Oh coccyx, my coccyx!

In Pelvic Floor Physical Therapy by Emily Tran7 Comments

feature-image-oh-coccyx-my-coccyx

 

By Admin

 

If you don’t know what or where your coccyx is, count yourself lucky.  This little bone can make quite a ruckus when it’s not happy, often called coccydynia.  The coccyx, or tailbone, is our little vestigial tail, after eons of evolution.  It is often ignored and forgotten by most, but to me, it’s one of the most important bones in the body.  Today we’ll go over why the coccyx matters and how it plays a role in pelvic pain, muscle tightness, nerve issues and even your neck movement!

 

#1) The coccyx: small but MIGHTY rudder

 

coccyx-spine

 

The coccyx is a tiny bone that joins with the pelvis at the sacrum to create the sacrococcygeal joint.  Despite popular thought, the sacrococcygeal joint is mobile in many people.  This joint varies from synovial (maximal mobility), to fibrocartilaginous (moderate mobility), to ossified (no mobility).1  Also, it is not unusual to have a small articular disc at the sacrococcygeal joint to help with this movement.  Research has documented normal coccygeal movement is between 5-25° from standing to sitting.2 So, the coccyx can move.  The location of the coccyx, at the base of the spine, and its ability to move can have far reaching implications on the rest of the body. For example: a change at the coccyx changes how the sacrum and pelvis moves. The pelvis is the body’s center of mass, so where the pelvis goes the body goes. Who would think such a little rudder could steer such a big ship?

 

#2) The coccyx: central attachment point of fascia, ligaments and muscles

 

pelvic-floor

 

The coccyx is also a central attachment point of fascia, muscles and ligaments on the inside and the outside of the pelvis.  I mean, just look at all those beautiful muscles.  And check out these ligaments!

 

 

 

So, if you imagine, a coccyx off-axis may create some problems.  Let’s just take the pelvic floor muscles as an example. If, say, the coccyx is pulled over to the left, all the pelvic floor muscles attached to the left side of the coccyx will get short and weak, while the ones on the right will get stretched out and weak.  This could lead to decreased “core” strength (pelvic floor is part of the “core”), incontinence (urinary or bowel) and/or pain (bowel, bladder, sex, exercise). The ligaments that attach to the coccyx also provide passive stability to the pelvis, primarily at the sacroiliac joint.  A shift at the coccyx could create ligamentous tension, leading to the same problems.  Some of these ligaments, like the anterior longitudinal and supraspinal ligament, even run all the way up to the head and neck!  You can imagine how childbirth, a fall or throwing your back out could create a problem, not only locally at the tailbone, but further up or down the chain.

 

#3) The coccyx: base of the nervous system, MAGIC

 

spinal-cord

 

This may be one of the more magical things.  The spine houses the spinal cord.  The spinal cord is the brain’s extension to the rest of the body.  It starts in the skull, runs the whole spine and then attaches to your coccyx.  The filum terminale (pictured above as Terminal filum), is the final thread of spinal cord that secures itself to the first coccygeal vertebra.  Sometimes, if there is stiffness in the spine or at the coccyx itself, it can impact the mobility and health of the nervous system.  When this happens the body may become protective in order to keep the nervous system safe.  Often this protection can create symptoms of numbness and tingling, or a tightness that does not resolve after normal healing time.  Examples of this would be a “hamstring tear” or “adductor strain” that has never fully healed.  Often, the tight “muscle” is actually an unhappy nerve, and stretching it may feel good in the moment, but afterward worsens the symptoms. Treating the tailbone is one aspect, along with a multitude of other rehabilitation techniques, to improve the health and mobility of the nervous system.

 

#4) Oh Coccyx, My Coccyx

 

So, what to do with all this information?  Well, hopefully be a little more thoughtful to your coccyx, it’s a cool little bone.  Nice things you can do for your coccyx include: proper sitting posture, pelvic clocks, or even just going for a gentle walk to get some blood flow.  And, if you’ve got pain down there, be sure to see your local pelvic floor PT or come visit us to get that tail wagging again!

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Are you unable to come see us in person? We offer virtual appointments!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.

 

References:

1.Lee DG, Lee L-J, Vleeming A, Jones MA. The pelvic girdle: An integration of clinical expertise and research. 4th ed. Edinburgh: Elsevier/Churchill Livingstone; November 17, 2010:24-25.

2. Fogel G, Cunningham P, Esses S. Coccygodynia: evaluation and management. J Am Acad Orthop Surg.2004;12:49–54.

 

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

Comments

  1. I have been looking through a lot of the blog posts and found them very helpful. I fell in Jan 2015 and my coccyx took the entire fall. For months I couldn’t even sit. Now the pain with sitting is pretty much gone. But I cannot empty my bowels and have severe abdominal pain and bloating everyday. Even passing gas is almost impossible sometimes. I saw a pelvic therapist for 6 months and we focused on dry needling and manual therapies. In other blog posts, it says that stretching the muscles is beneficial but this on relating to the coccyx says that it can hurt more after with the muscle stretching? So what is the best thing to get my right muscles to calm down? I have numbness always and sometimes burning at the tailbone region and have used my finger to help bowel movements every single time for a year since it is impossible otherwise. Please help!! I am only 24 and can barely function anymore since my stomach pain hasn’t taken over my life.

    1. Author Britt Van Hees says:

      “Thank you for asking. It sounds like the pelvic floor therapy that focused on your muscles, via dry needling and manual therapy, was very helpful, especially since you can now sit with pretty much no pain. However, your coccyx itself may be in a dysfunctional position, limiting your ability to have complete bowel movements. Also, since your nervous system attaches to your tailbone, your numbness and burning could be related as well. I would find an osteopath or physical therapist who is trained in assessing, and if appropriate, mobilizing your coccyx to help with these other symptoms. Feel free to give a call for specific referrals or if you live near by, come for treatment. It sounds like there are definitely some additional treatments that would be appropriate for you to address the coccyx itself. Also, you may also want to find a functional nutritionist or naturopath to determine if there is any digestive support to reduce bloating and improve your bowel quality. You can also check out some of these other blogs: https://pelvicpainrehab.com/pelvic-pain/403/put-your-constipation-woes-behind-you/ and https://pelvicpainrehab.com/constipation/3535/whats-right-way-poop/

  2. Thanks so much for this article. I have taken courses with Liz and Stephanie and continue to use their techniques at my clinic in Mcminnville. I have a patient with significant coccyx pain but more of the other symptoms that are referred from the coccyx’s neural connection. Do you have any PT techniques that have helped you treat coccydynia? Thanks for sharing your information and writing an article that is written so well. Kind regards, Nora

    1. Author Britt Van Hees says:

      “You are welcome! Yes, thank you for asking. There are a number of techniques to treat the coccyx that I have found helpful. I primarily work within the Institute of Physical Art paradigm, so that would be a good place to start. I believe the IPA has courses in Oregon, the Visceral course or perhaps the Pelvic Girdle Puzzle class would probably be the easiest way to get started. Osteopathic techniques can also be helpful. Essentially, you are trying to get the coccyx back “on axis” or “in alignment” with both external and internal treatment. Then you can treat the neural aspects with low vigor nerve glides. I would recommend taking a course before trying anything too crazy. Also, be aware, patients with heightening central nervous system response may need to work very slowly. And don’t forget, posture and appropriate biomechanics can do wonders for reducing symptoms- though I’m guessing you’ve already cleared that. Feel free to give our office a call if you have other questions.”

  3. What are your thoughts on coccygectomy? I spent 3-4 years in excruciating pain with inability to sit or basically function at all. I spent a year with a pelvic floor PT and did numerous other treatments to no avail. I was recommended to get a coccygectomy as a last resort and that happened over a year ago. My pain seems to have moved to concentrate in my rectum just inside my anus. 🙁 I was discharged from pelvic floor PT a year after the surgery because of no progress.

    1. Author Britt Van Hees says:

      “Hi Megan,

      Thank you for your question. You have gone through a lot with your pain. It sounds like the pain at your coccyx is now just shifted to another nearby location. Coccygectomy is not my first choice of treatment since it is such an important structure and often does not provide much relief of symptoms- like your experiencing. I would be interested in restricted tissue around that area or even dural tension somewhere along the spine causing your anal discomfort. Also, if your nervous system is being a little too hyper-protective it could exacerbate these symptoms. Feel free to give our office a call and we can talk a little more about some additional treatment strategies and if there are any appropriate referrals in your area.”

  4. Hi!
    Wow, thank you for this information!
    I am a 38yo mamma and massage therapist, and I just fell and may have broken my coccyx. I am off work waiting to see if I will heal enough to get back to life. I have been researching, after going to an immediate care clinic, and learning next to nothing about what has happened, what i need to know how to rehabilitate. Sounds like some visits to my pelvic floor PT will be happening in a few weeks. Very good to know how it can effect the nervous system, I also have a diagnosis(recent) for HNPP. My bottom, up my medial hip/sacral area, and inner thighs and vaginal area are numb currently.
    I don’t really have a question, mostly just a huge THANK YOU!

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