Coccydynia
1. Introduction
Coccydynia is the medical term used to describe pain that is felt around the coccyx (tail bone) which is the very lowest part of your spine. The coccyx is a small, fused portion of bone connected to the pelvis. It originates as an attachment point for ligament, muscle and other soft tissue structures of the pelvic girdle region. Coccydynia often develops during or after pregnancy, or after a fall onto the buttocks (1). It results in pain that may be worse during periods of sitting, or activities that involve bending and lifting. Often the pain will settle with simple, home-based treatments but in more persistent cases further investigation and/or treatment may be required (1,2).
Frequently Asked Questions
Coccydynia is the medical term used to describe pain in your coccyx (tail bone).
- Rare.
- It affects less than 1% of all non-traumatic causes of pain in the spine and pelvic region (1,6).
- No.
- Coccydynia usually improves well with simple advice and treatment.
- In most cases the pain settles with simple measures within 8-12 weeks (1,2,8).
- It is very rarely associated with any serious medical conditions.
- Pregnant women, or those who have recently given birth.
- Those that spend long periods of time sitting, such as drivers or those in office-based jobs.
- Those who are underweight or overweight.
- People who have had a recent fall onto the bottom of the lower back (1,3,4).
- Pain that is felt in the tailbone or buttocks region.
- The pain may be a dull ache, with intermittent sharper episodes.
- Worse when sitting down for longer periods.
- Pain that is increased when sitting on firmer surfaces, or trying to get to sleep at night (1,7).
- Take simple over the counter pain relief.
- Modify or reduce activities that cause or increase your pain.
- Use a doughnut cushion (a circular cushion that helps support the tailbone) when sitting for longer periods.
- Simple exercises to the muscles and soft tissues of the coccyx, low back and pelvis (3,6).
- This will depend upon several factors including other medical conditions, stage of injury, your ability to follow your rehabilitation plan, etc.
- Fortunately, most patients have a good outcome and usually improve within 6 – 12 weeks, with or without treatment (4,5).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
- Pain that is felt around the coccyx or the buttocks.
- Pain that often is described as a dull ache but may worsen with sitting, bending or lifting from the floor.
- Localised tenderness to the tip of the coccyx just above the buttocks (2,3).
3. Causes
Coccydynia can be either primary or secondary and usually results from:
- Direct trauma, usually due to a fall backwards onto the buttocks.
- Repetitive strain or microtrauma (a very slight injury), such as that experienced during childbirth.
- Pain in the coccyx region can also be referred from the lumbar spine or muscles of the pelvis.
- Being either overweight or underweight.
- Spending long periods of time sitting, bending or lifting objects from the floor (4,5).
4. Risk Factors
These factors could increase the likelihood of someone developing coccydynia. It does not mean everyone with these risk factors will develop symptoms.
- Gender – women are five times more likely to develop coccydynia than men.
- Body composition – being either overweight or being underweight can both increase the risk of developing coccydynia.
- Anatomical variations – those with a more pronounced curve of the coccyx may be more likely to develop coccydynia (3,5,6).
5. Prevalence
Coccydynia is a rare condition comprising less than 1% of all non-traumatic disorders of the spinal column. Women are five times more likely than men to develop coccydynia and a relationship exists between weight and the occurrence. A body‐mass index (BMI) of >27.4 in females and >29.4 in males increases the chance of developing coccydynia (7).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your abilities to help towards an accurate diagnosis. This may include assessing range of movement of your low back and, with your consent and chaperone if requested, may determine whether there is point tenderness of the coccyx itself to help confirm the diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Reassessment may be required if symptoms do not improve and appropriate adjustments to your treatment may be made. Imaging studies like magnetic resonance imaging (MRI) or X-ray are not required. However, in persistent cases that have not responded to a period of appropriate conservative management they may be considered.
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your coccydynia. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as advised to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
8. Rehabilitation
Research is very clear that active self-management is key for a timely recovery. This includes advice about remaining active within limitations and resuming normal activities, inclusive of work, as soon as possible (1,2).
Below is a rehabilitation programme created by our specialist physiotherapists targeted at addressing coccydynia. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, this programme provides an excellent starting point, as well as clearly highlighting exercise progression.
9. Coccydynia
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme focuses on maintaining range of movement within the low back and simple exercises to help increase the movement around the pelvis and lumbar spine.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Ongoing support and advice may allow you to self-manage and prevent future reoccurrence
11. Other Treatment Options
- Medication – you might benefit from specific medication options prescribed by an appropriately trained healthcare professional.
12. Links for Further Reading
25 locations and counting across the UK
References
- White WD, Avery M, Jonely H, Mansfield JT, Sayal PK, Desai MJ. The interdisciplinary management of coccydynia: A narrative review. Wiley; 2021. p. 1143.
- Howard PD, Dolan AN, Falco AN, Holland BM, Wilkinson CF, Zink AM. A comparison of conservative interventions and their effectiveness for coccydynia: a systematic review. 2013;21:213. doi: 10.1179/2042618613y.0000000040.
- Arif A, Sardar S, Farah Gilani M, Muneer R, Naz A, Manzoor N, Kashif M. Prevalence of Coccydynia Among Postpartum Women. 2022;108. doi: 10.54393/pjhs.v3i07.418.
- Sivas EG, Üniversitesi C, Fakültesi T, Tıp F, Rehabilitasyon V, Dalı A, Kliniği A, Sivas T, Güler E, Ünal HA. The relationship between disability and depression, anxiety, and sleep quality in patients with coccydynia. 2024;22. doi: 10.14744/agri.2023.23865.
- Garg B, Ahuja K. Coccydynia-A comprehensive review on etiology, radiological features and management options. 2020;12:123. doi: 10.1016/j.jcot.2020.09.025.
- Andersen GØ, Milosevic S, Jensen MM, Andersen MØ, Simony A, Rasmussen MM, Carreon L. Coccydynia—The Efficacy of Available Treatment Options: A Systematic Review. SAGE Publications; 2021. p. 1611.
- Patijn J, Janssen M, Hayek S, Mekhail N, Van Zundert J, van Kleef M. Coccygodynia. Pain Pract. 2010;10:554–9.
- Karadimas EJ, Trypsiannis G, Giannoudis PV. Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J. 2011;20:698–705.
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Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Deep Gluteal/Piriformis Syndrome
A presentation where the sciatic nerve is irritated in the buttock and can cause sciatica symptoms in the leg.
Cauda Equina Syndrome
A rare but serious condition as a result of compression of the nerves at the base of your spine.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Ankylosing Spondylitis
A rare condition that can cause joint stiffness and pain, often worse at night and when resting.