Painful sitting and coccydynia

This post is written by Dr. Liesel Jay, PT, DPT

Overview: 

Your coccyx, also known as your tailbone, resides at the end of your sacrum. The term “coccydynia” is representative of pain around this area. If you have pain with sitting, sensitivity to touch around your coccyx, pain with bowel movements, intercourse, or menstrual cycles, this could be what’s going on. 

There are so many variations of coccyxes that one can have and they are all considered normal. Your coccyx could naturally be shifted to the right or left and that could be your norm. It becomes an issue when there is pain associated with that or if the shift was caused by an accident. Falling onto your coccyx, childbirth, having a hysterectomy, cycling, snowboarding, and skating are all examples of causes of coccydynia. 

Tell Me More About the Coccyx and Pelvic Floor
There is so much that this seemingly little bone can do! The tiny little coccyx actually has 22 degrees of movement, which is really saying something. Its movement is coordinated by your lumbar spine, where if you extend or arch backward your coccyx will also extend back and vice versa. It supports all your pelvic floor musculature by being a point of insertion for these muscles to attach to. So, imagine your pelvic floor muscles being very tight and then pulling the coccyx toward your pubic bone (or if your pelvic floor is only tight on one side, it could be pulled just toward that side). This tension can lead to low back pain, sacro-iliac joint (SIJ) pain, and pain associated with peeing, pooping, and intercourse. 

What Can Pelvic Health PT’s Do to Help?
As pelvic health PT’s, we can assess restrictions in movement involving your low back, hips, and coccyx. Assessment of your coccyx usually involves both external and internal (through anus and rectum) areas of your body. With pelvic floor involvement, the area around the coccyx is also the area of focus for treatment. 

Things YOU Can Do Besides Pelvic PT
First, posture is key with many aches and pains we have and coccydynia is no different. When we think about good posture, many people can over-exaggerate it. We want to think about everything being “stacked” on top of one another. For example, in standing: 
Head is stacked over neck
Ears are in line with our shoulders
Shoulders are in a neutral position (not rolled forward or shoulder blades pinched back) and stacked over hips
Hips are stacked over knees 
Pelvis is neutral (not tipped forward like we’re arching our back and not tipped back like we’re tucking our tail)
Knees are stacked over ankles

This is a lot to think about throughout the day! We have gotten too used to the forward head and rounded shoulders posture from sitting and using a computer or phone that we need to be reminded to have better posture. 

Second, sitting Posture. When our coccyx is painful, sitting can feel like the absolute worst option. When this is the case, investing in a cushion with a center cut out can give the coccyx more space and also give you a reminder to relax the muscles around this space. You can also try using a rolled up towel (the long way) and making a u-shape with it. The rounded part of the “U” can be toward the back, but it’s not touching coccyx. Remember - you want the coccyx to have space, so arrange yourself and the towel for this to happen.

Sitting in an upright position and not slouched is also important to note, especially if you don’t have a cushion or towel to use. 

Last, work on relaxation and breathing. Coccydynia causes your muscles to get tight and try to protect that area. This is your body trying to help you, but unfortunately it usually makes things more painful and longer-lasting. A common response to coccydynia is becoming a “butt gripper.” You keep your butt muscles so tight and then have trouble relaxing them. So, take a deep breath into your belly and actively relax your butt muscles. Standing is the most common position to feel your butt muscles clench, so working on stretching those muscles and keeping them more relaxed will help. 

If the above suggestions are only taking you so far, the missing piece could be receiving hands-on treatment from a pelvic health PT. You really can get back to sitting comfortably again!