Fell on Your Tailbone?

Pelvic floor therapists provide essential care to those struggling with pelvic pain and bladder, bowel, and sexual dysfunction. The tailbone (also known as the coccyx) is often thought to act exclusively as part of the low back, rather than the pelvic floor. However, the coccyx has a unique structure, function, and developmental process that are important to pelvic floor therapists. An injury to the coccyx can significantly affect pelvic floor function. Fell on Your Tailbone? It Matters to Your Pelvic Floor Therapist

The coccyx bone is located at the endpoint of the spine, the furthest spinal section from the head. It is shaped like a triangle, and the base of the triangle connects to the sacrum portion of the spine. The coccyx can slightly flex and extend (the same movement directions as nodding your head), which is needed for different sitting postures.

The coccyx has an interesting development process that is not the same for everyone.

We are born with flexible, separate coccyx joints. From birth to early adulthood, the joints slowly fuse. However, some adults maintain distinct joints that never fuse. The joints that don’t fuse can even vary in composition. Some people have coccyx joints with cushioned discs (similar to joints of the low back), some have joints that show cystic and fibrous changes, and some contain synovial fluid that allows for more movement. This variability can make some people more susceptible to injury than others.

The joint between the coccyx and sacrum is also more mobile in early life. This joint fuses far later in life than the coccyx joints, and sometimes it doesn’t fuse at all.

The coccyx serves as a connecting point in two ways.

First, it impacts our stability while sitting. We need our bones and muscles to maintain balance and an upright posture while sitting. Given that the triangle is the most stable shape, sitting support mainly comes from three points of contact between our body and the seat: our two sit bones on the pelvis (the ischial tuberosities) and the coccyx.

Second, even though the coccyx is small, it serves as an attachment point for important tissues, including the following.

●       Gluteus maximus muscle, the largest and most powerful muscle in the body

●       Levator ani and coccygeus muscles, which act as a bowl to support the pelvic floor organs

●       Multiple essential ligaments, including the anococcygeal ligament, which plays a role in voluntary bowel movements

●       Sheet-like connective tissue (called fascia) that encompasses the pelvic floor and extends from the back

●       Fibrous threads at the end of the spinal cord

A backwards fall is one of the most common ways to injure the coccyx. Many injuries from falls resolve fully within a few months and do not cause lasting dysfunction or fester into issues later in life. However, a hard fall on the tailbone that is memorable to you—for example, falling off a horse—can make a difference in how the coccyx functions in the future. This can even be true for a fall that occurred years ago.

The flexibility of a non-fused coccyx can protect the bone from injury. However, even if the bone remains unharmed, muscular issues and improper biomechanics can develop from a fall. If these aren’t resolved and continue as the coccyx fuses over time, these issues can be more difficult to treat.

Additionally, once the coccyx fuses and loses its flexibility, hard falls become even more problematic. This is especially true for older adults, who often lose muscle mass in the buttocks, thus losing tailbone protection.

Issues stemming from coccyx injuries can include the following.

●       Issues with bowel and bladder function, including incontinence and pain

●       Sexual dysfunction

●       Numbness and tingling around the tailbone area and pelvic floor

●       Pain with sitting, which occurs because of how important the coccyx is in sitting posture, as well as irritation of the levator ani muscle

Thankfully, there are treatment options to improve issues related to coccyx injuries. Pelvic floor therapists are specially trained to address coccyx issues in an effective and sensitive manner.

Tailored stretches, posture exercises, skilled muscle and fascia massages, and precise joint movements to the coccyx can make a significant difference for those struggling with pain and bowel, bladder, and sexual function concerns. Knowing the coccyx endured trauma from a fall can help therapists build a comprehensive picture of why someone may be struggling with pelvic floor concerns.

If you are in need of Pelvic PT, reach out to one of our highly trained, Freedom PT Pelvic Physical Therapists

Reference

Lirette LS, Gassan Chaiban, Tolba R, Eissa H. Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain. The Ochsner Journal 2014;14(1):84. https://pmc.ncbi.nlm.nih.gov/articles/PMC3963058/