Coccydynia Case Report

Dr. Chelsey Shoemaker, D.O.

Coccydynia, or pain of the coccyx (tailbone), is a common musculoskeletal ailment. The tailbone, though rarely thought of during the day, plays a key role in a person's posture and ability to sit. It, along with a person's hip bones, bears the entire weight of the body when someone sits. It is located at the very bottom of the spine. It consists of three to five vertebral segments, interconnected by small discs or fibrocartilaginous joints. It is common for some or all of these to become fused as one ages.

Common causes of coccydynia include:

• Direct trauma to the tail bone. This would include a fall on the ice or pavement.
• Repetitive minor trauma to the tail bone. This occurs during periods of prolonged sitting on firm surfaces; including airline/car seats, bicycle seats, or the ground.
• Injury to the tail bone during childbirth. Prolonged births, mispositioned babies, or use of forceps can worsen the immense pressure applied to the coccyx during birth.
• Posterior bone spur on the tailbone or osteoarthritis. Years of poor posture, obesity, or repetitive trauma can lead to the production of bone spurs or loss of joint space between the coccygeal joints.

Mainstream medical treatment of coccydynia includes conservative treatment with seat cushions, nonsteroidal antiinflammatory pain medications, and heat or ice. In patients who experience discomfort for greater than 2 months, local injections at the site, pelvic floor physical therapy, and chronic pain medications are options for treatment. The most extreme treatment is complete surgical resection of the coccyx.

At the Feely Center for Optimal Health our first line treatment includes same day hands on treatment to resolve the patient's pain and misalignment of the tailbone. This saves our patients from months of discomfort, the hassle of multiple doctor office visits, and the use of unnecessary medications and expense. As an example of our success in treating this disease with Osteopathic manipulation; see the below case of a recent patient treated at the Center.

A 32-year-old female presented to the Center due to 5 months of progressing tailbone pain. Pain started 2 months after delivery of her first child. The baby boy was born via C- section after a failed induction. She experienced a long labor without cervical dilation due to misalignment of the baby. She did not experience any tailbone pain directly after birth, however, she noticed a mild ache develop 2 months after delivery at the very tip of her tailbone. Her pain was worsened during long periods of rocking and nursing several hours a day in a glider at home. Severe pain occurred two weeks prior to presentation when she bent down to pick up her baby from the ground. Since that event she has had significant pain when sitting, greatly affecting her life.

After a complete physical exam ensuring there were no life-threatening disease processes causing her pain, osteopathic manipulation was performed. She was instructed to place herself in specific positions which allowed key muscles and ligaments to relax. Dr. Feely utilized counterstrain Osteopathic techniques while the patient was lying on her stomach that completely resolved her pain. Using muscle energy and myofascial release techniques the bones of her spine, hips, and tailbone were moved into correct alignment, contributing to completing and maintaining her pain free state. Thus, she easily tolerated sitting directly on her tailbone, something she had not experienced in 5 months.