Tailbone Pain & Returning to Activity
What is the tailbone and how do I know if it’s contributing to my pain? The tailbone, otherwise known as the coccyx, is the structure at the base of your pelvis. It’s the attachment site of several pelvic floor muscles and can be the driving factor of stubborn, persistent pain. The tailbone can cause pain with sitting, laying on your back, pain with intercourse, and even difficulty having a bowel movement. It can be quite frustrating and limiting!
The most common tailbone injury is a fall backwards, landing on your pelvis. The tailbone pain may or may not set in directly after the initial fall. My patient, Sasha, was a skilled skier and enjoyed cycling in her free time. She shared with me that she had a fall about 8 months ago resulting in some low back pain. She told me that it wasn’t until about 4 months after her injury that her tailbone pain set in. She went to several physicians and physical therapists, underwent a course of physical therapy with an orthopedic specialist, bought cushions and donuts, and tried several pain medications to no avail. She came to me feeling frustrated, defeated, and disheartened. Her tailbone pain was not addressed, she couldn’t enjoy her active hobbies, and now she couldn’t even sit in a chair or be intimate with her partner without pain.
Sasha’s case is one that I see too often. Her physician gave her prescription medication, which addressed her symptoms but not the driver of her pain. Sasha’s orthopedic PT prescribed her exercises that addressed her hips and low back pain, but did not address a key muscle group that plays a role in tailbone pain. After assessing Sasha’s movement, lumbopelvic girdle, and pelvic floor muscles, we found that her pelvic floor muscles were guarded, uncoordinated, and weak. Because the tailbone is the attachment site of most pelvic floor muscles, it is crucial to assess this muscle group. Movement requires a component of mobility and a component of stability. Because of the trauma to the tailbone, Sasha’s pelvic floor muscles became overly tight and guarded to give her stability in that region. Our job now was to balance her muscles by releasing the overactive pelvic floor while giving her stability in her glutes and deep core by strengthening.
Tailbone pain can come on weeks or even months later, like in Sasha’s case. The pelvic floor muscles work together in a system with the hips, glutes, abdominal muscles, and back muscles. Initially, the fall might have caused some inflammatory pain that resolved as the inflammatory process ran its course. Over time, the tailbone lost mobility and guarded due to the surrounding muscles. This impacted the surrounding muscles, and the system as a whole was imbalanced.
Our goal in physical therapy is to assess the lumbopelvic region which includes the hips, low back, abdominal wall, and pelvic floor, and understand what dysfunction or imbalance may be causing your pain. We will work together to create a plan that suits your individualized goals, needs, and concerns. Whether you need to get back to skiing, hiking a fourteener, taking a yoga class without pain, or intimacy without anxiety, a thorough pelvic floor evaluation for tailbone pain can help you get there without pain slowing you down.
Written by: Dr. Isha Kelkar PT, DPT