What are the common causes of coccydynia. How can tailbone pain be diagnosed and treated. What lifestyle changes can help alleviate coccyx discomfort. When should you seek medical attention for persistent tailbone pain.

What is Coccydynia? Understanding Tailbone Pain

Coccydynia, commonly known as tailbone pain, is discomfort or pain in the coccyx – the small triangular bone at the base of the spine. This condition can cause significant discomfort and affect daily activities. Understanding the nature of coccydynia is crucial for proper management and treatment.

Anatomy of the Coccyx

The coccyx, often referred to as the tailbone, is the final segment of the vertebral column. It consists of 3-5 fused vertebrae and is connected to the sacrum by a joint and ligaments. The coccyx serves as an attachment point for various muscles, ligaments, and tendons, playing a role in weight-bearing when sitting.

Common Causes and Risk Factors of Coccydynia

Coccydynia can result from various factors. Understanding these causes can help in prevention and targeted treatment.

• Direct trauma or injury (e.g., falls, sports injuries)
• Repetitive strain or prolonged pressure (e.g., cycling, long periods of sitting)
• Childbirth
• Poor posture
• Obesity
• Bone spurs or degenerative joint changes

In some cases, coccydynia may develop without an identifiable cause, known as idiopathic coccydynia.

Hypermobility and Hypomobility of the Coccyx

Two key factors that can contribute to coccydynia are hypermobility and hypomobility of the coccyx:

1. Hypermobility: Excessive movement of the coccyx can stress the sacrococcygeal joint and surrounding tissues.
2. Hypomobility: Limited coccyx movement may cause the tailbone to protrude when sitting, increasing pressure on the bone and joint.

Both conditions can lead to muscle tension in the pelvic floor, exacerbating discomfort.

Recognizing Symptoms of Coccydynia

Identifying the symptoms of coccydynia is crucial for proper diagnosis and treatment. What are the typical signs of tailbone pain?

• Localized pain at the base of the spine
• Pain that worsens when sitting or standing from a seated position
• Discomfort during bowel movements
• Pain during sexual intercourse
• Tenderness when applying pressure to the coccyx

The pain may range from a dull ache to sharp, stabbing sensations. It can be constant or intermittent, and may radiate to the lower back or buttocks.

Diagnosing Coccydynia: Medical Evaluation and Imaging

Proper diagnosis of coccydynia involves a comprehensive medical evaluation. How do healthcare professionals diagnose tailbone pain?

1. Medical history review
2. Physical examination
3. Imaging studies (X-rays, MRI, CT scan)

During the physical exam, the doctor may gently manipulate the coccyx to assess mobility and pinpoint areas of tenderness. Imaging studies can help rule out other conditions and identify any structural abnormalities.

Differential Diagnosis

It’s important to distinguish coccydynia from other conditions that may cause similar symptoms, such as:

• Sciatica
• Pilonidal cysts
• Lumbar disc herniation
• Pelvic floor dysfunction

Conservative Treatment Approaches for Coccydynia

Most cases of coccydynia respond well to conservative treatments. What are the primary non-invasive approaches to managing tailbone pain?

• Rest and activity modification
• Use of specialized cushions (coccyx cushions)
• Application of ice or heat therapy
• Over-the-counter pain medications (NSAIDs)
• Physical therapy and exercises
• Postural corrections

Physical therapy may include manual therapy techniques, pelvic floor exercises, and stretches to improve flexibility and reduce muscle tension in the affected area.

Coccyx Cushions and Ergonomic Adjustments

Specialized coccyx cushions can significantly alleviate pressure on the tailbone when sitting. These cushions typically have a cut-out or depression at the back, allowing the coccyx to “float” rather than bear weight. Additionally, making ergonomic adjustments to workstations and seating can help reduce strain on the coccyx during prolonged sitting.

Advanced Treatment Options for Persistent Coccydynia

When conservative measures fail to provide relief, more advanced treatments may be considered. What are the options for treating chronic or severe coccydynia?

• Corticosteroid injections
• Nerve blocks
• Radiofrequency ablation
• Coccygectomy (surgical removal of the coccyx)

Corticosteroid injections can help reduce inflammation and pain in the short term. Nerve blocks may be used to diagnose the source of pain and provide temporary relief. Radiofrequency ablation involves using heat to disrupt pain signals from the nerves around the coccyx.

Coccygectomy: A Last Resort

Surgical removal of the coccyx (coccygectomy) is generally considered a last resort for severe, chronic cases that have not responded to other treatments. While it can be effective in reducing pain, it carries risks such as infection and delayed wound healing. The decision to undergo surgery should be made carefully after thorough discussion with a specialist.

Lifestyle Modifications and Self-Care for Coccydynia Management

Incorporating lifestyle changes and self-care practices can significantly improve coccydynia symptoms and prevent recurrence. What steps can individuals take to manage tailbone pain at home?

• Maintaining good posture while sitting and standing
• Using a standing desk or taking frequent breaks from sitting
• Practicing pelvic floor exercises and stretches
• Maintaining a healthy weight to reduce pressure on the coccyx
• Avoiding activities that exacerbate pain (e.g., cycling, horseback riding)
• Using supportive cushions during long car rides or flights

Developing a consistent self-care routine can help manage symptoms and improve overall quality of life for those with chronic coccydynia.

Pelvic Floor Exercises for Coccydynia Relief

Strengthening and relaxing the pelvic floor muscles can help alleviate coccydynia symptoms. Here are some simple exercises to try:

1. Kegel exercises: Contract and relax the pelvic floor muscles
2. Cat-cow stretch: Alternately arch and round the back while on hands and knees
3. Child’s pose: A gentle yoga pose that stretches the lower back and hips
4. Seated pelvic tilts: Alternately tilt the pelvis forward and backward while sitting

It’s important to perform these exercises carefully and consult with a physical therapist or healthcare provider for proper technique and guidance.

When to Seek Medical Attention for Coccydynia

While many cases of coccydynia improve with time and self-care, there are instances where medical attention is necessary. When should you consult a healthcare professional for tailbone pain?

• Pain persists for more than a few weeks despite home treatment
• Symptoms worsen or new symptoms develop
• Pain is severe and interferes with daily activities
• There’s a history of recent trauma or injury to the area
• You experience unexplained weight loss or fever along with coccyx pain
• There are changes in bowel or bladder function

Early intervention can prevent the development of chronic pain and ensure appropriate treatment is initiated promptly.

Specialized Care for Coccydynia

In some cases, referral to a specialist may be necessary. Specialists who commonly treat coccydynia include:

• Orthopedic surgeons
• Pain management specialists
• Physical medicine and rehabilitation physicians
• Neurosurgeons

These specialists can provide advanced diagnostic techniques and treatment options for complex or persistent cases of coccydynia.

Preventing Coccydynia: Proactive Measures for Tailbone Health

While not all cases of coccydynia can be prevented, there are steps individuals can take to reduce their risk of developing tailbone pain. What preventive measures can help maintain coccyx health?

• Maintaining good posture and ergonomics
• Using proper lifting techniques
• Strengthening core and pelvic floor muscles
• Avoiding prolonged sitting on hard or uneven surfaces
• Wearing protective gear during high-risk activities (e.g., contact sports)
• Managing weight to reduce pressure on the coccyx

By incorporating these preventive strategies into daily life, individuals can minimize their risk of developing coccydynia and promote overall spinal health.

Ergonomic Considerations for Tailbone Health

Proper ergonomics play a crucial role in preventing and managing coccydynia. Consider the following ergonomic adjustments:

1. Use an ergonomic chair with proper lumbar support
2. Adjust chair height so feet rest flat on the floor
3. Maintain a slight forward tilt of the pelvis while sitting
4. Take regular breaks to stand and stretch
5. Use a standing desk or sit-stand workstation when possible

These adjustments can help distribute weight more evenly and reduce pressure on the coccyx during prolonged sitting periods.

Coping with Chronic Coccydynia: Psychological and Emotional Support

Chronic tailbone pain can have a significant impact on an individual’s quality of life, affecting both physical and emotional well-being. How can those suffering from persistent coccydynia manage the psychological aspects of their condition?

• Seeking support from friends, family, or support groups
• Practicing stress-reduction techniques (e.g., meditation, deep breathing)
• Engaging in cognitive-behavioral therapy
• Exploring pain management strategies with a healthcare provider
• Maintaining social connections and activities within physical limitations

Addressing the emotional and psychological aspects of chronic pain is crucial for overall well-being and can contribute to more effective pain management.

Mindfulness and Relaxation Techniques for Pain Management

Incorporating mindfulness and relaxation techniques can help individuals cope with chronic coccydynia. Some effective practices include:

1. Progressive muscle relaxation
2. Guided imagery
3. Mindfulness meditation
4. Yoga or tai chi (modified as needed)
5. Biofeedback training

These techniques can help reduce muscle tension, improve pain perception, and enhance overall well-being for those living with chronic tailbone pain.

Tailbone (coccyx) pain – NHS

Tailbone pain is pain in the bone at the base of the spine (coccyx), near the top of your bottom. There are things you can do to ease the pain, but get medical help if it does not get better after a few weeks.

Check if you have tailbone (coccyx) pain

The main symptom of tailbone (coccyx) pain is pain and tenderness at the base of your spine, near the top of your bottom.

It may feel dull and achy most of the time, with occasional sharp pains.

The pain may be worse:

• while you’re sitting down
• when you sit down or stand up
• when you bend forward
• when you’re having a poo
• during sex
• during your period

You may also find it difficult to sleep and carry out daily activities.

How you can ease tailbone (coccyx) pain yourself

Tailbone (coccyx) pain may improve after a few weeks, but it can sometimes last longer. There are some things you can do to help ease the pain.

Do

• sit correctly – maintain good posture with your lower back supported

• use a specially designed coccyx cushion when sitting – sitting on an exercise ball can also help

• lie on your side to reduce the pressure on your coccyx

• try pelvic floor exercises (particularly important during pregnancy)

• use an ice pack (or a bag of frozen peas) wrapped in a towel on the affected area for 20 to 30 minutes – you can also use a heat pack for longer

• use non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to help reduce the pain

• use a laxative to soften your poo if the pain is worse when pooing – ask a pharmacist for a laxative that softens poo

Non-urgent advice: See a GP if:

• tailbone (coccyx) pain has not improved after a few weeks of trying treatments at home
• the pain is affecting your daily activities
• you have a high temperature, tailbone pain and pain in another area, such as in your tummy or lower back

Treatments for tailbone (coccyx) pain

Further treatments are available if simple things like pelvic floor exercises and ibuprofen have not helped your tailbone (coccyx) pain.

The 2 treatments that may be recommended first are:

• physiotherapy – the muscles around the coccyx can be manipulated to help ease the pain
• corticosteroid and local anaesthetic injections – into the joint that attaches the coccyx to the bottom of your spine; you’ll usually have a maximum of 2 injections given on consecutive months

If physiotherapy and injections do not help reduce the pain, surgery to remove part or all of your coccyx may be recommended.

Causes of tailbone (coccyx) pain

Common causes of tailbone (coccyx) pain include:

• pregnancy and childbirth
• an injury or accident, such as a fall onto your coccyx
• repeated or prolonged strain on the coccyx – for example, after sitting for a long time while driving or cycling
• poor posture
• being overweight or underweight
• joint hypermobility (increased flexibility) of the joint that attaches the coccyx to the bottom of the spine

Sometimes the cause of tailbone pain is unknown.

Page last reviewed: 15 March 2022
Next review due: 15 March 2025

Coccydynia (Tailbone Pain) Causes | Spine-health

Direct trauma to the tailbone is the most common cause of coccydynia, and usually leads to inflammation surrounding the coccyx, which contributes to pain and discomfort.

There are many cases reported in which pain begins with no identifiable origin (called idiopathic coccydynia).

See Coccydynia (Tailbone Pain) Symptoms

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Coccydynia is typically caused by the following underlying anatomical issues:

• Hypermobility, or too much movement of the coccyx puts added stress on the joint between the sacrum and coccyx and on the coccyx itself. Too much mobility can also pull the pelvic floor muscles that attach to the coccyx, resulting in tailbone and pelvic pain.
• Limited mobility of the coccyx causes the tailbone to jut outward when sitting, and can put increased pressure on the bones and the sacrococcygeal joint. Limited coccyx movement may also result in pelvic floor muscle tension, adding to discomfort.
• In rare cases, part of the sacrococcygeal joint may become dislocated at the front or back of the tailbone, causing coccyx pain.

The above factors may result from an injury to the coccyx, or may develop as idiopathic coccydynia.

In This Article:

• Coccydynia (Tailbone Pain)

• Anatomy of the Coccyx (Tailbone)

• Coccydynia (Tailbone Pain) Symptoms

• Coccydynia (Tailbone Pain) Causes

• Diagnosis of Coccydynia (Tailbone Pain)

• Treatment for Coccydynia (Tailbone Pain)

• Coccygectomy Surgery for Coccydynia (Tailbone Pain)

• Coccydynia (Tailbone Pain) Video

Possible Causes of Coccydynia

A diagnosis of coccydynia will usually identify one of the following underlying causes of pain:

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Certain factors may increase the chance of coccygeal pain developing. Risk factors for coccydynia include:

• Obesity. Pelvic rotation, including movement of the coccyx, is usually lessened in individuals who are overweight, leading to more continual stress being placed on the coccyx and increasing the chances of developing coccyx pain. One study found that a Body Mass Index (BMI) of more than 27.4 in women and 29.4 in men increases the risk for coccydynia following repetitive stress or a one-time injury.

  ¹
  Maigne JY, Doursounian L, and Chatellier G. Causes and mechanisms of common coccydynia: role of obdy mass index and coccygeal trauma. Spine 2000;25:3072-9. as cited in Nathan ST. Fisher BE. Roberts CS. Coccydynia: A Review of Pathoanatomy, Aetiology, Treatment, and Outcome. J Bone Joint Surg [Br] 2010; 92-B: 1622-7.

• Gender. Women have a higher chance of developing coccydynia than men, due to a wider pelvic angle as well as trauma to the coccyx endured during childbirth.

If pain is mild or moderate, it may not be necessary to identify the exact cause of coccydynia. In some cases, however, coccyx pain is severe or of a serious origin, so it is important to have a general idea why pain has developed so that it can be treated most effectively.

Dr. Richard Staehler is a physiatrist at the NeuroSpine Center of Wisconsin. He has more than 20 years of experience providing non-surgical treatment for spine pain.

• 1
  Maigne JY, Doursounian L, and Chatellier G. Causes and mechanisms of common coccydynia: role of obdy mass index and coccygeal trauma. Spine 2000;25:3072-9. as cited in Nathan ST. Fisher BE. Roberts CS. Coccydynia: A Review of Pathoanatomy, Aetiology, Treatment, and Outcome. J Bone Joint Surg [Br] 2010; 92-B: 1622-7.

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What bones are made of

author: Dr. med. Gesche Tallen, Erstellt am 2017/08/30, editor: Dr. Natalie Kharina-Welke, Translator: Dr. Natalie Kharina-Welke, Last modified: 2017/08/30

https://kinderkrebsinfo.de/doi/e121093

Contents

1. Bone
2. Articular cartilage
3. Periosteum
4. Bone marrow
5. Blood vessels and nerves

900 20

First of all, our bones are made up of bone substance, which contains calcium salts. In general, the bone as an organ also consists of such soft tissues as articular cartilage and periosteum (in the language of specialists, the periosteum), bone marrow inside the bones, as well as blood vessels and nerves that pass through the periosteum and bone marrow.

Bone matter

Bone makes up the bulk of our bones. It is very durable, as it contains calcium (experts talk about calcium salts), its weight can reach up to 70% of the weight of the bones. Bone substance occurs in bones mainly in two forms: compact bone and cancellous bone .

Compact bone is a hard, dense whitish mass. First of all, it envelops (covers) a thick layer of bone marrow cavities inside long tubular bones (for example, femurs or humerus). On the other hand, the spongy bone substance consists of fairly thin plates / crossbars. It can be found in our short, flat bones, such as our vertebrae.

Bone is made up of mature bone cells called osteocytes. Osteocytes have processes and with the help of these processes they are interconnected. Working together with young osteoblast cells, which are responsible for bone formation, new bone begins to grow. Bone is broken down by cells called osteoclasts.

Articular cartilage

Articular cartilage is found in almost all bones, with the exception of the bones of the skull. They cover the articular surfaces and are the last remaining part of the skeleton from embryonic (fetal, embryonic) development.

Periosteum

The periosteum (which specialists call the periosteum) covers the outside of all our bones. Therefore, the bone substance itself is nowhere to be seen. It is covered by either periosteum or articular cartilage.

Bone marrow

Bone marrow is a soft mass found in cavities within bones. Bone marrow is red and yellow. Red bone marrow is responsible for blood formation in the body. And yellow bone marrow is mostly adipose tissue.

Yellow bone marrow does not appear in a person immediately, but gradually, in the course of human development, red bone marrow is replaced by yellow. Therefore, the older a person becomes, the more yellow bone marrow becomes in him. In adults, the yellow bone marrow fills the central part of the long tubular bones (this can be, for example, the humerus), which experts call the diaphysis. Red bone marrow is found mostly inside short and flat bones (eg inside the vertebrae).

Blood vessels and nerves

Blood vessels and nerves are located in the bone substance, and in the periosteum, and in the bone marrow. They transmit information, nutrients and oxygen to bone cells. Through the smallest holes on the surface of the bones, they enter the bone, and from the bone they exit into the circulatory system or, respectively, into the nerves that connect them to the nervous system.

Bone augmentation: 5 different types of osteoplasty

Bone augmentation is one of the most common ancillary procedures in dentistry. For decades, it has been the only way to place an implant in patients with a lack of jaw volume. Now, when there are thin implants made of ultra-strong roxolid alloy, the technique is used less frequently, but does not lose its relevance.

The choice in its favor is made in case of poor condition of the bone tissue, after injuries, operations and tumors, as well as in the presence of factors that make one-stage express implantation impossible. With the help of the operation, it is possible to solve the issue of bone tissue deficiency and subsequently perform implantation in those patients to whom it was previously inaccessible.

What is bone augmentation?

Bone augmentation, also called bone augmentation, is a surgical procedure. The operation involves the creation of an artificial cavity in the bone, into which osteoplastic material is introduced or donor bone tissue is implanted. The methods of its implementation have their own characteristics, indications and contraindications, but lead to a single result – replenishment of the bone volume.

Why does the bone resorb? What types of bone deficiency exist? Where does the jaw drop faster?

Normal functioning of bone tissue requires a constant compression load. It is absent in the place of the extracted or fallen out tooth. The tissues cease to be supplied with blood normally, their nutrition is disturbed, and the cells cease to actively divide.

Bone undergoes resorption (resorption) as early as 3 months after tooth loss. The process affects the middle layer, which can lose volume in different directions:

• in height, and then it is impossible to implant a standard implant 1 cm long;
• in width, while it will not be possible to implant a structure of normal thickness.
• combined – both in height and width.

In different parts of the oral cavity, resorption processes proceed unevenly. On the lower jaw, the width decreases faster, on the upper jaw, the height decreases. The upper jaw is especially susceptible to resorption in the region of the bottom of the maxillary sinus. Therefore, molars from above are the most difficult to replace with implants.

What methods are used for bone augmentation?

The history of dentistry knows many ways of building. Some of them have lost their relevance today. Others have been modified and are being used successfully. The choice is determined by the degree of bone tissue insufficiency, the location of the defect, and a number of other reasons.

Basic methods of augmentation:

1. Biomembrane after tooth extraction . The use of barrier membranes has a preventive value. Their task is to prevent rapidly dividing soft tissue cells from occupying the cavity of the tooth socket after tooth extraction. In the cavity formed after dental extraction, osteoplastic material is placed and closed with a special membrane.
2. Bone splitting . This method is used when the width of the alveolar ridge is insufficient. The operation involves the division of the bone into two halves. At the end of the procedure, an osteoplastic mass is placed inside and, if necessary, non-load-bearing implantation can be performed. A biomembrane is placed on top of the surgical field, the cavity is closed with a gum flap and sutured. Engraftment time: 3-6 months.
3. Autotransplantation . Most often, this method is resorted to after operations or injuries, when there is a significant lack of bone tissue. The essence of the technique is the transplantation of a small part of one’s own bone tissue into the jaw. Most often, the pelvic bone, the chin area, or the ends of the lower jaw are used for transplantation.
4. Sinus lift . An operation in which the volume of tissues of the alveolar ridge of the upper jaw is restored. This is a necessary condition for implantation in this place, since complications and low primary stabilization are likely due to the proximity of the thinned bone to the bottom of the maxillary sinus. Sinus lift is performed by several methods and is more gentle than autotransplantation. Engraftment time: 3-6 months.
5. Osteoplasty with granules . This method involves the use of artificial material to restore the height of the bone. The operation proceeds with the opening of the gums, filling the holes with special granules, closing the bone mass from above with a bioresorbable membrane. Implants can be placed on request. Then the gum is sutured. Term: 6 months.

The choice of treatment method is always the physician’s prerogative. Only a competent implantologist can assess the condition of the patient’s bone tissue and select the treatment option that best suits this particular patient.

How is bone autotransplantation performed? Why is it rarely used?

The operation is traumatic and potentially leaves behind 2 foci requiring rehabilitation. In the place where the graft is taken from, a soft tissue incision is made, a piece of bone tissue is cut out, then the surgical field is closed with a biomembrane and sutured.

In the place where the graft is transferred, soft tissues are peeled off, a piece of bone is inserted, which has been given the necessary shape, and screwed with special screws. The sutures around the implanted area are treated with bone chips. The operating field is closed with a biomembrane and a gingival flap, which is sutured.

Among the disadvantages of the procedure is not only high trauma, but also the need for anesthesia. In case of replacement of large volumes (with injuries and after resection of tumors), anesthesia can be general, the operation is performed in a hospital and is not used in our clinic.

What is a sinus lift? What methods of implementation exist?

Sinus lift is an operation to increase the volume of bone tissue in the region of the bottom of the maxillary sinus. This place of the alveolar ridge is most susceptible to resorption processes. Performing a sinus lift increases the success rate of implantation of maxillary molars.

Technically, the operation can proceed in two ways:

1. In the open method, when a part of the skin is surgically separated from the side of the jaw, a hole is drilled in the bone, the periosteum is separated from the bone, and osteoplastic material is placed inside. The operation allows you to fill the deficit of up to 7 mm of bone tissue.
2. Closed and minimally invasive when accessed through the implant bed. True, with this option, only a small deficit is restored – 2-3 mm, since the cavity can be created quite small.

Current protocols aim to minimize tissue trauma and may include simultaneous implant placement to reduce overall treatment time.

What materials are used? Which is preferable?

For extension, depending on the technique used, an autograft, an artificial granular biocompatible mass, bone mass from a donor can be used. The patient’s own bone takes root best, but the plasty process is more traumatic. Therefore, it is used only for very large areas of transplantation. In our clinic, bone-replacing materials Bio Oss by the Swiss company Geistlich are actively used. Also, to stimulate the growth of the patient’s own bone, PRP technology is used – platelet-rich plasma.

Can I smoke after the operation?

Doctors of our clinic recommend smoking cessation for the whole period of implant engraftment and bone growth. Nicotine worsens the blood supply to the bone, disrupting blood microcirculation. Lacking nutrition, cells do not divide as actively as they should, and the total period of bone tissue maturation is significantly extended.

Can I experience pain during surgery? What will I feel? What sensations can be after the operation?

The bone augmentation procedure is performed under local anesthesia. No sensations, and, moreover, no pain. After the operation, as the anesthesia wears off, discomfort may occur.