Coccydynia

David Disselbrett, MSPT, JSCC Body Systems Physical Therapy
Anchorage, Alaska

Description

Coccydynia is pain at the coccyx (tailbone).  Typical causes include falls, poor sitting posture, and giving birth. Other causes such as infections, cysts, neoplasms and fractures can be ruled out by imaging, which is usually recommended after failed treatment attempts or severe and worsening symptoms.  Several people with coccydynia report no direct cause of their pain and their symptoms are resistant to typical treatments including direct manual therapies, exercise, rest, medication and injections. Coccydynia can be present for several years or decades and will be present with other physical and medial complaints. Chronic coccydynia often requires a multi system approach. Dysfunctional and painful tissue at the coccyx can include the bone itself, ligaments, muscles, dura, nerves, arteries and veins. Often, local treatment is not sufficient, however.  Other structures far removed from the coccyx can place strain on local structures and maintain coccyx dysfunction.  Examples include pelvic floor tightness and pain, breathing pattern abnormalities, dysfunction of the cranium and dura (lining of the spinal cord and brain), lower extremity and pelvic mobility, abnormal visceral mobility at the pelvis and abdomen, emotional trauma, and low back pain.

Treatment

Treatment for coccydynia can be very effective with Fascial Counterstrain. Recent injuries are commonly treated locally around the pelvis, sacrum, back, and of course the coccyx.  The therapist will identify tissue that is painful and creating dysfunction during movement using the cranial scan.  Then, local tender points in the area that was identified by the scan will be found.  They correspond to specific tissue requiring release.  The tissue is gently moved into a position of ease and held for several seconds until there is a release and mobility is restored. By treating each involved system and its corresponding tenderpoints in the order of worst first, painful and sensitive areas are treated easily with the patient fully clothed. 

More complicated and resistant symptom presentations can be treated as well. The Fascial Counterstrain cranial scan is very effective at finding the most restricted and therefore relevant tissue to treat.  This may actually be found in an area that is distant from, and therefore generally not considered to be related to symptoms.  For example, tension in the dura lining the brain or spinal cord within the neck will generate tension throughout the dura, which is anchored to the coccyx by the filum terminale.  The cranial scan is able to identify this problem so that the therapist can include treatment of this component when addressing coccydynia.  Finding relevant dysfunction in each of the tissue systems involved, including those in distant parts of the body, is what differentiates Fascial Counterstrain from most other treatments.  Amazing results can be achieved by treating multiple systems in a non threatening and pain free 

manner.