Coccyx pain / Tailbone pain - diagnosis, therapy, prevention

What is the tailbone, and where is it located?

The coccyx is the final segment of our spine. The two to five segments of bone that make up the coccyx are usually tightly connected and form a triangular bone. The coccyx is located in the lowest point of the spine and serves as an attachment for muscles, tendons and ligaments of the pelvis. Although the tailbone is small, it can have a major impact on our welfare. The tailbone does not have the best reputation. Especially since most people only come to their senses once they have fallen for it - whether on wet autumn leaves, icy sidewalks or slippery stairs.

Like the tibia, the tailbone is surrounded only by a thin, sensitive periosteum, which offers little protection. The coccyx is the regressed part of the skeleton's tail which does not move when walking or standing, but it was discovered through X-rays examinations that it has a forward and backward mobility of 20 degrees. The so-called Coccydynia is the name used to refer to pain in the coccyx's area (Os coccyges) or tailbone pain. Coccyx injuries are often painful and tedious.

Women are affected more than men

Women are more affected by tailbone pain or coccydynia than men. Why? Because the tailbone is heavily strained during pregnancy and especially by giving birth, but the most common reason for both gender is: sitting for long periods. The sedentary nature of the actually active movement people in the western countries often adds up to 10 to 14 hours a day and to 14 million students are being taught how to properly sit. In Germany people sit at least 9.6 hours a day and this not only causes the musculature to contract, leading consequently to back pain but also favors vascular diseases such as the coccyx fistula. A coccyx contusion is much more frequent than a rupture of the tailbone.

Coccyx pain has different causes

The main causes of coccyx pain cannot be always easily determined. However: it is clear that coccyx pain is often a consequence of violent falls on the buttocks - for example, with sports accidents. Bruises or fractures cause severe pain and can be felt while sitting, climbing stairs, when bowel movements and even during sexual intercourse. Even difficult childbirth, irritations in the area of tendons or muscle tendons on the bone (tendo-pathologies), tumors in the coccyx or congenital anomalies can be considered causes. Even long sitting on softer surfaces can cause coccyx pain in some people. Other possible causes of coccyx pain may be: periostitis, coccyx dislocation, coccyx fistula, malposition of the coccyx, injuries in the pelvic region, lumbago, herniated discs, surgical procedures, nerve irritation, gynecological problems (for example endometriosis).

A typical symptom is a stabbing, burning pain in the coccyx region

Not every disease has clear and typical symptoms that lead directly to the main problem but Coccydynia does. Its typical and clear symptoms are: burning and stinging pain in the coccyx area. It is possible, though, to feel it also in other parts of our body, such as the hip, lumbar and anal areas. The biggest problem is that patients with coccyx pain usually cannot sit on hard surfaces for long time in fact they feel it immediately when sitting down, only when sitting for a long time or even when getting up. This kind of pain is produced by inflammation in the periosteum which can also lead to nerve pain. They are triggered by affected nerves on the lower sacrum and coccyx. But it does not matter for what brings them because sufferers usually can not sit for days, weeks, sometimes even months, without suffering. Be careful, coccyx pain can become chronic if you do not seek the help of a specialist.

Coccyx pain diagnosis

The prerequisite for an accurate diagnosis is the Anamnesis: conversation between the specialist and the patient in which the latter describes in detail his pain and clinical history. The step that follows is the physical examination, which will reveal a Coccydynia; if the pressure on the coccyx is painful. The examination can be considered complete once the imaging procedures have been made. As you already know: imaging techniques (e. g. X-rays of the coccyx, computed tomography and magnetic resonance imaging) usually reveal no visible changes. However, they should still be done in order to rule out a local inflammation or a tumor. Significantly more meaningful is a magnetic resonance imaging (MRI), in which one can better assess bone injuries, fractures, and injuries of adjacent soft tissues.

Tumors are also clearly visible through the MRI examination. If an inflammation or a coccyx tumor is suspected, the doctor, in order to control the affected area properly, may prescribe do to the examination with contrast agent. Next - the internal examination: Through the rectum, the specialist can feel how mobile the coccyx is, tracking tensions in the pelvis or changes in the internal organs. If this examination causes pain for the patient, the suspected coccydynia is confirmed.

Therapies for tailbone pain - physiotherapy and painkillers

Acute coccydynia can be alleviated by concomitant, general therapeutic approaches. Conservative therapies such as pain therapy and local injections already relieve the pain. However, chronic coccyx pain is feared because of its lengthy nature. If no cause is found, local infiltrations with corticosteroids or local anesthetics may be introduced at the junction between the sacrum and coccyx bones. Analgesics may also be administered to accompany the treatment. Additional measures may include physiotherapy for its specific exercises and in case of serious problems with sitting a seat ring may be prescribed.
Possible treatments for coccyx pain include conservative therapies as well as infiltration and denervation. With denervation, the specialist inserts a specific cannula under radiological control exactly where the nerves are irritated and stimulates them to understand if it is the point of origin of the pain. Thereafter, through the glass fibers of a needle comes a laser which is led directly to the affected area and with its heat deactivates the irritated nerve fibers (denervation).
A surgical removal of the coccyx is taken into consideration only in case of chronic tailbone pain, but is rarely needed.

Prognosis and prevention - mind your own back-related behavior!

After treatment on the tailbone, as a patient you have to gain long-term back-related behavior in everyday life, that is to say: learn how to sit properly and how to strengthen your muscles. Try to integrate more exercises in your routine; for example, going to work by bike, walk during your lunch break. Yes, it will help your tailbone.

Prevention of tailbone pain

Three simple tips for the prevention of tailbone pain: replace your office chair with an ergonomic office chair or an ergonomic stool, use a coccyx pillow (it will take your tailbone almost pressure-free) And: STAND UP! Get out of the vicious circle of sitting. Play the 40-15-5 rule. Sit for 40 minutes, work standing for 15 minutes, and walk around for 5 minutes. Include gymnastic exercises in your everyday life - so you can strengthen the back muscles, your pelvic floor ... and equally relieve the coccyx.

Dr. med. Munther Sabarini

Dr. med. Munther Sabarini
Specialist in Neurosurgery

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

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