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Causes and Characteristics of Coccydynia

Jennifer Stone, PT, DPT, OCS, PHC

November 21, 2019

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Question

What are the characteristics and causes of coccydynia? 

Answer

There are a lot of possibilities in regards to the causes of coccydynia. I would say the most common, at least that I see walking into the clinic, is trauma. Trauma to that area can include vaginal delivery, especially instrument-assisted or shoulder dystocia.  A fall is very common. I live in Missouri and it's very common for people to slip on ice because we often have ice first or rain first (which will freeze) and then snow on top of it so that people can't necessarily see that there's ice under the snow. Therefore, we have a lot of coccydynia due to falls. A near fall can also cause coccydynia.  The reason for that is that when you slip and try really hard to catch yourself, those muscles activate and sometimes that can set off a muscle spasm or some other problems that can lead to coccydynia. Certainly, a direct blow can cause coccydynia, but that is one of the less common ways that I actually see people being injured. Water slides are such common causes of coccydynia that there are entire articles looking at incidents of coccydynia that start after a person went down a water slide. 

Another possible cause would be repetitive microtrauma. For example, sitting on hard surfaces for long periods of time or just sitting awkwardly with poor body mechanics. You certainly could also have repetitive microtrauma from not balancing your musculature and balancing intra-abdominal pressure ideally as well. That wouldn't necessarily be related to sitting, that would be more so with activity.

A pelvic floor spasm is a very likely cause of coccydynia, especially if that spasm is unilateral resulting in uneven pressure across the tailbone. Scar tissue from a pilonidal cyst removal or a coccygectomy is another cause.  Idiopathic coccydynia is actually fairly common as well, meaning we just don't know what started it.  Those ones, unfortunately, have the least ideal prognosis. Rapid weight loss is also a common cause of coccydynia, and most people think that this is just due to shifting pressures. Often people who lose weight very rapidly are losing a lot of muscle mass as well as fat and water. Finally, pelvic organ prolapse is also a very common cause of coccydynia.

Characteristics of coccydynia include pain with sitting, pain that is typically worse with leaning back and also worse with sitting on really hard surfaces, and interestingly, it's actually often also worse with sitting on a very, very soft surface. So there's a happy medium in there somewhere that is more comfortable for people. It might be actually better if they're sitting on a toilet, or a donut cushion and the reason for that is that both of those will actually unweight the coccyx to where they're sitting more on their ischial tuberosity. They will often have pain with transitions, especially transitions where they're going from a lot of hip flexion to not very much hip flexion, or the reverse, so sit to stand, stand to sit. Usually, the pain will improve some with walking or any kind of repetitive low impact movement. Patients with coccydynia often will have pain with bowel movements and sometimes will have pain with sex, especially with the penetrative aspect of sex. 

 


jennifer stone

Jennifer Stone, PT, DPT, OCS, PHC

Dr. Jennifer Stone graduated from Texas State University in 2009 and completed her transitional DPT through MGHIHP in 2010. She completed an orthopedic residency through Evidence In Motion in 2010 and is a board-certified orthopedic clinical specialist through the American Board of Physical Therapists Specialties (ABPTS). She received a pelvic health certification through Herman & Wallace in 2013. She serves as the Director of Operations for Evidence in Motion and program director for Evidence In Motion’s pelvic health content. She is also an adjunct faculty member for the University of Pittsburgh’s entry level DPT program. Dr. Stone is an active member of the American Physical Therapy Association (APTA). Her clinical experience includes orthopedics, pelvic health, and practice management in both hospital and private practice settings. Jennifer is passionate about teaching and opening the world of pelvic health to all types of clinicians

 


Related Courses

Pelvic Organ Prolapse and You
Presented by Jennifer Stone, PT, DPT, OCS, PHC
Recorded Webinar

Presenter

Jennifer Stone, PT, DPT, OCS, PHC
Course: #3877Level: Intermediate2 Hours
  'The instructor's style is very conducive to learning'   Read Reviews
This course provides an overview of types of pelvic organ prolapse, discusses causes of pelvic organ prolapse, and discusses rehabilitative management of both post-operative and non-operative patients with pelvic organ prolapse. This course is best suited for physical therapists who already have some underlying pelvic floor/pelvic health knowledge, but may also be taken by those who do not with the understanding that some additional outside study of anatomy may be needed. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 1 hour of general and 1 hour of Direct Access CE credit.

Behavioral Health & Physical Therapy: What Is Our Role?
Presented by Jennifer Stone, PT, DPT, OCS, PHC
Recorded Webinar

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Course: #4654Level: Intermediate2 Hours
  'Very interesting'   Read Reviews
In 2023, it is no longer adequate to treat people’s bodies solely. This course introduces learners to some behavioral health concepts, including methods for screening, integrating behavioral health management into care, and understanding the impact of behavioral health concerns on physical health.

The Aging Adult and the Pelvic Floor: Applications for All Providers
Presented by Jennifer Stone, PT, DPT, OCS, PHC
Recorded Webinar

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Course: #3641Level: Intermediate2 Hours
  'The instructor is very knowledgeable in her field'   Read Reviews
This course provides information regarding the impact of aging on the pelvic health of older adults along with practical tips to promote ideal pelvic floor activation and function in this population. This course will have applications both for pelvic health therapists who wish to know more about older adults and geriatric therapists who wish to understand the role of the pelvic floor better. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Mindfulness: Beyond Guided Meditation
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Course: #3902Level: Intermediate2 Hours
Mindfulness can be a really powerful cognitive-behavioral tool and has many relevant applications when treating patients with pain, especially chronic pain. Many courses for rehabilitation professionals teach guided meditation, which is an amazing tool. However, mindfulness has many other applications and opportunities for use in the treatment of patients with pain. This session discusses the history and science behind mindfulness, as well as provides a variety of practical mindfulness tools for the everyday practitioner. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Motivational Interviewing
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Course: #4671Level: Introductory2 Hours
  'Clear information presented and good examples'   Read Reviews
Motivational interviewing is a behavioral health technique that has been proven to help people with making changes. Physical therapists are uniquely positioned to help their clients make meaningful changes in their lives. This course provides practical tips and guidelines for integrating motivational interviewing into your treatment program.

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