Coccyx Tailbone Injury: Runner’s Guide to Treatment and Prevention

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Etymology

Coccyx derives from the Greek word kokkux, meaning the bird cuckoo because of it’s resemblance to a cuckoo’s bill.  Coccydynia means painful coccyx. The word is formed by the suffix -dynia which means pain from the Greek word odyne.  When running, your entire body is engaged in physical activity. This is the secret to running’s effectiveness: the fact that you need to use your entire body during the process means that running is a very effective exercise for losing weight and improving your cardiovascular health. However, a trade-off to running’s effectiveness is that the possibility of injury is high. The injuries that can come about as a result of running can occur in many different places on the body and can be caused by many different factors.  This discussion will cover many aspects cowritten by Eddy Mihai and curated by Diana Rangaves, PharmD, RPh to maintain quality.  Sometimes, running injuries occur out of nowhere, with no clear cause. Other times, running injuries are due to your body not being acclimated to the amount of running you engage in. The most common cause of running injuries, as well as the most easily preventable, are injuries caused by bad habits, such as poor posture, gait, or equipment. Despite being easy to prevent and identify, these injuries can still occur with little to no warning and result in extended periods of inactivity as a result. Most notable of these injuries are the ones that can afflict your coccyx or tailbone.

 

What is Coccyx Injury?

Also known as coccydynia, coccyx pain is a common injury that can come about as a result of running. The pain is caused by inflammation of the tailbone, or coccyx. The tailbone is located at the very bottom of your spinal column, and is made up of several fused segments of bone. As part of your pelvic floor, the tailbone is considered a vestigial body part, left over from prehistoric humans. However, it still plays a role in balancing the body while seated, acting similarly to one of the legs on a tripod. The pain experienced from coccydynia is usually described as a dull ache, which feels worse when sitting down or defecating.

Symptoms

The primary symptoms of coccyx injury are pain and tenderness in the base of the spine. If the tailbone area of your back feels sensitive to touch, and if you experience pain from the actions of sitting down and standing up, the condition you are dealing with may be coccydynia. In some cases, individuals with coccydynia may also experience pain while defecating, as the coccyx plays a role in rectal functions. Others may experience diminished pain while sitting that worsens when standing up; this is caused by muscle tightness in the gluteal area that can contribute to tailbone injury.

List of Symptoms for Coccyx Injury:

Causes

31% Unknown cause of pain
27% Hypermobility (excessive flexing of the coccyx forwards and upwards when sitting)
22% Posterior luxation (partial dislocation of the coccyx backward when sitting)
14% Spicule (bony spur) on the coccyx
5% Anterior luxation (partial dislocation of the coccyx forwards when sitting)

Ordinarily, pain in the coccyx is most commonly caused by falling and landing on the tailbone, or some other action that causes an impact to your lower spine. Another common culprit is repetitive activity that can put stress on the tailbone, such as poor seated posture. Women are much more likely to experience coccydynia than men, mainly due to complications during childbirth. In some extreme cases, coccyx injury is caused by an infection or the development of a tumor.

While many of these causes seem separate from running, the truth is that running can worsen cases of tailbone pain as well as impede recovery. Since running is a repetitive movement that engages the entire lower body, the recovery process for coccydynia can be extended due to frequent running. For this reason, you can consider running to be a potential cause for worsened tailbone pain, as well as a cause for delayed recovery. Additionally, stress on the coccyx while running can occur in situations where the surface you are running on is uneven, or if the shoes you are wearing fail to provide adequate support.

List of Causes for Coccyx Injury:

Unstable or dislocating coccyx

An unstable or dislocated coccyx is a common cause for coccydynia. Often times, misnomered as a ‘fractured coccyx’. The coccyx can be either hypermobile or dislocate both backward and forward. Pain will usually occur when sitting down. Such a joint slippage/dysfunction can also cause the pulling or tearing of the surrounding tissues which can seriously affect the patient’s quality of life.

Causes include hard trauma to the area such as falls, repetitive impacts or strains such as from skating, cycling, rowing, running. Also, pregnancy and childbirth. Many causes are unknown.

Symptoms include inflammation, pain, inability to sit and/or walk properly.

Diagnosis is put after some imaging tests (X-rays) with the patient standing in different positions. The images are then analyzed alongside the patient’s medical history. A palpation exam may also be used.

Treatment consists of pain management, usually by the way of corticosteroid injections, until the joint heals by itself or surgery is deployed. The removal of the coccyx is successful in most cases.

Epidemiologically speaking, Dr. Maigne and colleagues noted that 55% of cases of coccyx pain were apparently caused by instability of the coccyx when sitting down.

Bony spur, or spicule, on coccyx

A spicule or bony spur on the coccyx is a fairly common condition in which there’s a growth/spur on the tip of the coccyx which causes pain and discomfort. Furthermore, thinner patients experiment greater pain due to the lack of fat padding over the spur.

The main cause is thought to be genetic. Formation occurring in the embryo.

Symptoms include the usual pain and discomfort when sitting, walking, jumping, or similar.

Diagnosis is put with the help of imaging and physical exams. MRIs are usually deployed because of their greater detail which allows the identification fo the spur. Other physical and/or palpation tests may also be necessary as the protuberance is almost always pointed backward.

Treatment involves local injections and surgery.

Epidemiologically speaking, Dr. Maigne found that a spur of bone on the coccyx is the cause of pain for 14% of patients.

Misaligned, rigid, or long coccyx

A normal coccyx is composed of two or three segments, and rarely out of one or four pieces. Furthermore, a normal coccyx points forward and flexes slightly when sitting. However, if the coccyx does not present normal attributes, it can lead to pain and discomfort due to its rigidity, misalignment, or longness.
Most common conditions include a sharply angled coccyx, a coccyx pointing more to one side, a completely rigid coccyx formed by a whole fused segment connected to the sacrum, and a longer coccyx formed by four pieces.

Causing such problems is thought to derive from genetical factors alone.

Symptoms include pain, discomfort when sitting, lying or walking.

Diagnosis is put with the help of common imaging techniques such as X-rays.

Treatment involves the use of corticosteroids, especially in the case of a misaligned or rigid coccyx. Surgery is deployed much more rarely in these cases.

Epidemiologically speaking, Dr. Postacchini F. and Dr. Massobrio M. discovered that a coccyx curving slightly forward was the most common pain-provoking condition in the general public.

Muscle spasm or tightness

Muscular dysfunction might be a cause for coccydynia. Taut bands (strongly contracted muscle fibers) are relatively common and are usually very painful when pressed.

Causes include stress, genetics, neurological disorders, trauma etc.
Symptoms include painful bowel movements and dyspareunia (painful sexual intercourse).

Diagnosis is usually completed after a rectal examination of the muscles in order to locate knots or trigger points,  near the coccygeus muscles, obturator internus, gluteus maximus, and adductor magnus.

Treatment consists of dry needling, procaine or corticosteroid injections, massage, stretching, physical therapy, psychotherapy etc.

Pilonidal cyst

Sometimes, an abscess with pus and hair can develop all over the body, most commonly on the top of the buttock cleft. The pus may drain in a sinus passageway and cause pain, discomfort etc.

Causes include genetics, ingrown hairs, or a result of a congenital pilonidal dimple.

Symptoms include swelling, inflammation, and discharge of pus.
Diagnosis si put upon visual inspection by a doctor.

Treatment usually consists of a small surgery in order to remove the pilonidal cysts or antibiotics, depilatory creams etc.

Epidemiologically speaking, it has been shown that 7% of healthy children have a skin-lined sinus in the buttock area, suggesting that the condition occurs because of a preexisting sinus from birth which may get infected.

Tarlov/meningeal cyst

A cyst on a spinal cord may or may not cause pain, depending on the cyst’s location.

Causes include hemorrhagic infiltration of the spinal tissue, inflammation within the nerve root cysts accompanied by inoculation of fluids, arachnoidal proliferation alongside the exiting sacral nerve root, breakage of venous drainage in the perineuria and epineurium etc.

Symptoms include pain and discomfort. The pain is usually nerve pain and can radiate towards other parts of the body.

Diagnosis is put after various imaging and blood tests, usually MRIs.

Treatment includes intradural injections of corticosteroids, surgical drainage or removal.

Epidemiologically speaking, around 40% of patients with symptomatic Tarlov cysts can associate a history of physical trauma or childbirth.

Pudendal neuropathy

Although this condition is not really coccydynia, as the coccyx is not involved, it can exhibit the same symptoms. If the pudendal nerve is damaged, then problems with the genitals, rectum, and perineum may occur.

Causes include a history of physical traumas, childbirth, weightlifting, and sometimes even from severe constipation. Other rare causes include diabetes or multiple sclerosis.

Symptoms include all types of pain, rectal pain, and discomfort when sitting or walking.

Diagnosis is put with the help of an anesthetic injection into the area to help rule out other causes, the most common procedure is a pudendal nerve entrapment.

Treatment includes nerve blockers, steroid, botox injection, and decompressing surgery.

Cancer

Coccyx pain and discomfort may be a symptom of a tumor in the area. Also, some tumors might develop around the spinal cord which can create symptoms in the coccyx area by pressing against certain spine nerves.

Cause include genetics, lifestyle, and other external factors.

Symptoms include pain, discomfort, neuropathy etc.

Diagnosis is put upon complex imaging and blood sample tests.

Treatment includes lifestyle and dietary changes and a large array of cancer treatments.

Referred pain/idiopathic coccydynia

Pain in the coccyx area is often referred by patients even if the problem is elsewhere. In fairly rare cases, the problem cannot be identified and treatment consists of solely symptom management.

Partly by excluding other possible diagnoses, partly by investigating the various possible causes of back pain.

Causes might be unknown.
Symptoms include pain, discomfort, and other typical coccydynia symptoms.
Diagnosis is partially put via exclusion and partially via further investigation.
Treatment consists of symptom management.

Neuropathic pain

Damage to the nerves, diseases, or other changes in the nervous system can provoke neuropathic pain, numbness that radiates towards the coccyx area.

Causes include traumas, past surgical interventions, genetics, drug abuse etc.

Symptoms include pain, discomfort, numbness, muscle weakness, “pins and needles” etc.

Diagnosis includes analyzing the patient’s medical history, palpation, and physical exams.

Treatment consists of conventional painkillers: tri-cyclic anti-depressants or anti-convulsants. Other drugs, therapies, and alternative therapies may also be deployed. Also, Transcutaneous electrical nerve stimulation (TENS or TNS), acupuncture, and spinal stimulation methods are sometimes effective.

Previous medical procedures

The following list of medical procedures are commonly reported by patients to cause coccyx pain:

Spinal procedures

  • Spinal tap
  • Epidural anesthesia
  • Injection of x-ray contrast fluid into the spine
  • Spinal fusion
  • Injection for lumbar pain
  • Laminectomy
  • Lumbar radiofrequency procedure

Abdominal procedures

  • Gastric bypass surgery
  • Colorectal surgery
  • Removal of ovary
  • Removal of pilonidal cyst
  • Hysterectomy
  • Surgery for endometriosis
  • D&C (dilatation and curettage)
  • Colonoscopy
  • Fitting of intrauterine contraceptive device
  • Cystoscopy (endoscopy of the bladder)

Some of these procedures are performed in the pelvic region which can result in pressurizing the coccyx during intervention or that the intervention caused some muscular imbalances or that protective layers of fat have been removed etc. Other reports might suggest that prolonged sitting in reclined hospital beds might cause various problems in the coccyx area.

Deposits of calcium in joints

Calcification refers to the accumulation of calcium salts in soft tissues and bones which can cause coccydynia.

Causes of calcification vary from infections to
calcium metabolism disorders, persistent inflammation, genetics, or autoimmune disorders affecting the skeletal system and connective tissues.

Symptoms are many and manifest in different ways. Some of the include coccydynia, teeth tartar, arthritic bone spurs, kidney or gall stones, heterotropic bones etc.

Diagnosis is normally put through blood tests and imaging exams, mainly X-rays.

Treatment consists of corticosteroid, steroid, and/or vitamin administration.

Ehlers-Danlos Syndrome

Ehlers-Danlos Syndrome (EDS) is a genetic syndrome in which there’s a faulty collagen production. Although there are 7 recognized types of EDS, the most common one is called Hypermobility EDS (HEDS) or EDS 3.

Coccyx subluxations are moderately common in HEDS patients because of the collagen misproduction which impacts tendons and ligaments, allowing for an unusually high range of motion and flexibility in joints. Such condition is oftentimes misnomered as “double jointed”.

The main cause seems to be genetic.

Symptoms can greatly vary and some people do not experience symptoms until later in life. Some include joint deterioration due to recurrent subluxations and dislocations, stretchy skin, Gastroesophageal reflux disease, irritable bowel syndrome, gastroparesis, dysautonomia or postural orthostatic tachycardia, and frequent allergies or mast cells activation syndrome.

Diagnosis is put through exclusion, analyzing medical history of the patient and family, blood samples, biopsy, and imaging techniques such as X-ray.

Treatment consists of symptoms and drug administration management as a cure has not been found yet.

Epidemiologically speaking, around 15-20% of HEDS patients has experienced serious coccyx problems.

Risk Factors

Since coccydynia is most often caused by direct impact to the tailbone, having a prior injury to that area is the most common risk factor. However, there are many other potential risk factors to this injury. For instance, poor sitting posture can be a risk factor for many cases of chronic tailbone pain, which has causes such as poor core strength and a high BMI, also known as obesity. In addition to the risks that can come about from childbirth, women are a greater risk of coccyx injury, due to the differences in the shape of their pelvis from men.

Individuals at Risk for Coccyx Injury:

  • Individuals with prior injury
  • Individuals with poor seated posture
  • Individuals with a sedentary lifestyle
  • Women
  • The obese

False Positives

Since the coccyx is located in the lower back, many different conditions that cause lower back pain can potentially be misdiagnosed as coccydynia. Before beginning treatment, make sure to rule out these conditions that have similar symptoms and can affect the same general area. There are many potential causes for pain in the lower back, and failing to identify the specific source of this pain will drastically reduce the effectiveness of treatment. In addition to wasting time and money, improper treatment can result in the injury becoming worse, possibly even causing permanent damage.

  • Sciatica: This is a condition that is caused by the compression of the sciatic nerve in your lower back, causing pain in the area. It can be brought about as a result of more serious conditions, such as bone spurs or a herniated disc, but not from coccyx inflammation. It can be confused with coccydynia due to it affecting a similar area and being often caused by trauma. An effective method of differentiating between the two conditions is that sciatica usually causes pain to radiate down one side of the body, not just in the lower back.
  • Stress Fracture: This is a much more serious cause of lower back pain than tailbone inflammation. If you experience symptoms more extreme than lower back pain, such as limited mobility and a loss of feeling in your extremities, it is possible that instead of having a coccyx injury you are suffering from a stress fracture in your spinal column.
  • Hemorrhoids: Pain in the lower back that becomes more severe when seated can be the result of an inflamed blood vessel in the rectal area, known commonly as a hemorrhoid. These can be caused by similar conditions to coccydynia and may cause similar pain. One effective way to differentiate between the two conditions is to check for bleeding, which is a sign of hemorrhoids.
  • Ovarian Cyst: For women experiencing pain in the same area, this is a possible cause. Ovarian cysts are a common condition for women, and are usually harmless or easily treated. However, if you begin to feel pain in your lower abdomen, one way to differentiate between a cyst or tailbone inflammation is the presence of nausea.
  • Pilonidal Cyst: This is an abscess that can develop from an infection in your lower back, starting in one of your hair follicles. It can be caused in similar ways to coccyx injury, and pain felt on the onset of this injury mirrors the pain from coccydynia. However, the cause of this condition is an infection, and has nothing to do with your bones.
  • Shingles: This is an infection related to chicken pox and herpes, which can affect the nerves in your lower back. This condition is usually very easy to differentiate from coccyx injury due to the development of a large rash, but in some cases the rash doesn’t develop. It is always a good idea to rule out shingles or any other infection as a cause of lower back pain, as the treatment process is much different.
  • Cancer: The development of a tumor in your lower back region will result in pain that mimics coccyx inflammation. This includes cancer that affects the bones, colon cancer, and even rarer developments of tumors from remnants of vestigial body parts. Because of the similarity of symptoms, it is recommended that you undergo imaging tests such as an MRI if you are being diagnosed for back pain and may be at risk for cancer.
  • Gluteus maximus syndrome: The gluteus maximus muscles are very big buttock muscles that help perform squatting motions. They’re attached to the coccyx as well as to other bones, so a muscular problem will most certainly transfer symptoms to the coccyx. Causes include physical traumas, overuse, genetics etc. Symptoms will usually manifest as pain and discomfort when sitting or raising oneself.
    Diagnosis is put by a range of motion physical examination and palpation. Treatment consists of anti-spasmolytics, pain-killers etc.
  • Piriformis syndrome is a slightly controversial diagnosis of a neuromuscular disorder in which the sciatic nerve becomes compressed or irritated by the piriformis muscle. Causes include physical traumas, genetics, sedentarism, and overuse.  Symptoms include pain, tingling, and numbness in the hip/ buttocks region and alongside the lower thigh and into the leg. Diagnosis is put by analyzing imaging exams, physical tests, and local anesthetic injections to rule out other conditions.  Treatment involves anti-spasmolytics, non-steroidal anti-inflammatory drugs, painkillers, physical therapy etc.

Complications

Fortunately, coccyx injury does not usually result in complications. The exception to this is if your condition requires surgery, which is outlined in more detail below. There is the possibility of developing complications after coccygectomy, most notably an infection in the affected area. These infections can become serious enough to cause rectal injury to the point of incontinence, so this surgery is usually only recommended in extreme cases.

Treatment

When seeking treatment for tailbone inflammation, the first course of action is to receive an accurate diagnosis of your pain. Talking to a doctor or other medical professional for an examination will make sure you are treating the cause of your pain properly, avoiding the prolonging of your pain and the possibility of developing more serious conditions.

Diagnosis

When going to a doctor for a professional diagnosis, they will perform a few different tests on you in order to ascertain if the source of your problem is coccydynia. First, the doctor will poke and prod certain areas of your body to gauge your pain levels. From there, the doctor may also try a rectal examination to directly study the coccyx, as well as to judge the tension in the surrounding muscles that may also be contributing to the pain or inflammation. After this point, any further analysis needed will need the implementation of imaging technology.

In general, doctors will discourage the use of x-rays when scanning for pain in the pelvic area, due to the risk of exposing your genitals to radiation. However, they will perform the procedure if you insist on it, and it can still prove useful in obtaining a diagnosis. One effective imaging method doctors will use when determining the source of lower back pain is fluoroscopy. In this procedure, a continuous beam of x-rays are beamed into the target area of the body, in order to receive a continuous image. In conjunction with this, the doctor will inject anesthetic into the tailbone area and gauge how the body reacts to it, determining what part of the body is the origin point of the pain.

Another commonly used imaging process for diagnosing coccydynia is magnetic resonance imaging, or an MRI scan. This is a more advanced scanning method than standard x-rays, providing a full 360-degree image of the body part being scanned. While not initially common, using MRI scanning to diagnose tailbone pain has gained popularity in recent years, and can be effective in cases where X-ray scans fail to show enough information. One particular method of MRI scanning doctors like to use is the seated MRI, which can provide a dynamic image of the problem spots in your coccyx.

After performing one or more of these diagnostic procedures, your doctor will be able to determine what is causing your lower back pain. If the source is shown to be coccyx injury, then you may want to try some of these treatment methods.

P.R.I.C.E.

This is a common procedure when handling mild athletic injuries such as sprains, and is usually the first course of action recommended for treatment. P.R.I.C.E. is an acronym that stands for protection, rest, ice, compression, and elevation.

  1. Protection: Upon injury realization, the patient has to protect the affected region from further traumas or other types of aggravating factors.
  2. Rest: During the onset of pain, stop all activity immediately. Stop running for a few hours to a few days, and spend more time seated if possible. If sitting causes too much pain, lie on your stomach instead.
  3. Ice: Apply an ice pack to your lower back for short periods of time. If you don’t have an ice pack, you can make one by filling a resealable plastic bag with ice cubes. The best practice to avoid skin damage is to apply the ice for twenty minutes every hour.
  4. Compression: Applying compression to your back will help you correct posture issues and reduce pain. For the coccyx, the best form of compression is a back brace.
  5. Elevation: Keeping the injured part of your body elevated will help blood flow to the body and provide further rest. With coccyx injury, using a special cushion or doughnut pillow while seated is effective. When sleeping, you can keep your tailbone elevated by sleeping on your stomach.

Medication

While resting and letting your body recover, you can relieve some of the pain through the use of medication. In particular, non-steroidal anti-inflammation drugs (NSAIDs) are safe, over-the-counter pain relievers that can help relieve discomfort from coccyx injury.
The drugs are a short-term solution for pain and should not be used extensively to mask the pain and aggravate the condition. Do not substitute definitive treatment with medicine. Furthermore, the following drugs have multiple administration methods such as orally, suppository, injections, gels, patches etc. Try to avoid ingestion and search for an alternative administration method, if possible as to reduce side-effects.

Drugs for non-neuropathic pain

“Normal” pain which arises from the injury itself and stops whenever the injury has healed is commonly referred to as non-neuropathic pain. For this type of pain, the following compounds are recommended:

List of Effective NSAIDs for Coccyx Injury:

  • Aspirin
  • Paracetamol/acetaminophen, commonly found in Tylenol
  • Ibuprofen, commonly found in Advil and Motrin
  • Naproxen, commonly found in Naprosyn and Aleve
  • Oxaprozin
  • Piroxicam

In cases that are direr, you may need to have medication injected directly into your coccyx by a doctor. These are stronger anti-inflammatory medicines with steroids in them, called corticosteroids.

List of Opiates/Opioids Used for Treating Coccyx Injury:

In cases of more severe pain, or in periods of recovery after surgical treatment to the coccyx, more powerful painkillers may be prescribed to you. These are usually opioids, and they can provide stronger pain relief for extended periods of time. It is important to only take opioids responsibly, as the possibility of addiction is high when taking them.

  • Morphine
  • Fentanyl
  • Oxycodone, commonly found in OxyContin
  • Demerol
  • Hydrocodone, commonly found in Vicodin

Drugs for neuropathic pain

Neuropathic pain come from the nervous system itself whenever nerves are touched or damaged. The pain is consistent and the patient may experience tingling, burning, “pins and needles” sensations.

  • Cannabinoids
  • Duloxetine (Cymbalta)
  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Tricyclic antidepressants

 

Corticosteroids

For both neuropatic and non-neuropatic pain, corticosteroids might be prescribed to keep an anabolic state and inflammation low. Ask your doctor about steroids and corticosteroids and see if it might benefit your case.

List of Corticosteroids Used for Treating Coccyx Injury:

  • Prednisone is the most commonly prescribed
  • Cortisol
  • Methylprednisolone

Physical Therapy

One potential method that can be used to treat coccyx injury is undergoing physical therapy. Depending on how severe the pain from tailbone inflammation is, different methods are available to soothe the pain and treat the causes of injury in cases that don’t involve trauma. Before trying any of the methods listed below, be sure to consult a doctor or medical professional beforehand. They will help you determine if physical therapy will be helpful in treating your condition.

  • Massage: In many cases of coccydynia, muscles surrounding the pelvis can become taut and uncomfortable. To combat this, therapists may recommend a massage treatment that targets these muscles, relieving tension and restoring flexibility to the area. This massage can be performed on the outside of the body, near your lower back, or inside the body by inserting a gloved finger into your anus to directly stimulate the muscles closest to your tailbone.
  • Acupuncture: This is a common alternative to Western methods of pain relief that involves the placing of needles into specific points of your body. Although it has many skeptics, there have been studies proving that acupuncture can be an effective method of relieving pain in the lower back. When applying acupuncture, popular points for relieving pain are located near the elbow or lower back.
  • Mesotherapy: This is a pain relief treatment invented in France. It is similar to acupuncture in that it involving placing several needles in the body, with the difference being that the needles are injected more shallowly and used to distribute homeopathic medicines such as echinacea and chamomile. In addition to relieving pain, mesotherapy can reduce inflammation in the affected area as well.
  • Inversion therapy: Hanging upside down with the help of an inversion table can immediately relieve some of the symptoms by depressurizing the coccyx area.
  • Meditation:  Some forms of meditations that focus on breathing patterns may provide some symptom relief and a better state of mind. Yoga is also a great alternative for those who want to stay active.
  • Lumbar extender: A so-called lumbar extender device can also improve the patient’s quality of life by laying on the equipment and extending and stretching their lumbar area.

Surgery

Coccygectomy

In the event where damage sustained to the tailbone is so severe that pain will not go away after following periods of rest, activity modification, and physical therapy, the last option is surgery. Known as coccygectomy, a surgical procedure can remove all or part of the tailbone in order to relieve the pain caused by the injury. The situations in which this surgery is recommended are limited, usually reserved for cases in which a bursa is developed in the area, or in cases where injection treatments were necessary. Performing a coccygectomy is simple since the incision is small and does not require any muscles to be moved out of the way. The most difficult part of the procedure is recovering afterward, which can take up to a full year. Sitting is extremely uncomfortable during this recovery time, so pain medication may be prescribed.

Spinal Cord Stimulators

Spinal cord stimulators are also called neurostimulators which are programmable digital devices for chronic and neuropathic pain. The compact device is implanted surgically into the lower abdomen wall and wired to a strip of electrodes located along the back of the spinal cord. By sending low-voltage electrical pulses to the electrodes, the device manages to interfere with the pain signals sent to the brain, relieving the patient partially or totally of pain.

Spinal Pumps

Intrathecal drug delivery or more commonly spinal pumps are chemical alternatives to spinal cord stimulators. The pumps release small dosages of painkilling drugs around the spinal cord. Because of this internal way of delivering the drugs, smaller dosages are needed which cause fewer side-effects. The procedure involves surgically placing a compact drug reservoir alongside a pump which delivers the substances through the lower abdomen wall.

Invasive nerve blocking procedures

Completely blocking a nerve is a surgical procedure which seeks to block the nerve-brain pain transmission, but oftentimes, the pain will somewhat still persist as a ghost pain. So, it’s is very important to reduce pain as much as possible using other methods prior to undergoing a nerve blocking procedure so that the brain will “forget” the existing pain in that area. Another side-effect involves small parts of the skins becoming numb.

There are three location in which a nerve block may be placed:

1. Ganglion Impar Block

A cluster of nerve cells between the sacrum and coccyx is one location. A curved needle is passed beneath the coccyx or through the coccyx itself to block this particular nerve ganglion.

2. Caudal Epidural Injections

The second possible area is located around the lower end of the spine called the caudal epidural. Although blocking the nerves in this location is less effective, it’s is still deployed upon necessity.

3. Nerves behind the coccyx

In this location, a fairly modern method named Endoscopic Coccygeal Nerve Ablation is usually deployed. The procedure uses an endoscope (small camera tube). Then, the endoscope is passed through a 5 mm skin incision over the coccyx. Subsequently, a small tool is passed through the endoscope which burns the nerves. This latter technique is more effective and precise.

There are three durations of effectiveness:

A. Temporary nerve block

A local anesthetic (lignocaine or bupivacaine) is injected around the nerve which blocks pain for hours or even days. Oftentimes, the procedure is repeated and the symptom relief is almost permanent.

B. Semi-permanent nerve block

Freezing the nerves (cryoanalgesia) may block the pain for weeks or even moths. A valid non-destructive alternative may be the pulsed radiofrequency treatment which causes lesions to the nerves without damaging them.

C. Permanent nerve block

A permanent nerve block or rhizotomy is a surgical procedure in which the nerves are completely severed. Although the procedure has a high success rate, the alcohol, phenol, or glycerin injections may cause more destruction than intended. Also, the nerves may grow back but the treatment can be repeated.

Prevention

Whether you have never personally experienced coccydynia and wish to avoid it, or if you have just recovered from coccydynia and want to prevent it from occurring in the future, there are steps you can take that will prevent further injury to your tailbone. It is reasonable to expect that by following the methods and suggestions outlined below, you will avoid having damage done to your tailbone.

Diet

Maintaining proper nutrition through your diet will result in a lot of health benefits, not just preventing tailbone injuries. Proper plant-based dieting can prevent obesity, which is a major risk factor for coccyx injury, among many other health-threatening conditions. Maintaining a vegan or a plant-based diet can lower all cause mortality and help drastically improve coccydynia symptoms by improving calcium assimilation, completely lowering inflammation, and keeping a healthy body weight.

Additionally, certain foods contain anti-inflammatory properties, meaning any injuries sustained to your tailbone accidentally can be mitigated, prevent the inflammation which causes the pain from coccydynia.

Food to Eat When Trying to Avoid Coccyx Injury:

  • Fish Oil: This can be derived most effectively from supplements. Fish oil that is high in Omega-3 fatty acids can prevent joint pain and inflammation. It is because of these benefits, on top of known benefits fish oil provides to cardiovascular health, that these supplements are commonly taken by the elderly. However, the benefits that make fish oil effective at treating arthritis can also be harnessed to prevent coccydynia, as some patients have found.
  • Leafy Greens: Leafy green vegetables are a staple of any healthy diet, for very good reason. Vegetables such as spinach, broccoli, and kale contain high amounts of vitamins that can prevent inflammation in the body. In addition to its anti-inflammatory properties, the high amounts of fiber found in leafy greens will aid in digestion and defecation, preventing pain that may after suffering from tailbone trauma. Mixing kale into a smoothie, eating salad with spinach leaves, or steaming broccoli for dinner are all effective ways to promote overall body health and prevent coccydynia.
  • Berries: Certain types of fruits have high amounts of anthocyanins. These are what causes them to have such bright colors, but it also provides plenty of positive health benefits when consumed in large quantities. Anthocyanins are found in cherries, blueberries, and raspberries, and they can improve eyesight and liver function on top of the anti-inflammatory properties that make them ideal to combating tailbone inflammation.
  • Nuts: Many nuts are filled with high amounts of Vitamin E, which can prevent inflammation. Some particular nuts that are ideal to implement into a healthy diet are almonds, pecans, peanuts, and hazelnuts.
  • Cherry juice: contains anthocyanins which decrease tissue inflammation.

Food to Avoid When Trying to Avoid Coccyx Injury:

  • Red Meat: Red meat such as beef contains high amounts of Omega-6 acids. Unlike Omega-3 acids, which can work towards reducing inflammation, Omega-6 has been linked to increased inflammation in the body, according to one scientific study. In addition, red meat also has higher concentrations of saturated fats, which contribute to obesity and other potential risk factors for running injuries such as coccydynia.
  • White Bread: Bread that has high concentrations of refined carbohydrates, such as white bread, are counter-intuitive to an anti-inflammatory diet. In addition to contributing to obesity, refined carbohydrates are linked through scientific study to the production of inflammatory microbiota in the body.
  • Soda: Cutting out sugary drinks such as soda is the first step toward any reputable diet. This is because most sodas on the market contain high amounts of sugar or high-fructose corn syrup. Both of these have been shown to contribute greatly to obesity, as they can bombard your body with extra calories without filling you up, due to their liquid form. In addition, these chemicals can cause inflammation and prevent the development of Omega-3 acids in the body.

Exercise

Along with a proper nutritious diet, another terrific method of reducing the possibility of developing all manner of running injuries is to improve your strength and flexibility. There are exercises you can perform with limited equipment that will target your lower back and tailbone, preventing coccyx injury in many cases. Additionally, targeted stretches and yoga poses can improve the flexibility in these key areas, allowing you to run without causing pain or stress to your tailbone.

Strengthening Exercises to Prevent Coccyx Injury:

Maintaining an active lifestyle is crucial in speeding your recovery time. The patient should start with light, low impact exercises, and progress toward more complex routines.

10% rule:
The 10% rule (10PR) is very important to keep in consideration after an injury. The principle states that the athlete should increase his weekly mileage by no more than 10 percent over the previous week. This allows a safe gradual progression of physical activity which reduces the chances of re-injury.

  • Walking: Start your physical rehabilitation through walking or treadmilling. Start with a very low pace and progress towards light jogging. The latter will really build and stabilize your whole torso area. It has a benefic effect on muscle spasm, tightness, and it will build muscles around the coccyx. It’s also good for the psyche.
  • Swimming: Swimming is also an excellent physical activity which will work your whole body. This low-impact activity will prove extremely beneficial towards recuperation. It’s also great because it works the cardiovascular system.
  • Anal lock: The pubococcygeus muscle (PC muscle) is a hammock-like muscle that stretches from the pubic bone to the coccyx (tail bone) constituting the pelvic cavity floor and supporting the pelvic organs. The PC muscle is part of the levator ani muscle and training it can help in strengthening the area. The exercise consists of contracting the muscles for about 15 seconds. The way you contract them is the same way you might “hold on” whenever you’d need to go to the bathroom. So, practice a couple of sets a day, in bed, sitting, and virtually in any other position, just focus on the squeeze and hold for around 15 seconds. By strengthening this muscle, you’ll also increase your sexual performance.
  • Bridges: This exercise will strengthen your core while engaging your lower back. Start by laying flat on your back with a rug or mat beneath your body. Your back and arms should be flat on the ground, and your knees should be bent upward so your feet can rest flat on the ground as well. Keeping your arms and feet on the ground, slowly lift your butt off the mat until your upper legs, groin and back are lined up straight. Hold this position for a few seconds, then slowly return to the starting position. Repeat this exercise ten times for one set, and perform three sets a day.
  • Weightless Squats: This exercise mainly works the upper legs, but will engage your tailbone and can reduce pain. Start from a standing position, with your back straight and your legs apart. Slowly lower your upper body, bend the knees and keep the back straight and chest out. For added balance, try holding your arms straight out in front of you. Hold the position once your butt is lower than your knees, then slowly lift your upper body back up. Repeat this exercise ten times for one set, and perform two to three sets a day.
  • Clamshell exercise: Lie on your side while resting your head on one hand. Put on foot on top of the other and flex your knees. Proceed to close and open the gap with your legs in front of you. You should feel the burn in your hips, glutes, inner and outer tights. Keep your body static and a neutral spine. Breath calmly, keep the core tight, and do a couple of dozen reps per set.

Stretches to Prevent Coccyx Injury:

The following exercises are a few pertinent examples on which the patient should expand on. Basically, all stretches are beneficial for this condition. Stretching provides a variety of benefits, so don’t hesitate in reserving an hour or two a day for strengthening and stretching.

  • Cat and Cow Stretch: This is a yoga stretch that targets your back and neck, relieving pain and increasing flexibility in these areas. Start by laying on the floor with your knees bent, supporting your body weight with your hands and knees. Your back should be straight and off the ground. Slowly curve your back inward while lifting your head up, so that your neck and back form a concave curve. Hold this position for a few seconds, then bend your back outward while lowering your head, forming a convex curve with your back and neck. Repeat these two movements ten times a day.
  • Child Pose: This yoga pose targets your pelvis as well as your knees and back. Start by kneeling on a mat or rug, with your butt resting on your feet and your knees touching. With your arms lifted straight up, slowly lower your entire upper body until your palms are touching the floor. Hold this position for thirty seconds to a minute, then return to the starting position. Perform this stretch two to three times a day.
  • Sun Bird Pose: This yoga stretch targets the back while strengthening the tailbone muscles. Begin on all fours, similar to the starting position of the cat and cow stretch. Lift one leg up to the point where your knee is touching your elbow. While doing this, lift up your opposite arm, supporting all your weight on the leg and arm still touching the ground. Extend both your leg and arm outward while rounding your back, forming a straight line with your body that begins at your foot, extends past your back and neck, and ends at your arm. Hold for a few seconds, then tuck your leg and arm back into your body while relaxing your back. Repeat this movement ten times with each leg.

Conclusion

For the most part, tailbone injury shouldn’t be a major concern when running. However, if something happens to cause your coccyx to become inflamed, the pain can be inconvenient to the point where running regularly becomes impossible. Fortunately, using the methods outlined above, the pain can be minimized in cases of coccydynia, and you can avoid further inflammation of the tailbone in the case of an injury. Keep in mind, however, that while this article cites numerous reputable sources and studies from medical professionals, you should not interpret this article as professional medical advice. Always talk to a doctor if you experience pain.

Co-written by Eddy Mihai

Curated by Diana Rangaves, PharmD, RPh

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