Tailbone pain

author : AMSSM
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Member Question:

I'm experiencing soreness over my tailbone that I'm not familiar with. My running has been moderate not only in distance  but pace. I've restarted a yoga program that previously had not caused any trouble, so I don't think that's the issue. I typically stretch for 15 to 30 minutes five to six times a week in the evening. My work leaves me sitting quite a while, so that contributes surely.  Could my running be ramped up too quickly? Or does biking on a trainer cause stress that road riding doesn't? What causes this type of soreness? Thanks.

Answer from Sam Schimelpfenig, MD
Member AMSSM

Coccydynia (also referred to as coccygodynia) is defined as pain in and around the region of the coccyx, commonly referred to as the tailbone.
The coccyx is composed of several bones and forms the terminal end of the spinal column. There are fibrocartilagious discs between the bones of the coccyx which are comparable to the discs present in the spinal column. There are several muscle groups that insert on the coccyx including the levator ani (a group of muscles that help support the pelvic floor) and a portion of the gluteus maximus (which functions to extend the thigh during walking and running). Several important ligaments also attach to the coccyx.

The main function of the coccyx is to be a weight-bearing structure when a person is seated; it forms a tripod with the two ischium bones. The coccyx bears more weight when the seated person is leaning backward and less weight when the person leans forward.

The tailbone is most commonly injured during a fall, when the injured person lands directly on the tailbone; it can also be injured by mild repetitive trauma such as prolonged sitting with poor posture, or by sitting on a hard narrow surface (i.e. a bicycle seat). In women, childbirth is a common cause of injury. Rare causes of this type of pain include metastatic cancers, pudendal nerve injury, or pilonidal cysts. Approximately one third of all coccyx pain is idiopathic, meaning that there is no known direct cause of the discomfort.

Diagnosis is suspected based on localized tenderness over the coccyx on exam. X-rays are rarely helpful, even in the event of an acute injury, as most fractures and dislocations are treated with conservative methods. Other imaging modalities such as MRI, CT, and bone scans are used even less commonly, and typically only if the there is suspicion of other causes of coccydynia.

In your case, several factors may be contributing to your discomfort (assuming there is no history of direct trauma to the area). As you suspect, the prolonged periods of sitting required by your job is likely a major contributor; changing position and leaning forward will relieve pressure on the tailbone. Using a donut shaped cushion will also help alleviate some of the discomfort.

It is possible that your running may also be prolonging your recovery due to the attachment of the gluteus maximus muscles. Finally, the static position assumed when cycling on a trainer can put additional stress on the coccyx - you may try visiting a bicycle store to find a seat with a larger cut-out section for the tailbone and consider adjusting the fit of your bicycle or your position on the seat so that you lean more forward to remove additional stress from the tailbone. It is a common problem that many people sit on the bike seat upright, and then lean forward without shifting their hips. Proper cycling position involves putting weight on the front of the pelvis, which usually requires a cyclist to stand up on the pedals for a second or two, move up off the seat, and then reposition the pelvis so that the cyclist is almost lying on their stomach on the bike seat. This is an exaggeration, but it may help you understand the difference between a position that is causing strain on the tailbone and one that is more comfortable or sustainable.

Stretching is always a good idea. Local application of heat or ice, protection of the area, and careful use of analgesics as needed are the mainstays of treatment. Occasionally, more advanced imaging studies, injections, manipulation, or even coccygyectomy (surgical removal of the coccyx) are used in protracted cases - you should discuss this with your physician if your symptoms do not seem to be improving with conservative measures.

 

Sam Schimelpfenig, MD
Member AMSSM
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date: May 24, 2011

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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