Coccydynia is pain in the tailbone that makes itself felt when sitting down, standing up from a chair and during longer sitting on a hard surface. It is sometimes also felt during bowel movements and during intercourse, because the pelvic floor muscles attach to the coccyx.
The most common causes are a fall onto the buttocks, childbirth - particularly instrumental delivery - and chronic overload from sedentary work. Sometimes the coccyx is locked in flexion and does not tilt on sitting the way it should, with the surrounding muscles holding it there.
This is one of the few conditions where physiotherapy is the first-line treatment - ahead of injections and well ahead of considering removal of the coccyx. Manual therapy and release of the attaching muscles improve symptoms in most patients, provided the work is done from the side where those muscles are accessible - that is, examination and treatment per rectum, always with explicit consent.
Therapy
- History: injury, childbirth, long sitting, previous surgery
- Examination of coccyx mobility
- Manual therapy of the coccyx, including internally
- Releasing the levator ani and coccygeus muscles
- Work on the ligaments and fascia of the sacrococcygeal area
- Correcting sitting position and choosing support
- A home programme