The term Coccydynia describes pain in the coccyx and pelvis, but also pain in the more distant areas, which have their cause in the imbalance of the muscles and ligaments of the pelvic floor. It can be pain for example in the neck, chest, lumbar spine or head.
The syndrome causes anatomical shortening of the muscle fibres or increased tension of the muscles attached to the coccyx for example as a result of injury. This shortening or in other words hypertonus is asymmetric and it pulls the tailbone (coccyx) towards one side. Subsequent formation of sacroiliac joint (the so called SI - sacroiliac joint), restricts the mobility in the hip joints. Furthermore, there is a tension that is transferred by muscles upward to the spine as well as down to the legs.
Increased muscle tension in the area of the short pelvic ligaments and muscles is caused by short term mechanical irritation (falling down on the tailbone during skiing, skating etc.) or by long term irritation (cyclists who sit for a long time on the saddle of the bicycle, put pressure on their tailbone, but also office workers who sit most of the day).
By pregnant women it is caused by hormones which relieve the ligaments, the tailbone is during sitting exposed to bigger pressure. During birth is the head of the baby pressing outwardly on the tailbone of the mother, which can cause this syndrome by women.
Dividing the causes
- Primary - the cause of coccydynia is directly in the pelvic floor (disbalance of the muscles and ligaments of the pelvic floor).
- Secondary - inflammation in the lesser pelvis (for example inflammation of the urinary tract, sexual organs) or the problem can be in the legs (blockage in the knee, ankle, etc.), which is transferred through the muscles to the pelvis. If we do not treat the primary source, we won’t be able to remove for good the increased muscle tension and problems in the pelvis, instead these problems will be returning.
The secondary symptom can be headache, pain in the cervical and thoracic spine. Pain in the thoracic spine with symptoms manifesting in the arms by pain or in the chest and lumbar spine is not an exception. Pain in the lumbar spine can increase during hormonal disbalance, menstruation, menopause - also by men.
Headaches can strongly resemble migraine, but the typical aura does not appear in this case - temporary sight, sensory, tongue or movement disorder. But what does accompany the headaches is tired eyes, disorders of vision and sharpness. Pain can be also localized only to certain parts of the head, or it impact the whole head, which has a pressure/tension character.
Pain in the thoracic spine can on the other hand resemble problems with heart including breathing insufficiency, pain beneath the sternum bone etc. The manifestations are in the lumbar area transferred to the groins, lower abdomen, hips and buttocks. The general image will reveal, whether the pain has relation to defecation, walking or sexual intercourse. If we reveal some connections, it should lead us to the cause in the pelvis.
Painful menstruation (dysmenorrhea) is a symptoms of the syndrome of the pelvic floor, even though most women consider it normal. This syndrome can be a reason of functional infertility. In case of pregnancy it worsens the birth pains.
University educated physiotherapist knows the connections even between seemingly unrelated symptoms. Therefore we ask about regularity and course of menstrual cycle by women, pain during sexual intercourse, defecation, functional problems of the musculoskeletal system etc.
We search after deviations in the body posture, shifting and asymmetry in the pelvis. Uneven leg length, differing range of rotation in the hip joints or asymmetrical surface of the foot affects the involvement in the pelvis and it can be a cause of asymmetrical tension in the pelvic floor. Painfulness of the gluteal muscles is approximately in the upper third closer to the sacrum bone, which is often one-sided. Coccydynia and syndrome of the pelvic floor can point to the blockage of the SI joint (sacroiliac joint), especially when it is repeating.
Don’t forget on the pain of the spine and head. These symptoms are accompanied by increased sensitivity on touch and pressure in characteristic zones alongside the spine. Typical response is skin redness of the irritated sector of the skin. Headaches are characteristic by blockages in the head joints.
In our facility we specialize on combined treatment of physiotherapy and shock wave therapy. We developed this technique and named it Physiotherapy All-Inclusive or FOKUS All-Inclusive. In treatment we also use radial shock wave - if we treat muscles in higher tension and trigger points in the surface muscle structures - or focused shock wave - if the muscle or ligamentous tension is deeper in the abdominal cavity and pelvis (for example adhesion after appendectomy). These technologies enable us to advance in the treatment of the syndrome, faster that it used to be in physiotherapy till now, without the need to of using medicaments against pain.
It is very important to modify muscle disbalance, treating increased muscle tension and muscle spasms in the spine, ribs, pelvic floor, and removing the blockages. We use mobilization and techniques of the soft tissues, we teach our clients methods of Ludmila Mojžíšová. The most frequently used mobilization is mobilization of the coccyx per rectum (through rectum), which provides us with reliable diagnosis.
Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic