Coccydynia

Last updated
Coccydynia
Other namesCoccygodynia
Specialty Rheumatology, Pain management

Coccydynia is a medical term meaning pain in the coccyx or tailbone area, [1] often brought on by a fall onto the coccyx or by persistent irritation usually from sitting.

Contents

Synonyms

Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, or coccalgia. [1]

Anatomy

Structure

Coccydynia occurs in the lowest part of the spine, the coccyx, which is believed to be a vestigial tail, or in other words the “tail bone”. The name coccyx is derived from the Greek word for cuckoo due to its beak like appearance. The coccyx itself is made up of 3 to 5 vertebrae, some of which may be fused together. The ventral side of the coccyx is slightly concave whereas the dorsal aspect is slightly convex. Both of these sides have transverse grooves that show where the vestigial coccygeal units had previously fused. The coccyx attaches to the sacrum from the dorsal grooves, with the attachment being either a symphysis or as a true synovial joint, and also to the gluteus maximus muscle, the coccygeal muscle, and the anococcygeal ligament.

Orientations of the coccyx

There are four different orientations for the coccyx, as described by Postacchini and Massobrio. In type I the coccyx is curved anteriorly with its apex facing downward and caudally. In type II this forward curvature is more dramatic and the apex extends forward. Type III is where the coccyx angles forward sharply. Lastly, type IV is characterized by the coccyx being subluxated at the sacrococcygeal joint.

Pathophysiology

There are common pathophysiological ways that a person may develop coccydynia. The two main causes for this condition are sudden impact due to fall, and coccydynia caused by childbirth pressure in women. [2] Other ways that coccydynia develops are partial dislocation of the sacrococcygeal synchondrosis that can possibly result in abnormal movement of the coccyx from excessive sitting, and repetitive trauma of the surrounding ligaments and muscles, resulting in inflammation of tissues and pain.

Diagnosis

A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it. The first task of diagnosis is to determine whether the pain is related to the coccyx. Physical rectal examination, high resolution x-rays and MRI scans can rule out various causes unrelated to the coccyx, such as Tarlov cysts and pain referred from higher up the spine. Note that, contrary to most anatomical textbooks, most coccyxes consist of several segments: 'fractured coccyx' is often diagnosed when the coccyx is in fact normal or just dislocated at an intercoccygeal joint. [3] [4]

A simple test to determine whether the coccyx is involved is injection of local anesthetic into the area. If the pain relates to the coccyx, this should produce immediate relief. [5]

If the anesthetic test proves positive, then a dynamic (sit/stand) x-ray or MRI scan may show whether the coccyx dislocates when the patient sits. [6]

Use of dynamic x-rays on 208 patients who gave positive results with the anesthetic test showed:

This study found that the pattern of lesions was different depending on the obesity of the patients: obese patients were most likely to have posterior luxation of the coccyx, while thin patients were most likely to have coccygeal spicules.

Angle of incidence

Sagittal coccygeal movement is measured using the angle of incidence—or the angle at which the coccyx strikes the seat when an individual sits down. [7] A smaller angle indicates the coccyx being more parallel to the seat, resulting in flexion (or “normal” movement) of the coccyx. [7] A larger angle indicates the coccyx being more perpendicular to the seat, causing posterior subluxation (or “backward” movement) of the coccyx. [7]

Sagittal view of coccyx in standing and sitting position Stand to Sit Coccyx.jpg
Sagittal view of coccyx in standing and sitting position

Causes

One way of classifying coccydynia is whether the onset was traumatic versus non-traumatic. In many cases the exact cause is unknown and is referred to as idiopathic coccydynia.

Coccydynia is a fairly common injury which can often result from falls, particularly in sports such as cycling, skateboarding, skating or ice hockey. Coccydynia is often reported following a fall or after childbirth. In some cases, persistent pressure from activities like bicycling may cause the onset of coccyx pain. [8] Coccydynia due to these causes usually is not permanent, but it may become very persistent and chronic if not controlled. Coccydynia may also be caused by sitting improperly thereby straining the coccyx.

Rarely, coccydynia is due to the undiagnosed presence of a sacrococcygeal teratoma or other tumor in the vicinity of the coccyx. [1]

Prevalence

A study of 2000 cases of back pain referred to hospital found that 2.7% were diagnosed as coccydynia. [9] This type of pain occurs five times more frequently in women than in men. It can occur at any age, the mean age of onset being around 40. [1] There are no ethnicity or race associations with coccydynia.

Clinical features

Activities that put pressure on the affected area are bicycling, horseback riding, and other activities such as increased sitting that put direct stress on the coccyx. The medical condition is often characterized by pain that worsens with constipation and may be relieved with bowel movement. Rarely, even sexual intercourse can aggravate symptoms.

Non-surgical treatment

Coccyx cushion with a cutout Coccyx cushion.jpg
Coccyx cushion with a cutout
Donut cushion Coccix Cushion.jpg
Donut cushion

Since sitting on the affected area may aggravate the condition, a cushion with a cutout at the back under the coccyx is recommended. If there is tailbone pain with bowel movements, then stool softeners and increased fiber in the diet may help. Anti-inflammatory medications such as NSAIDS may be prescribed. [1]

If the pain persists, other treatments may be applied. Manual treatment is carried out by repeated massage of the muscles attached to the coccyx, via the anus. Such treatment is usually given by an intimate partner, chiropractor, osteopath or physical therapist. Thiele applied this treatment to a series of 169 coccydynia patients, and reported 63% cured. [10]

Orthopaedic surgeons commonly inject corticosteroids into the painful joint. Maigne and Tamalet applied this treatment to 86 patients under fluoroscopic guidance. [11] Two months after the injection, 50% of the patients with luxation or hypermobility were improved or healed, but only 27% of the patients with no visible abnormality improved. Where an abnormality had been found, and injection relieved the pain, the abnormality remained but ceased to be painful.

Temporary or permanent nerve blocks are sometimes applied in cases of coccydynia. Foye et al reported that repeated temporary nerve blocks by injection at the ganglion impar could give relief in a number of cases, and occasionally a single injection was sufficient. [12]

Surgical treatment

If non-surgical treatments fail to relieve the pain, or in cases of cancer, surgery to remove the coccyx (coccygectomy) may be required. In cases where pain persists after surgery, standard drugs for chronic pain, such as tri-cyclic anti-depressants, may help alleviate the pain. [13]

Prevention or to ease coccyx pain

Body positioning and alignment is significant for producing less stress in the coccyx region. Bad posture can influence coccyx pain. People may not realize that they are over stressing their coccyx while doing daily activities. Pain in the coccyx can be caused from many incidents like falling, horseback riding, or even sitting on hard surfaces for a long period of time. The main focus is to prevent coccyx pain from occurring, by correcting everyday activities that contribute to tailbone pain. You can take hot or cold water baths. Have a stream of hot or cold water run down your back continuously if pain becomes unbearable. Use cold water if pain persists. Repeat the procedure in intervals of 5-6 minutes.

Proper equipment used to preventing coccyx pain

There is no definite way to fully prevent coccyx pain because an accident can occur at any given time. However, people who are obese are at a higher risk for developing coccyx pain. Carrying excessive weight contributes to more stress on the coccyx while sitting down causing increased chances of pain. [14] Prevention of carrying excessive weight gain can help reduce the tension and pressure on the coccyx. In other words, the coccyx for obese people may be more posteriorly outward when they are sitting down. [14] Avoidance of contact sports like basketball, football, and or hockey can decrease the risks of coccyx pain, because it can help reduce the chances of falling. Another method is proper safety equipment for sports is to prevent coccyx pain. For example, there are hockey pants that provide extra cushion that protect the thigh, coccyx, and buttocks. These results will lead to less falls that can cause trauma to the coccyx.

Stretches and strengthening exercises for prevention

A kneeling groin stretch can help prevent coccyx pain from occurring after long periods of sitting. The adductor magnus is involved in the kneeling groin stretch, and when it is tight it can contribute to tailbone pain, so stretching can help prevent tailbone pain. Other stretches like piriformis stretch, and hands to feet stretch, can relieve stress off the muscles around the coccyx, after sitting for a long time. These release tension built up around the muscles in the coccyx.

See also

Related Research Articles

<span class="mw-page-title-main">Back pain</span> Area of body discomfort

Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia based on the segment affected. The lumbar area is the most common area affected. An episode of back pain may be acute, subacute or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain or a burning sensation. Discomfort can radiate to the arms and hands as well as the legs or feet, and may include numbness or weakness in the legs and arms.

<span class="mw-page-title-main">Coccyx</span> Bone of the pelvis

The coccyx, commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates since Nacholapithecus, the coccyx is the remnant of a vestigial tail. In animals with bony tails, it is known as tailhead or dock, in bird anatomy as tailfan. It comprises three to five separate or fused coccygeal vertebrae below the sacrum, attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between the sacrum and the coccyx.

<span class="mw-page-title-main">Pilonidal disease</span> Skin infection between the buttocks

Pilonidal disease is a type of skin infection which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end. Symptoms may include pain, swelling, and redness. There may also be drainage of fluid, but rarely a fever.

Pudendal nerve entrapment (PNE), also known as Alcock canal syndrome, is an uncommon source of chronic pain in which the pudendal nerve is entrapped or compressed in Alcock's canal. There are several different types of PNE based on the site of entrapment anatomically. Pain is positional and is worsened by sitting. Other symptoms include genital numbness, fecal incontinence and urinary incontinence.

<span class="mw-page-title-main">Lordosis</span> Medical condition

Lordosis is historically defined as an abnormal inward curvature of the lumbar spine. However, the terms lordosis and lordotic are also used to refer to the normal inward curvature of the lumbar and cervical regions of the human spine. Similarly, kyphosis historically refers to abnormal convex curvature of the spine. The normal outward (convex) curvature in the thoracic and sacral regions is also termed kyphosis or kyphotic. The term comes from the Greek lordōsis, from lordos.

<span class="mw-page-title-main">Piriformis syndrome</span> Medical condition

Piriformis syndrome is a condition which is believed to result from compression of the sciatic nerve by the piriformis muscle. The largest and most bulky nerve in the human body is the sciatic nerve. Starting at its origin it is 2 cm wide and 0.5 cm thick. The sciatic nerve forms the roots of L4-S3 segments of the lumbosacral plexus. The nerve will pass inferiorly to the piriformis muscle, in the direction of the lower limb where it divides into common tibial and fibular nerves. Symptoms may include pain and numbness in the buttocks and down the leg. Often symptoms are worsened with sitting or running.

<span class="mw-page-title-main">Coccygeus muscle</span> Muscle of the lower back arising by its apex from the spine of the ischium

The coccygeus muscle or ischiococcygeus is a muscle of the pelvic floor, located posterior to levator ani and anterior to the sacrospinous ligament.

<span class="mw-page-title-main">Anococcygeal nerve</span> Nerve in the pelvis

The anococcygeal nerve is a nerve in the pelvis which provides sensory innervation to the skin over the coccyx. The number of anococcygeal nerves vary between one and three.

Sacrococcygeal teratoma (SCT) is a type of tumor known as a teratoma that develops at the base of the coccyx (tailbone) and is thought to be primarily derived from remnants of the primitive streak. Sacrococcygeal teratomas are benign 75% of the time, malignant 12% of the time, and the remainder are considered "immature teratomas" that share benign and malignant features. Benign sacrococcygeal teratomas are more likely to develop in younger children who are less than 5 months old, and older children are more likely to develop malignant sacrococcygeal teratomas.

The pelvic portion of each sympathetic trunk is situated in front of the sacrum, medial to the anterior sacral foramina. It consists of four or five small sacral ganglia, connected together by interganglionic cords, and continuous above with the abdominal portion. Below, the two pelvic sympathetic trunks converge, and end on the front of the coccyx in a small ganglion, the ganglion impar, also known as azygos or ganglion of Walther.

<span class="mw-page-title-main">Sacrococcygeal symphysis</span>

The sacrococcygeal symphysis is an amphiarthrodial joint, formed between the oval surface at the apex of the sacrum, and the base of the coccyx.

<span class="mw-page-title-main">Anterior sacrococcygeal ligament</span>

The anterior sacrococcygeal ligament or ventral sacrococcygeal ligament consists of a few irregular fibers, which descend from the anterior surface of the sacrum to the front of the coccyx, blending with the periosteum.

<span class="mw-page-title-main">Spinal disc herniation</span> Injury to the connective tissue between spinal vertebrae

A spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including posture.

<span class="mw-page-title-main">Superior cluneal nerves</span>

The superior cluneal nerves are pure sensory nerves that innervate the skin of the upper part of the buttocks. They are the terminal ends of the L1-L3 spinal nerve dorsal rami lateral branches. They are one of three different types of cluneal nerves. They travel inferiorly through multiple layers of muscles, then traverse osteofibrous tunnels between the thoracolumbar fascia and iliac crest.

Coccygectomy is a surgical procedure in which the coccyx or tailbone is removed. It is considered a required treatment for sacrococcygeal teratoma and other germ cell tumors arising from the coccyx. Coccygectomy is the treatment of last resort for coccydynia which has failed to respond to nonsurgical treatment. Non surgical treatments include use of seat cushions, external or internal manipulation and massage of the coccyx and the attached muscles, medications given by local injections under fluoroscopic guidance, and medications by mouth.

In the human body, the lateral sacrococcygeal ligaments is a pair of ligaments stretching from the lower lateral angles of the sacrum to the transverse processes of the first coccygeal vertebra.

Rectal pain is the symptom of pain in the area of the rectum. A number of different causes (68) have been documented.

<span class="mw-page-title-main">Sacroiliac joint dysfunction</span> Medical condition

The term sacroiliac joint dysfunction refers to abnormal motion in the sacroiliac joint, either too much motion or too little motion, that causes pain in this region.

<span class="mw-page-title-main">Coccyx fracture</span> Medical condition

A coccyx fracture is a fracture of the coccyx, commonly called a broken tailbone or ‘puzzle fracture.’

<span class="mw-page-title-main">Pelvis</span> Lower part of the trunk of the human body between the abdomen and the thighs

The pelvis is the lower part of the trunk, between the abdomen and the thighs, together with its embedded skeleton.

References

  1. 1 2 3 4 5 Patel, R; Appannagari, A; Whang, P.G. (May 2008). "Coccydynia". Current Reviews in Musculoskeletal Medicine. 1 (3–4): 223–226. doi:10.1007/s12178-008-9028-1. PMC   2682410 . PMID   19468909.
  2. ↑ Patel, Ravi, Anoop Appannagari, and Peter G. Whang. "Abstract." National Center for Biotechnology Information. U.S. National Library of Medicine, 07 May 2008. Web. 21 May 2013.
  3. ↑ Postacchini F, Massobrio M (October 1983). "Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx". J Bone Joint Surg Am. 65 (8): 1116–24. doi:10.2106/00004623-198365080-00011. PMID   6226668.
  4. ↑ Kim NH, Suk KS (June 1999). "Clinical and radiological differences between traumatic and idiopathic coccygodynia". Yonsei Medical Journal . 40 (3): 215–20. doi: 10.3349/ymj.1999.40.3.215 . PMID   10412331.
  5. ↑ Marx, Fred A. (1996). "Coccydynia/Levator Syndrome, A Therapeutic Test". Techniques in Coloproctology. 4 (1).
  6. ↑ Maigne JY, Doursounian L, Chatellier G (December 2000). "Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma". Spine. 25 (23): 3072–9. doi:10.1097/00007632-200012010-00015. PMID   11145819. S2CID   25790826.
  7. 1 2 3 Maigne, J., Doursounian, L., & Chatellier, G. (2000). Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. SPINE, 25(23), 3072-3079.
  8. ↑ Foye P, Buttaci C, Stitik T, Yonclas P (2006). "Successful injection for coccyx pain". Am J Phys Med Rehabil. 85 (9): 783–4. doi:10.1097/01.phm.0000233174.86070.63. PMID   16924191.
  9. ↑ Ghormley RK (1958). "An Etiologic Study of Back Pain". Radiology. 70 (5): 649–653. doi:10.1148/70.5.649. PMID   13554831.
  10. ↑ Thiele, George H. (1963). "Coccygodynia: Cause and treatment". Diseases of the Colon & Rectum. 6 (6): 422–436. doi:10.1007/bf02633479. PMID   14082980. S2CID   35310988.
  11. ↑ Maigne, JY; Tamalet, B (1996). "Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position". Spine. 21 (22): 2588–93. doi:10.1097/00007632-199611150-00008. PMID   8961446. S2CID   20186649.
  12. ↑ Foye, P; Buttaci, C; Stitik, T; Yonclas, P (2006). "Successful injection for coccyx pain". Am J Phys Med Rehabil. 85 (9): 783–4. doi:10.1097/01.phm.0000233174.86070.63. PMID   16924191.
  13. ↑ Onghena, Patrick; Van Houdenhove, Boudewijn (1992). "Antidepressant-induced analgesia in chronic non-malignant pain: a meta-analysis of 39 placebo-controlled studies". Pain. 49 (2): 205–219. doi:10.1016/0304-3959(92)90144-z. PMID   1535121. S2CID   17744448.
  14. 1 2 Maigne, Jean-Yves, and Doursounian Levon. "Causes and Mechanisms of Common Coccydynia: Role of Body Mass Index and Coccygeal Trauma." Spine Journal 2.5.23 (2000): 3072-3079.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.