Coccyx Pain

The anatomy: The coccyx, also known as the tailbone, is a small bone attaching to the bottom of your sacrum.  

The impact from the pelvic floor: Your pelvic floor muscles attach to the tailbone assisting it to move forward and backward depending on the length/tension to the pelvic floor muscles.

The movement: If you slouch and sit tall, you can feel the tailbone shift forward and backward respectively.  Because of the muscular attachment, when you contract your pelvic floor, the tailbone shifts forward.  

Is the tailbone stuck in flexion? If the pelvic floor is tight, the tailbone may be stuck forward, which can create pain when transferring from sit-stand or during prolonged standing or walking.  

Is the tailbone stuck in extension? Surrounding muscle attachments and myofascial tension to the back of the coccyx (such as the gluteus maximus) can pull on the coccyx into extension, which may result in pain sitting or or bending forward. 

Flexibility: If your pelvic floor muscles are tight, your therapist will recommend down-training to reduced resting muscle tone and ensure your pelvic floor is staying in a mid-range motion (not elevated to the attic where it is in a maximally shortened position and not living in the basement where it is in the most lengthened state).  

Joint mobility: If the tailbone does not flex or extend, external or internal joint mobilizations may be recommended.

Even if flexibility is addressed, we must address what other factors are creating the muscle imbalance leading to mobility restrictions.  Your therapist must consider your daily posture.

Posture training: To reduce pelvic floor tone, also consider how the posture influences the system:  Many people have a "tucked bum." This creates muscle shortening through the back side of the pelvic floor where the tailbone lives.  If we just focus on pelvic floor muscle stretches and don't change postural habits, the pelvic floor muscles will stay tight regardless of how many stretches we give the pelvic floor.  Consider other muscles and joints that may influence the "tucked bum posture."  This could be due to limitations to the hip, the thoracic spine, or even the foot or ankle.  These mobility restrictions should be addressed as well.  Consider if someone has weakness and has a compensatory movement pattern. This example will result in maladaptive dynamic posture that can influence load and stress through the coccygeal region. 

Stability: Strength training to muscles surrounding the tailbone may be given to improve load tolerance and increase muscle mass and reduce bony pressure when sitting.