Coccydynia, or coccygodynia, is pain in the region of the coccyx (Lirette et al. 2014).
The coccyx is the terminal segment of the spine. The word coccyx is derived from the Greek word for the beak of a cuckoo bird because of the similarity in appearance when the latter is viewed from the side. The coccyx is a triangular bone that consists of 3 to 5 fused segments, the largest of which articulates with the lowest sacral segment (Lirette et a. 2014).
The Function of the Coccyx
The coccyx has several important functions. Along with being the insertion site for multiple muscles, ligaments, and tendons, it also serves as one leg of the tripod—along with the ischial tuberosities—that provides weight-bearing support to a person in the seated position. Leaning back while in a seated position leads to increased pressure on the coccyx. The coccyx also provides positional support to the anus (Lirette et al. 2014).
What can predispose you to Coccydynia?
There are factors associated with increased risk according to Lirette et al (2014):
-Women are 5 times more likely to develop coccydynia than men.
-Adolescents and adults are more likely to present with coccydynia than children.
– Rapid weight loss can also be a risk factor because of the loss of mechanical cushioning when seated
Mechanism of Injury that can occur with Coccydynia
The mechanism of injury can either be external or internal trauma. External trauma usually occurs due to a backwards fall, leading to a bruised, dislocated, or broken coccyx. The location of the coccyx makes it particularly susceptible to internal injury during childbirth, especially during a difficult or instrumented delivery. Minor trauma can also occur from repetitive or prolonged sitting on hard, narrow, or uncomfortable surfaces (Lirette et al. 2014).
Nontraumatic presentations can result from a number of causes, including degenerative joint or disc disease, hypermobility or hypomobility of the sacrococcygeal joint, infectious etiology, and variants of coccygeal morphology (Lirette et al. 2014).
Conservative Coccydynia Treatment
Conservative treatment is successful in 90% of cases, and many cases resolve without medical treatment. Relatively simple measures are sufficient in most cases. Modified wedge-shaped cushions (coccygeal cushions) canrelieve the pressure on the coccyx while the patient is seated and are available over the counter. Circular cushions (donut cushions) have been suggested for the treatment of coccydynia but they can place pressure on the coccyx by isolating the coccyx and ischial tuberosities and are more useful for treating rectal pain (Lirette et al. 2014).
Manual Therapy for Coccydynia
For the few cases that do not respond to these conservative treatments, more aggressive treatments may be indicated. Pelvic floor rehabilitation can be
helpful for coccydynia that is associated with pelvic floor muscle spasms. Manual manipulation and massage can be both diagnostic and therapeutic. Intrarectal manipulation can identify and potentially correct a dislocated sacrococcygeal joint. Manual manipulation and massage can help relieve associated
muscle spasms or ligament pain (Lirette et al. 2014).
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Lirette LS, Chaiban G, Tolba R, Eissa H (2014). Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. Spring;14(1):84-7