What causes tailbone pain. How is coccydynia diagnosed. What are the best treatments for tailbone discomfort. Who should you see for coccyx pain relief. When is coccygectomy necessary for chronic tailbone issues.

Understanding the Anatomy of the Tailbone (Coccyx)

The coccyx, commonly known as the tailbone, is a small triangular structure located at the base of the spine. It consists of 3-5 fused vertebrae and serves several important functions in the human body:

• Provides attachment points for pelvic floor muscles
• Assists with leg movement
• Supports the anus and vagina
• Helps distribute body weight when sitting

The coccyx connects to the sacrum (the large triangular bone at the bottom of the spine) via the sacrococcygeal joint. This joint, along with surrounding ligaments, allows for slight movement of the tailbone.

Evolutionary Significance

Interestingly, the coccyx is a vestigial structure – a remnant of the tail our early human ancestors possessed. Through millions of years of evolution, humans lost the need for a tail, but the coccyx remained as a reduced structure that still serves important anatomical functions.

Common Causes of Tailbone Pain (Coccydynia)

Tailbone pain, medically referred to as coccydynia, can arise from various factors. Understanding these causes is crucial for proper diagnosis and treatment. Here are some of the most common reasons for coccyx discomfort:

Trauma and Injury

What types of injuries can lead to tailbone pain? Traumatic incidents are a frequent cause of coccydynia. These may include:

• Falls, especially those landing directly on the buttocks
• Sports-related injuries
• Car accidents

Such traumas can result in bruising, fracture, or damage to the ligaments supporting the coccyx. Even seemingly minor impacts can cause significant discomfort due to the tailbone’s sensitive nature.

Childbirth and Pregnancy

How does childbirth affect the tailbone? The process of giving birth can put immense strain on the coccyx. As the baby passes through the birth canal, it may cause:

• Manual displacement of the coccyx
• Stretching or tearing of supporting ligaments
• Fractures in severe cases

Additionally, the hormonal changes and weight gain associated with pregnancy can increase pressure on the tailbone, potentially leading to discomfort even before delivery.

Prolonged Sitting and Poor Posture

In our modern, sedentary lifestyle, prolonged sitting has become a significant contributor to tailbone pain. Extended periods in a seated position, especially on hard or narrow surfaces, can irritate the coccyx and surrounding tissues. Poor posture while sitting can exacerbate this issue by placing uneven pressure on the tailbone.

Medical Conditions

Several underlying medical conditions can cause or contribute to coccydynia:

• Degenerative joint disease
• Bone spurs
• Pilonidal cysts
• Sciatica
• Rare cases of spinal tumors

Recognizing the Symptoms of Tailbone Pain

Identifying the symptoms of coccydynia is crucial for seeking timely medical attention. While the primary symptom is pain in the tailbone area, there are several other indicators to be aware of:

Pain Characteristics

How does tailbone pain typically manifest? The discomfort associated with coccydynia can vary in intensity and nature:

• Dull, aching pain at the base of the spine
• Sharp pain when moving from sitting to standing
• Increased pain when sitting for extended periods
• Pain that worsens when leaning back while seated

Associated Symptoms

Beyond localized pain, individuals with coccydynia may experience:

• Pain or discomfort during bowel movements
• Pain during sexual intercourse
• Increased pain when bending or lifting
• Tenderness or swelling around the tailbone
• Radiating pain to the lower back or buttocks

It’s important to note that the severity and combination of symptoms can vary significantly between individuals. Some may experience mild discomfort, while others might find the pain debilitating.

Diagnostic Approaches for Tailbone Pain

Accurate diagnosis is crucial for effective treatment of coccydynia. Healthcare providers employ various methods to determine the cause and severity of tailbone pain:

Medical History and Physical Examination

The diagnostic process typically begins with a thorough review of the patient’s medical history and a physical examination. During this stage, the healthcare provider will:

• Inquire about the onset and nature of symptoms
• Ask about any recent injuries or changes in activity
• Perform a gentle external examination of the tailbone area
• Check for any visible swelling, bruising, or deformities

Imaging Studies

What imaging techniques are used to diagnose tailbone issues? Depending on the suspected cause, a doctor may order one or more of the following imaging studies:

• X-rays: To visualize the bone structure and check for fractures or misalignments
• MRI (Magnetic Resonance Imaging): For detailed images of soft tissues, useful in identifying inflammation or tumors
• CT (Computed Tomography) scan: To provide detailed cross-sectional images of the coccyx and surrounding structures

Specialized Tests

In some cases, additional specialized tests may be necessary:

• Coccygeal discogram: Involves injecting a contrast dye into the disc spaces to identify any abnormalities
• Bone scan: Can help detect fractures, infections, or tumors that might not be visible on standard X-rays

These diagnostic approaches help healthcare providers determine the underlying cause of tailbone pain and develop an appropriate treatment plan.

Conservative Treatment Options for Coccydynia

For many individuals suffering from tailbone pain, conservative treatments can provide significant relief. These non-invasive approaches are typically the first line of defense against coccydynia:

Rest and Activity Modification

How can lifestyle changes help alleviate tailbone pain? Simple adjustments in daily activities can make a substantial difference:

• Avoiding prolonged sitting
• Using a donut-shaped cushion to reduce pressure on the tailbone
• Applying ice or heat to the affected area
• Sleeping on your side with a pillow between your knees

Physical Therapy

A physical therapist can provide valuable assistance in managing coccydynia through:

• Stretching exercises to improve flexibility
• Strengthening exercises for the pelvic floor muscles
• Manual therapy techniques to mobilize the coccyx
• Posture correction guidance

Medications

Various medications can help manage pain and inflammation associated with tailbone issues:

• Over-the-counter pain relievers (e.g., ibuprofen, acetaminophen)
• Topical analgesics
• In some cases, prescription pain medications or muscle relaxants

Injection Therapies

For more persistent cases, a doctor may recommend injection therapies:

• Corticosteroid injections to reduce inflammation
• Local anesthetic injections for temporary pain relief
• Nerve block injections to interrupt pain signals

These conservative treatments often provide significant relief for many patients with coccydynia. However, in cases where pain persists despite these measures, more advanced interventions may be necessary.

Advanced Interventions for Chronic Tailbone Pain

When conservative treatments fail to provide adequate relief, healthcare providers may consider more advanced interventions for chronic coccydynia:

Radiofrequency Ablation

What is radiofrequency ablation and how does it help with tailbone pain? This minimally invasive procedure involves using heat generated by radio waves to disrupt nerve function:

• Targets specific nerves that transmit pain signals from the coccyx
• Can provide long-lasting pain relief
• Usually performed as an outpatient procedure

Neurostimulation

In some cases, neurostimulation techniques may be employed:

• Spinal cord stimulation: Involves implanting a small device that sends electrical pulses to the spinal cord to alter pain perception
• Peripheral nerve stimulation: Similar to spinal cord stimulation but targets specific peripheral nerves

Coccygectomy

As a last resort for severe, chronic cases that don’t respond to other treatments, surgical removal of the coccyx (coccygectomy) may be considered:

• Involves partial or complete removal of the tailbone
• Typically reserved for cases with significant pain and disability
• Requires careful patient selection and thorough preoperative evaluation

It’s important to note that while coccygectomy can be effective for some patients, it carries risks like any surgical procedure. The decision to undergo surgery should be made carefully in consultation with a specialist.

Seeking Professional Help: When to Consult a Tailbone Specialist

Knowing when to seek professional medical help for tailbone pain is crucial for proper management and prevention of chronic issues. Here are some guidelines on when to consult a tailbone specialist:

Persistent or Worsening Pain

When should you be concerned about ongoing tailbone pain? Consider seeing a specialist if:

• Pain persists for more than a few weeks despite home remedies
• Discomfort gradually worsens over time
• Pain significantly interferes with daily activities or sleep

Signs of Infection or Serious Condition

Certain symptoms may indicate a more serious underlying condition:

• Fever or chills accompanying tailbone pain
• Unexplained weight loss
• Severe pain that doesn’t improve with rest
• Numbness or weakness in the legs
• Loss of bladder or bowel control

Trauma-Related Pain

If your tailbone pain resulted from a fall or other traumatic incident, it’s advisable to seek medical attention, especially if:

• Pain is severe or doesn’t improve within a few days
• You notice visible bruising or swelling
• There’s a possibility of fracture

Specialist Consultation

Who should you see for tailbone pain? Depending on your specific symptoms and situation, you may be referred to:

• Orthopedic specialist
• Neurosurgeon
• Pain management specialist
• Physical medicine and rehabilitation physician

These specialists can provide comprehensive evaluations and develop tailored treatment plans for your specific case of coccydynia.

Living with Tailbone Pain: Lifestyle Adaptations and Self-Care

While medical treatments are often necessary for managing coccydynia, incorporating lifestyle changes and self-care practices can significantly improve quality of life for those dealing with tailbone pain:

Ergonomic Adjustments

How can you make your environment more tailbone-friendly? Consider these ergonomic modifications:

• Use a standing desk or alternate between sitting and standing throughout the day
• Invest in an ergonomic chair with proper lumbar support
• Use a coccyx cushion or wedge pillow when sitting for extended periods
• Adjust car seats to reduce pressure on the tailbone during drives

Exercise and Stretching

Regular physical activity can help manage tailbone pain:

• Engage in low-impact exercises like swimming or walking
• Practice gentle yoga or stretching routines focusing on the lower back and hips
• Perform pelvic floor exercises to strengthen supporting muscles

Stress Management

Chronic pain can be exacerbated by stress. Implementing stress-reduction techniques can be beneficial:

• Practice mindfulness meditation
• Try deep breathing exercises
• Consider cognitive-behavioral therapy to develop coping strategies

Dietary Considerations

While diet may not directly affect tailbone pain, maintaining a healthy weight can reduce pressure on the coccyx. Additionally, some individuals find relief by:

• Increasing fiber intake to ease bowel movements
• Staying hydrated to promote overall tissue health
• Avoiding inflammatory foods that may exacerbate pain

By incorporating these lifestyle adaptations and self-care practices, individuals with coccydynia can often achieve better pain management and improved overall well-being. However, it’s important to remember that these measures should complement, not replace, professional medical advice and treatment.

Living with tailbone pain can be challenging, but with the right combination of medical care, lifestyle adjustments, and self-management techniques, many individuals find significant relief and improved quality of life. Always consult with healthcare professionals for personalized advice and treatment options suited to your specific condition and needs.

How Can a Coccygectomy Specialist Help Me?

Are you suffering from pain or tenderness at the bottom of your spine? Tailbone pain, otherwise known as coccydynia, can make everyday activities painful and difficult. Luckily, you have options, including minimally invasive coccygectomy, to help reduce the pain and get you back to doing the things you love.

Understanding the Tailbone

At the base of the spine is a triangular series of bones known as the coccyx. The sacrococcygeal joint connects the coccyx with the sacrum—another triangular structure that helps to support the weight of the upper body. The coccyx is composed of three to five bones connected by small joints and ligaments.

Early humans used to have tails supported by the coccyx. Of course, over many generations of evolution, humans no longer have tails. Even without tails, the coccyx stills serves a purpose. It connects many of the pelvic floor muscles to other areas of the body. These muscles help out with leg movement and support the anus and vagina. In addition, the coccyx distributes weight when a person is seated.

Causes of Tailbone Pain

Tailbone pain is usually a result of an anatomical condition in the coccyx. Too much movement, known as hypermobility, can put stress on the coccyx or the joint connecting it to the sacrum. Conversely, limited mobility of the area may cause the coccyx to put extra pressure on the sacrococcygeal joint.

These anatomical conditions can result from several factors. Common causes of tailbone pain include:

• Trauma to the Tailbone: Usually, falls or other injuries result in tailbone pain. Trauma may cause inflammation to ligaments that support the coccyx. Some injuries may even bruise or fracture the tailbone. Prolonged sitting or using a narrow surface on which to sit, like a bicycle seat, can also irritate the coccyx.
• Childbirth: As any mother will agree, childbirth is hard on the body. As the baby passes through the birth canal, it can put manual strain on the coccyx leading to bone, disc, or ligament injuries.
• Spine Cancer: Tumors on or around the spine may also apply strain to the coccyx.
• Obesity: Carrying extra weight in the midsection puts stress on several areas of the body including the tailbone. This type of weight distribution reduces the movement of the pelvis leading to more stress on the coccyx.
• Osteomyelitis: Some viral or bacterial infections elsewhere in the body can reach the spine through the blood or when nearby soft tissues are infected. Adults can develop osteomyelitis (or a bone infection) in any part of the spine, including the coccyx.
• Bursitis: When tiny, fluid-filled sacs that help to cushion the joints become inflamed—a condition known as bursitis—it may result in tailbone pain.

Symptoms of Coccydynia

The telltale sign of coccydynia is tailbone pain felt at the bottom of the spine near the buttocks. It may feel like an aching or soreness that ranges from mild to severe. In some cases, the discomfort radiates to the pelvic floor muscles causing tightness and discomfort.

Other symptoms include:

• More pain when sitting. Sitting or leaning backward puts more weight on the tailbone, leading to flare-ups of pain.
• Difficulty sitting or standing. When pelvic bones rotate to facilitate sitting or standing, pain may become more intense.
• Discomfort during bowel movements or sex. Since the coccyx is so close to the anus and genitals, these activities can become painful.

In some cases, tailbone pain goes away on its own or with a conservative treatment. Other patients may experience chronic pain that lasts for several months. If your pain isn’t going away or keeps returning, then it may be time to see a coccygectomy specialist or tailbone doctor.

Diagnosing Your Tailbone Pain

If you’re dealing with nagging pain from a sore tailbone, you should consult with a doctor or a coccygectomy specialist to obtain an accurate diagnosis. By learning the cause of your discomfort, your doctor can determine the most appropriate treatments.

Your doctor will review your medical history and discuss your symptoms. This discussion should include a description of your current symptoms, when they started, and what activities seem to make them worse. In addition, your doctor will ask about any work or lifestyle habits that may put added stress on the coccyx, like mountain-biking or desk work.

Your back pain doctor will also conduct a thorough physical exam. During the exam, your doctor checks for any tenderness in the area and determines if there is any swelling. In addition, a physical exam can detect any tumors or bone spurs on the coccyx.

While not always necessary, your doctor may order diagnostic imaging tests to take a closer look at the area. These tests can include an X-ray, MRI, or CT scan depending on your symptoms. Your physician may also perform a coccygeal discogram. This procedure uses an injection of a local anesthesia to identify the exact region where you’re experiencing pain.

Treatment Options for Your Tailbone Pain

In many cases, a conservative treatment can help to reduce pain in the tailbone. Some of these treatments can be completed at home without medications. For example, using ice packs or heating pads may reduce inflammation and muscle tension in the region. Using a special seat cushion can also allow you to take pressure off the area.

Doctors may suggest modifications to your daily activities to reduce strain on the coccyx. For example, if you have a desk job that requires long periods of sitting, your doctor may suggest creating a work area where you can alternate between sitting and standing. If your tailbone pain is caused by repetitive movements or sports activities, consulting with a physical therapist can provide insights into protecting your coccyx. In addition, you can learn stretches to reduce muscle tension and pain. A physical therapist or chiropractor may also perform manual manipulations to adjust the sacrococcygeal joint, thus allowing for more coccyx mobility.

Over-the-counter medications like non-steroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation in the area. If bowel movements are contributing to your tailbone pain, your doctor may also suggest stool softeners or fiber supplements.

Some people have found sufficient pain relief with a Transcutaneous Electrical Nerve Stimulator, or TENS device. This unit uses electrodes applied on the skin near the coccyx region. The electrical pulses disrupt pain signals from your coccyx to the brain. These units are available online or at local drug stores. Since there are different types of TENS units, consult with your doctor about which option may be best for your condition.

Achieving Pain Relief Beyond Conservative Treatments

In many cases, the right combination of conservative treatments will alleviate your tailbone pain. In more severe cases, however, a coccygectomy specialist can suggest additional treatment options.

One such treatment option is a steroid injection. Using imaging guidance, your doctor will inject a numbing agent as well as a steroid into the affected area. This reduces inflammation in the target region, resulting in pain relief that can last from a week to several years.

Those who suffer from chronic tailbone pain may finally get relief with minimally invasive spine surgery. Those with anatomical changes or excessive mobility of the coccyx are good candidates for a coccygectomy. During this procedure, your coccygectomy specialist will perform a tailbone resection (or removal).

This procedure begins when your physician makes a small incision just above the coccyx. Then the periosteum (protective cartilage over the bone) is dissected. This allows your surgeon to remove either all or part of the coccyx.

The procedure is short—usually under an hour. The recovery time, however, can take a couple months to a year before tailbone symptoms fully disappear. However, when symptoms do fade, their disappearance can be permanent.

Seeking Help for Your Tailbone Pain

If you are ready to take the next step in treating your tailbone pain, then NJ Spine & Orthopedic is ready to help. Our dedicated team will listen to your story and learn your goals for treatment. Dr. Scott Katzman, a leading coccygectomy specialist and award-winning doctor, will review the best treatment options for you and discuss both conservative and minimally invasive relief methods.

If a coccygectomy is recommended, then Dr. Scott Katzman is regarded as a top international choice for this surgery. That’s because NJ Spine & Orthopedic has earned a 99% success rate at helping our patients eliminate tailbone pain.

Mayo Clinic Q and A: Tailbone pain often goes away without medical treatment

• By

  Liza Torborg

  August 9, 2019

DEAR MAYO CLINIC: My tailbone has been hurting for the past few weeks. I have read that it takes a while to heal, but is there anything I can do in the meantime to lessen the pain? At what point would it be necessary to see my doctor?

ANSWER: Although tailbone pain can be uncomfortable, in most cases it will go away on its own within a few months. During that time, there are steps that you can take to lessen the pain. If your pain lasts for more than two months or if it gets worse despite self-care, make an appointment to see your health care provider about your concern.

Your
tailbone, or coccyx, is the bony structure at the bottom of your spine that
helps support your pelvic floor. Tailbone
pain is a condition called “coccydynia.” Those with coccydynia usually
experience dull, achy pain in or around the tailbone. This pain may become
sharper or more intense after sitting or standing for a long time, during sex,
or with urination or a bowel movement.

Numerous
situations can result in tailbone pain. It is often the result of an injury due
to a trauma during childbirth or a fall. Tailbone pain sometimes can arise
after sitting on a hard surface for a long time, or sitting on an ill-fitting
or jouncing seat. In some cases, the pain may be the result of sitting posture
changes brought on by obesity or aging. Rarely, the cause of tailbone
pain is something more serious, such as an infection, benign tumor or cancer.

Medical treatment typically is not
needed for tailbone pain. But try this to lessen the pain while you’re seated: Sit
completely upright, keeping your back firmly against the chair, your knees
level with your hips, feet on the floor and shoulders relaxed. Although it is
best to avoid sitting on hard surfaces, a heavily cushioned, overstuffed
surface can allow you to sink into an unnatural, painful seating posture, which
also isn’t ideal. Select a supportive chair with a moderate amount of
cushioning.

If pain is not relieved by those changes,
adjusting your weight by leaning forward slightly when seated may help. Sitting
on a doughnut-shaped cushion or a V-shaped wedge cushion may help distribute
weight away from the painful area. Using heat or ice on the painful area, as
well as taking over-the-counter pain relievers, also may offer some relief.

Use these techniques until the pain
subsides. In many cases, the pain will lessen and then disappear over the
course of several weeks or several months. In only a minority of people does
tailbone pain last beyond that length of time.

If tailbone pain persists for more than
two months or if it gets worse despite these measures, see your health care
provider for an evaluation to rule out other potential causes. For chronic
tailbone pain, a consultation with a specialist in pain medicine or physical
medicine and rehabilitation may be useful.

When necessary, treatment for chronic tailbone pain may include instruction in pelvic floor relaxation techniques; physical therapy; or manipulation of the coccyx, which is usually performed through the rectum. An anesthetic and corticosteroid injection may help some severe or persistent cases. These injections usually are performed by an anesthesiologist or other pain management expert. Given the potential for substantial complications, surgery is only considered as a last resort in severe cases. — Dr. David Bell, Community Internal Medicine, Mayo Clinic, Rochester, Minnesota

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The coccyx is a small, triangular bone located at the bottom of the spinal column between the sacrum and the perineum. Pain in the coccyx (coccygodynia) is an unpleasant sensation of discomfort, pain or pressure in the perineum and anal area. With symptoms of pain in the coccyx, you should first consult a neurologist, based on the results of the initial examination, the doctor may prescribe an additional consultation with the surgeon. Diagnosis of pain in the coccyx begins with a thorough examination and physical examination by a doctor. The doctor may ask a series of questions about the nature of the pain, when it started, and other associated symptoms. The primary diagnosis of pain in the coccyx will require an X-ray of the coccyx and a subsequent consultation with a surgeon or neurologist. As an additional examination, the doctor may prescribe:

• CT coccyx
• MRI coccyx
• Soft tissue MRI
• Rheumatologist consultation

Causes of coccygodynia

Tailbone pain can be caused by several causes. The most common ones include:

• injury – an injury to the coccyx or a fracture of the coccyx can lead to pain in the coccygeal region. The injury may be the result of a fall on the coccyx, trauma during childbirth, or other physical injury
• inflammation or infection in the coccyx, such as an abscess or pyoderma, can cause coccygeal pain and discomfort
• hemorrhoids, which are located in the lower rectum and near the anus, can cause pain in the coccyx
• Anal fissures can cause sharp pain in the coccyx area, especially during or after defecation. They may be associated with constipation, trauma, or other causes.

Other possible causes of tailbone pain can include tumors, cysts, myositis (muscle inflammation) and even nerve disorders such as sacral radiculopathy.

Diseases that cause tailbone pain

Major diseases that can cause tailbone pain include:

• Pilonidal cyst is a chronic inflammatory condition that usually develops in the area between the buttocks, near the coccyx. It is usually caused by congenital factors or trauma
• Rectal tumors, such as anal or rectal cancer, can cause pain in the coccyx, which may be due to tumor growth and pressure on adjacent tissues and nerve endings
• inflammation of the sacroiliac joints located between the coccyx and the sacrum can cause pain in the coccyx.
• Proctagnia is a condition in which the lower part of the large intestine prolapses due to weakened pelvic floor muscles, which can cause heaviness and pain in the coccyx
• Sciatic neuralgia is a condition in which the sciatic nerve passing through the coccyx is pinched, which can cause acute pain in the lower back and coccyx radiating to the legs and buttocks
• An anorectal abscess is an infection in the tissues of the anorectal region that can cause acute pain in the coccyx and anus.

How to diagnose the cause of coccyx pain

Coccyx pain can have various causes, and a comprehensive examination is necessary for differential diagnosis, including:

• physical examination by a surgeon. The doctor will perform a physical examination to evaluate the coccyx area and may ask questions about the nature of the pain, symptoms, and factors that may have caused it
• x-ray of the coccyx to detect bone damage in the area of ​​the coccyx
• Magnetic resonance imaging of the coccyx provides more detailed images of soft tissues and structures in the coccygeal region of the coccyx
• Magnetic resonance imaging of the sacroiliac joint provides data on sacroiliitis and inflammation of the joints
• CT scan of the coccyx can be used to obtain more detailed information about the bones and tissues of the coccyx region.

How to treat coccygodynia

Coccyx pain treatment depends on its cause. Here are some possible approaches to therapy:

Conservative treatment:

• use of pain medications: The doctor may recommend taking non-steroidal anti-inflammatory drugs to relieve pain and reduce inflammation
• warm compresses or warm baths help relieve tension and pain in the coccyx
• lifestyle change. If coccygeal pain is associated with a sedentary lifestyle or prolonged sitting, it is recommended to get up more often, warm-up exercises and the use of a seat cushion
• topical application of anesthetic ointments or gels that can relieve pain and soothe irritation in the coccyx area.

Physiotherapy:

• exercises and stretching. A physiotherapist can suggest special exercises and stretches to help relieve tension in the coccyx area and strengthen the corresponding muscles
• manual therapy. Massage or manual therapy improves circulation, relieves spasms and reduces pain.

Injection:

• spinal block. The neurologist may decide to perform a blockade by injecting an anesthetic or steroid directly into the coccyx area to relieve pain and inflammation.

In some cases where conservative treatment does not improve or where there are structural problems, surgery may be required. An example would be the removal of a pilonidal cyst or the correction of a damaged coccyx.

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Specialization: Neurologist, Vertebrologist

Medical experience: since 2003

Where does the reception: Clinic Scandinavia on Moskovsky

Babintseva Elena Yurievna

Specialization: Neurologist, Acupuncturist

Medical experience: since 1993

Where does the reception: MC Riorit

Daneeva Nadezhda Andreevna

Specialization: Neurologist

Medical experience: since 2009year

Where does it take: Rebellion Affordable Medicine

Gotovchikov Andrey Alexandrovich

Specialization: Neurologist

Medical experience: since 1998

Where does the appointment: MC Energy of Health, Clinic of Neurology of the First Med

Klimkin Andrey Vasilyevich

Specialization: Neurologist, Ultrasound

Medical experience: since 2010

Where does the reception: MC Energy of Health, Research Institute of Children’s Infections (NIIDI St. Petersburg)

Murzina Elena Gennadievna

Specialization: Neurologist, Manual Therapy, Osteopath

Medical experience: since 2010

Where does the reception: MC Energy of Health, Family Medicine Center on Manezhnaya

Ivanova Maria Alexandrovna

Specialization: Neurologist, Osteopath

Medical experience: since 2005

Where does the reception take place: MC Longa Vita, Gaide on Ligovsky

Asadullaeva Patimat Muradovna

Specialization: Neurologist

Medical experience: since 2007

Where does the reception: MC Longa Vita, MC Atlant

Kalachev Pavel Alekseevich

Specialization: Neurologist, Manual Therapy, Vertebrologist

Medical experience: since 2009

Where does the reception: MC Longa Vita

Trubnikov Ilya Igorevich

Specialization: Neurologist, Manual Therapy, Osteopath

Medical experience: since 2015

Where does the reception: MC Longa Vita, MC RIN-Med, Clinic Medpomoshch 24 on Zanevsky

Almazov Kirill Sergeevich

Specialization: Neurologist, Vertebrologist

Medical experience: since 2012

Where does the reception: SM-Clinic on Malaya Balkanskaya

Archipenko Elena Yurievna

Specialization: Neurologist

Medical experience: since 2012

Where does the reception: SM-Clinic on Malaya Balkanskaya

Borovikova Olga Aleksandrovna

Specialization: Neurologist

Medical experience: since 2013

Where does the appointment: SM-Clinic on Vyborgsky, Elizavetinskaya Hospital

Zimakova Tatyana Viktorovna

Specialization: Neurologist, Manual Therapy, Osteopath

Medical experience: since 2002

Where does the reception: SM-Clinic on Udarnikov

Kabanov Alexey Yurievich

Specialization: Neurologist, Vertebrologist, Somnologist

Medical experience: since 2013

Where does the reception: SM-Clinic on Danube

Ovchinnikov Mikhail Alexandrovich

Specialization: Neurologist, Manual Therapy, Vertebrologist, Osteopath

Medical experience: since 2008

Where does the reception: SM-Clinic on Vyborgsky

Pasko Nadezhda Anatolyevna

Specialization: Neurologist

Medical experience: since 2009

Where does the reception: SM-Clinic on Vyborgsky

Pitsuha Svetlana Anatolyevna

Specialization: Neurologist

Medical experience: since 1997

Where does the reception: SM-Clinic on Udarnikov

Surkin Kamil Mitkhatievich

Specialization: Neurologist

Medical experience: since 1987

Where does the reception: SM-Clinic on Danube, Clinic International Academy of Health

Aleshina Vera Valerievna

Specialization: Neurologist

Medical experience: since 2009year

Where does the reception: SM-Clinic on Udarnikov

Gribov Gennady Vyacheslavovich

Specialization: Neurologist, Neurosurgeon, Surgeon

Medical experience: since 2010

Where does the reception: SM-Clinic on the Danube, Vsevolozhsk Central District Hospital

Zdor Alexander Anatolyevich

Specialization: Neurologist

Medical experience: since 1984

Where does the appointment: SM-Clinic on Marshal Zakharov, PERSONS on Moskovsky, Desir Clinic on Moskovsky

Ivanova Galina Yurievna

Specialization: Neurologist

Medical experience: since 1988

Where does the reception: SM-Clinic on Udarnikov

Kovaleva Natalya Aleksandrovna

Specialization: Neurologist

Medical experience: since 2008

Where does the reception: SM-Clinic on Danube

Kurbanbaev Nurali Bakhtiyarovich

Specialization: Neurologist

Medical experience: since 2016

Where does the appointment: SM-Clinic on Marshal Zakharov, SM-Clinic on Malaya Balkanskaya

Repin Pavel Nikolaevich

Specialization: Neurologist

Medical experience: since 2016

Where does the appointment: SM-Clinic on Marshal Zakharov, SM-Clinic on Danube

Skripnik Tatyana Anatolyevna

Specialization: Neurologist

Medical experience: since 1997

Where does the reception: SM-Clinic on Udarnikov

Shenyak Tatyana Mikhailovna

Specialization: Neurologist

Medical experience: since 1981

Where does the reception: SM-Clinic on Udarnikov

Stepashin Maxim Nikolaevich

Specialization: Neurologist, Manual Therapy, Osteopath

Medical experience: since 2005

Where does the appointment: SM-Clinic on Malaya Balkanskaya, Healthy Back Center

Shogenov Ramish Kurbanovich

Specialization: Neurologist, Vestibulologist, Vestibulologist

Medical experience: since 2008

Where does the reception: MC Riorit

Levina Ekaterina Olegovna

Specialization: Neurologist

Medical experience: since 1998

Where does the appointment: Clinic Dr. Pelya

Obukhov Andrey Vasilyevich

Specialization: Neurologist, Manual Therapy, Osteopath

Medical experience: since 1995

Place of admission: Clinic of Dr. Pel, Medical Center Express

Revtovich Anton Arkadyevich

Specialization: Neurologist

Medical experience: since 2010

Where does the appointment: Clinic of Dr. Pel, Clinic for Bioacoustic Correction on Moskovskaya

Author: Bogatov Nikita Dmitrievich

Specialization: Manual Therapy, Osteopath

Where does the reception: MRI Center and Clinic RIORIT, Clinic Incentro

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Literature

1. Human anatomy: textbook: in two volumes / M. R. Sapin, D. B. Nikityuk, V. N. Nikolenko, S. V. Chava; ed. M. R. Sapina. – M.: GEOTAR-Media. – 2012. – T. II. – 456 p.
2. Dedukh N.V. Intervertebral discs: structural organization in health and disease // Probl. Osteol. – 2008. – T. 11. – No. 3-4. – P.11-17.
3. Marks V.O. Orthopedic diagnostics (guide-reference). Mn., “Science and technology”. – 1978. – 512 p.
4. Smirnov A.V. X-ray diagnosis of primary osteoporosis // Modern. Revm. – 2011. – No. 1. – P.47-52.
5. Smirnov A.V., Erdes Sh.F. Diagnosis of inflammatory changes in the axial skeleton in ankylosing spondylitis according to magnetic resonance imaging. Nauchno-prakt. Revm. – 2016. – No. 1. – P.53-59.

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Coccygodynia – symptoms and treatment

Coccygodynia, pain in the coccyx, usually occurs when sitting. The intensity of the pain varies and is sometimes aggravated by the sitting position. Less severe symptoms can be controlled by changing sitting position or injecting local anesthetic and corticosteroids into the painful area. In case of unsuccessful treatment, surgical removal of the coccyx may be indicated.

Our clinic has accumulated experience in the management of patients with tailbone pain. Such patients are treated by traumatologists-orthopedists and neurologists.

Sign up for Coccygodynia treatment

Prevalence

Who is more likely to have tailbone pain? Coccygodynia is five times more common in women than in men. Although it can occur over a wide age range, the median age of onset is 40 years. Coccygodynia has many causes: it can be post-traumatic, starting with a fracture or bruise, or after a difficult vaginal delivery. 1-3 In most cases coccyx subluxation or hypermobility is found, which can be seen on dynamic radiographs taken with the patient standing and sitting 1-3 . The cause of pain in patients with normal coccygeal mobility is unknown. 2

This is what it looks like on an x-ray

Sacrococcygeal Anatomy

Five fused
sacral and three or four fused coccygeal vertebrae form the terminal
end of the spinal column. The lower end of the sacrum connects to the coccyx
through the articular-disc complex. This joint can be
symphysis (inactive cartilage) or synovial joint. Coccyx
is a triangular structure consisting of three or four
coccygeal vertebrae, which are usually fused, although the first coccygeal segment
may not merge with the second. The sacrococcygeal joint can also
grow together. The coccyx provides attachment for the gluteus maximus muscle.

IMPORTANT
INFORMATION! It is fundamentally worth understanding that there are 3 states of the coccyx:

A, Normal standing coccyx. B, Increased
mobility of the coccyx when flexed when the patient is sitting.
C, Rear
subluxation of the coccyx when the patient is sitting.
D, Coccygeal
spicule – a bone spike (arrow) extending from the posterior surface of the coccygeal
segment.

Etiology or causes of coccygodynia

Why does the coccyx hurt? Common causes are obesity, previous trauma to the area or childbirth, and instability.

Obesity, which reduces the rotation of the pelvis when the patient is seated, is three times more common in patients with coccygodynia than in the normal population. 2

An interesting fact is that coccyx instability is equally common in people with and without a history of trauma. In this regard, according to studies, only trauma up to 3 months ago is associated with the development of pain in the coccyx.

Patients with normal coccygeal mobility have an idiopathic (no apparent cause) type of coccygodynia that may be associated with pelvic floor muscle tension and spasm or other pelvic muscle abnormalities.

Coccygodynia that occurs when the coccyx is immobile is often associated with inflammation of the membrane (adventitia bursitis) at the tip of the coccyx. Other suggested etiologies include post-traumatic arthritis of the sacrococcygeal joint and nonunion fractures or dislocations of the coccyx.

Abnormal psychological conditions as a cause of coccygodynia have been largely discredited as behavioral testing of these patients reveals personality profiles similar to other patient groups. 5

Other and very rare causes of pain in the sacrum and coccyx are lesions of the lumbar discs, arachnoiditis of the lower sacral nerve roots, tumors of the coccyx or sacrum, pilonidal cysts and sinuses, perirectal abscesses. 4

Symptoms of coccygodynia

Basic
symptom is PAIN. The onset of pain may be subtle, which can lead to prolonged
delay from onset to diagnosis. Patients usually complain about
pain in and around the coccyx without significant low back pain, radiation, or
referred pain. Pain is localized in the sacrococcygeal joint or
movable segment of the coccyx, and it can be relieved by sitting on your feet or on
buttock.

Chronic
pain is pain that persists > 3 months. Patients may
experiencing frequent urge to defecate or pain during defecation. Women with
vaginitis, discharge, or a history of concomitant pelvic pain should be
refer to a gynecological consultation. Associated constipation should
treat accordingly. If the patient has blood in the stool,
the possibility of tumor or metastases should be considered.

Physical examination or what the doctor does during the appointment

Doctor
examines the surrounding skin and soft tissues for the presence of pilonidal
cysts or fistulas. External palpation or rectal examination (via
rectum) can reveal bone growths, local edema. Coccyx follows
palpate from the outside, and in case of insufficient information content, the segment should be
manipulate rectally to detect pain caused by coccygeal movement
segments.

Diagnosis of coccygodynia

Diagnosis initially consisted of standard X-ray examinations. Unfortunately, often there is no difference on a conventional x-ray between sick and healthy people.

They were replaced by dynamic radiographs – this is the most reliable way to diagnose coccygodynia. Unfortunately, such a study is practically not performed anywhere in St. Petersburg, so we organized such a study for our patients in the framework of cooperation with proven radiologists.

In their study, Maigne and colleagues 1–3,6 compared standing and sitting lateral radiographic images of the coccyx in 582 patients with coccygodynia and reported abnormalities in 70%. The normal coccyx rotates slightly (between 5° and 25°) posteriorly or anteriorly when sitting, and returns to its original position when standing (Figure 2, A). Anomalies of the coccygeal segments in the sitting position have an anterior hypermobility >25° (Fig. 2b and 3). Subluxation or posterior displacement of the movable segment of the coccyx is observed when the patient is seated (Fig. 2, C and 4, A). The spicule of the distal end (Fig. 2, D) is most often seen when the coccyx is immobile (<5° of movement while seated). 2

Anatomical
signs of coccygodynia. 1
A, Normal
standing coccyx view.
B, Increased coccyx mobility
when flexed while the patient is sitting.
C, Rear
subluxation of the coccyx when the patient is sitting.
D, Coccygeal
spicule (arrow) extending from the posterior surface of the coccygeal segment.

A 19-year-old man fell on his buttocks 2 years prior to presentation and immediately developed coccygodynia. His symptoms were chronic and disabling. A. Lateral radiograph showing posterior subluxation of the coccygeal movable segment. B, Sagittal T2-weighted MRI with spin echo showing distal coccygeal edema, especially coccygeal subluxation.

Advanced Imaging

Magnetic resonance imaging can also show edema in these inflammatory lesions (Fig. 4b). None of the imaging modalities can accurately diagnose coccygodynia, and they are not as accurate as comparable standing and sitting dynamic radiographs.

Non-surgical treatment of coccygodynia in St. Petersburg

Non-surgical treatment is effective in more than 85% of cases. His tactics seem simple and reasonable. From smallest to largest. This is how we treat patients in the clinic.

• In acute or mild coccygodynia, treatment begins with anti-inflammatory and analgesic drugs, load reduction, soft pillows under the coccyx.
• If this approach is not effective, then physiotherapy is connected (ultrasound, high-intensity magnetic stimulation showed a good effect
• Further, in case of insufficient effect, targeted blockade of the coccyx is performed under ultrasound guidance. If it has a good effect, the treatment is stopped. If there is an effect, but insufficient, then several blockades are performed.
• If the effect is insufficient, a blockade + setting the coccyx in place and stretching the muscle elevating the rectus passage (with anesthesia) is performed.
• If this does not help, a decision is made on the operation to remove the coccyx.

You can read more about treatment with links to scientific sources by expanding this section.

Non-surgical treatment options include non-steroidal anti-inflammatory and pain medications, rest, hot baths, and a pillow to protect the coccygeal region from repetitive injury. Physical therapy, consisting of diathermy and ultrasound, can bring temporary relief.

Wray et al [5] used stepwise treatment in their study, with each step being slightly more invasive than the previous one. First, an anti-inflammatory hormonal drug (methylprednisolone (40 mg)) and a local anesthetic (bupivacaine (10 ml 0.25%)) were injected into the flank and tip of the coccyx.
For persistent coccygodynia, the drug mixture was repeatedly administered and the coccyx was manipulated through the rectum, repeatedly bending and stretching it for a minute. If the treatment was successful at first, but the pain returned, the injections and manipulations were repeated.

If there was no effect, then after 6 weeks a coccyxectomy was performed – surgical removal of the coccyx. The cure rate with a single injection was 59%, but cure in 85% of cases was achieved by manipulation and injection.

Although relapses occurred in the injection group (21%) and manipulation group (28%), retreatment in each group resulted in good success. Coccygectomy was performed in 20% of patients and had a success rate of 91%.
Maigne and Chatellier 6 prospectively compared levator ani massage, joint mobilization, and slight stretching of the levator ani muscle without the addition of injections. After 6 months, successful treatment was 29.2% with massage, 16% with mobilization and 32% with stretching, for a total of 25.7% of overall success. When a patient had a satisfactory result, it was invariably achieved within a week.
Good results tend to remain stable. Patients with normal coccyx mobility showed the best results (43% success after 6 months). Worst of all were patients with immobile coccyx (16%). Outcomes for patients with unstable subluxation (22.2%) and hypermobility (25%) were moderately successful. Massage and stretching proved to be more effective than manipulation. When therapy failed, patients switched to injections or surgery.

For acute coccygodynia (duration ≤ 2–3 months), 8 weeks of rest with a stool softener, adjustable seating, and non-steroidal anti-inflammatory drugs are given. If this fails to alleviate symptomatic coccygodynia or the patient develops chronic symptoms (duration > 2–3 months), examination is done, including standing and sitting coccyx radiographs in addition to MRI to assess for edema of injury, tumor, or other disorders. Usually, stretching, massage and injections begin at this time. If these treatments fail or the pain recurs, a coccyxectomy may be suggested.

Surgical treatment

Operation,
consisting of total coccygectomy or simple removal of the movable segment,
should be performed only after unsuccessful conservative treatment.

Our clinic is not
engaged in surgical treatment.

Summary

Dynamic radiographs can help identify causes and abnormalities in most patients with coccygodynia, and patients with normal coccygeal mobility can also be successfully treated. In most patients, injections of corticosteroids and anesthetics, combined with massage or stretching of the levator ani muscle, are effective.

The doctors of our clinic have experience in treating patients with coccygodynia in St. Petersburg. Within the framework of the clinic, you can perform the whole range of medical procedures, including blockade. We perform blockades under ultrasound guidance for maximum accuracy! We also refer to proven specialists to perform dynamic radiographs.

1. Maigne JY, Tamalet B: Standardized radiological protocol for the study of general coccygodynia and the characteristics of lesions observed in the sitting position: clinical features differentiating dislocation, hypermobility and normal mobility. Spine 1996; 21:2588-2593.

2. Maigne JY, Doursounian L, Chatellier G: Causes and mechanisms of generalized coccydynia: the role of body mass index and coccygeal injury. Spine 2000; 25:3072-3079.

3. Maigne JY, Guedj S, Straus C: Idiopathic coccygodynia: seated lateral radiographs and coccygeal discography. Spine 1994; 19:930-934.

4. Postacchini F, Massobrio M: Idiopathic coccygodynia: analysis of 51 operative cases and radiographic examination of a normal coccyx. J Bone Joint Surg Am 1983; 65:1116-1124.

5. Ray S.K., Ishom S., Hoskinson J.: Coccydynia: etiology and treatment. J Bone Joint Surg Br 1991; 73:335-338.

6. Maigne JY, Chatellier G: Comparison of three manual treatments for coccydynia: a pilot study.