on the coccyx. (Men tend to sit only on their ischial tuberosities without a lot of pressure applied to the coccyx).
  • Childbirth is a common cause of the condition.

The two most common causes of coccydynia are:

  • Local trauma. A fall on the tailbone can inflame the ligaments or injure the coccygeal attachment to the sacrum.
  • Childbirth. During delivery, the baby’s head rides over the top of the coccyx and can injure the same structures.

Conservative treatments for coccydynia

Patience is very important, since it often takes many weeks, or even months, for the pain to subside. Treatments for coccydynia:

If the pain is persistent or severe, additional conservative treatments may include:

  • Chiropracticmanipulations can provide relief.
  • Stretching the ligaments attached to the coccyx can be helpful.
  • Modalities with ultrasound, light/laser, electrostimulation can also be helpful.
  • A donut-shaped pillow to help take pressure off the coccyx when sitting.
  • Home icing.
  • A local injection of a numbing agent (lidocaine) and steroid (to decrease inflammation in the area) can provide some relief.
  • Anti-inflammatory medications