Spinal problems - coccyx pain

Coccygeal problems can be difficult resolve. There are many underlying issues which can contribute to them:-

1. Trauma. Falling onto the coccyx is probably the most common cause of coccyx problems. It can be a single fall with a major impact produced by falling from a horse, or slipping downstairs and impacting the coccyx on the stair edge. A foolhardy school ‘prank’ when a chair is pulled away as the subject sits down, can also produce the same result.
2. Sitting an a hard surface, say watching sport or using a hard kitchen chair can exert pressure on the coccyx and result in strain of the associated ligaments.
3. Coccyx problems are far less common in well covered individuals. The thinner you are, the more prone you will be to coccyx strain. If you lose weight this can be an unfortunate sequel. Loss of gluteal muscle bulk can have the same result.
4. Changes in pattern of activity can initiate problems. Notably, a change of occupational habit or sitting to study exams.
5. The inherent shape of your coccyx can make a difference. Some are angled so as to be more vulnerable. If the junction between the sacrum and coccyx is acute, this won’t help.
6. Single or repetitive birth trauma to the coccyx and its associated ligament structure may be involved.

Very often a combination of the above will result in the onset of symptoms. If you are a sufferer, it is worth reflecting on what is happening in your life.

The most common coccygeal problems are musculo-ligamentous. These involve a strain of the ligaments between the sacrum, coccyx and spasm of the surrounding muscles. Trauma may result in a positional abnormality between the sacrum and coccyx. This can usually be seen on X-ray, but many NHS departments are reluctant to undertake X-rays without good justification. This is the case in Ipswich.

If you have a coccyx problem there are a number of things you can do:-

1. Look at the possible causes above. Try to make changes in your life to keep mechanical stress off the coccyx.
2. Use a coccyx cushion with a cut-out which helps keep pressure off the coccyx. These are available from www.physio-med.co.uk
3. Ice packs can help reduce inflammation.
4. Consider being assessed by a physical therapy practitioner. Andrew Gilmour and his colleagues are frequently asked to do this.
5. There are a range of helpful treatments.
  •  Hands on treatment can reduce muscle spasm and thickening of the ligaments.
  • Acupuncture dry needling can strengthen the ligaments and reduce muscular trigger points.
  • Local steroid is often extremely helpful, when undertaken by an experienced practitioner. Andrew Gilmour has referred patients to Dr Simon Harley musculoskeletal physician for more than 15 years.
  • Often a combination of hands on treatment and trigger point injections is more beneficial than one or the other.

6. Some practitioners advocate manipulation of the coccyx and the junction between it and the sacrum to correct positional faults. If you entertain this, be sure your practitioner has experience in the technique, has explained it thoroughly and you have given your consent. You would be well advised to have a chaperone with you. We do not perform this technique.
7. Only consider surgery as a last resort and in extreme circumstances. It can be a useful solution but post surgical scarring can be a very problematic sequel.
8. If coccyx problems persist in spite of your own best efforts and that of your chosen practitioners, you may require chronic pain management. Local NHS hospitals provide these on referral from your General Practitioner. We can arrange referral to a private pain specialist if you need it.


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