Coccydynia

Pain in the area of the coccyx (tailbone) is called coccydynia, Coccyaglia  or coccygodynia (or sometimes a variety of other spellings). Coccydynia can be anything from discomfort to acute pain, varying between people and varying with time in any individual. Extended hours of sitting can cause a number of issues including coccyx pain also known as tailbone pain.  The condition is much more common in women than men. The majority of coccyx injuries occur in women because:

            ·         The women's coccyx is rotated, leaving it more exposed to injury

            ·         Women have a broader pelvis, which means that sitting places pressure on their coccyx (male anatomy causes them to sit without much pressure on the coccyx)

            ·         Childbirth is a common cause of the condition. 

It is derived from Greek word for “cuckoo” due to its resemblance to the beak of this bird, the coccyx comprises the most distal aspect of the vertebral column. It consists of three to five rudimentary vertebral units that, with the exception of the first coccygeal segment, are typically fused. The ventral surface of the coccyx is slightly concave with transverse grooves that demarcate the regions where the vestigial coccygeal units had previously fused. The dorsal aspect is slightly convex and displays similar transverse markings as well as multiple paired tubercles known as the coccygeal articular processes, the most superior of which are referred to as the coccygeal cornu. These structures articulate with the sacral cornu of the inferior sacral apex at S5, either as a symphysis or as a true synovial joint; this articulation represents one of the borders of the foramen for the exiting dorsal branch of the fifth sacral nerve root. The coccyx also serves as a site of attachment for the gluteus maximus muscle, the coccygeal muscle, and the anococcygeal ligament.

Body mass index (BMI) appears to influence the prevalence of coccydynia, as obesity is three times more common in patients with coccydynia than in the normal population . The coccyx of a leaner patient normally rotates during sitting so that the coccyx is in an optimal position to absorb the forces that are generated during this activity. As the BMI increases, the degree of pelvic rotation with sitting is reduced and the angle of incidence is increased. Consequently, the coccyx in obese patients is more susceptible to sudden elevations in intrapelvic pressure that occur with a fall and repeated sitting down. This increased exposure to pressure places the coccyx at an increased risk of posterior subluxation.Normal and below-normal weight patients are more likely to develop coccydynia consequent to lesion patterns other than posterior subluxation as their coccyges rotate in a more optimal fashion to lessen forces from falls and sitting .

Symptoms 

The symptoms described vary:

•  Pain during or after sitting: 
•  Acute pain while moving from sitting to standing. 
•  Pain caused by sitting on a soft, but not a hard surface : This   is usually      happens when the joint between the sacrum and coccyx is      unstable, so that the coccyx can be pushed out of place when you put  pressure on it by sitting or lying. When you sit on a hard surface, most  of your weight is taken on your 'sit-bones' , the hard bits at the bottom  of your pelvis. But when you sit on a soft surface, the foam rubber  pushes up between the bones, increasing the pressure inside you and  pushing the coccyx out of place.
•  Deep ache around the coccyx
•  Sensitivity to finger pressure on the tip or edges of the coccyx Local pain in the tailbone area that is worse when touched or when any pressure is placed on it
•  Shooting pains down the leg
•  Like sitting on a marble that moves around
•  Like sitting on a knife
•  Like being impaled on a garden cane, with or without chilli peppers
• Pain during bowel movements, and sometimes before
• Increased pain around the time of a woman's monthly period - this may be due to variations in the levels of estradiol.
• Pain during sexual intercourse, either in men or women.
• Pain during menstruation

If the pain was caused by trauma, then there may be other parts of the body damaged as well. If this damage includes the sacrum, hips or legs, it may be very difficult to sort out what is causing the most pain

Secondary symptoms

 Painful feet, from standing too much. One particular problem that  can develop is plantar fasciitis. Plantar means the foot, and fasciitis is inflammation of the fascia, or fibrous tissue enclosing and connecting muscles. This condition is sometimes called heel spurs.

• Exhaustion, depression, lack of sleep.
• Painful back, from sitting in awkward positions to relieve the pressure on the coccyx. 
• Other aches and pains around the body. In the case of coccyx pain, the whole area of the buttocks can become hypersensitive because of this effect. This, of course, makes sitting even more uncomfortable, and chairs and sitting positions which were initially OK can become uncomfortable. Hips may become painful if you are lying on them most of the time. 

Causes of pain

• Unstable or dislocating coccyx
• Spur on coccyx
• Misaligned, rigid, or long coccyx
• Muscle spasm or tightness
• Pilonidal cyst
• Tarlov/meningeal cyst
• Pudendal neuropathy
• Cancer
• Referred pain
• Neuropathic pain
• Previous medical procedures
• Deposits of calcium in joints
• Idiopathic coccydynia
• Imaginary pain

 Exercise for coccyx pain

·         Using Cold packs
Applying cold packs or ice to the affected area can help reduce coccyx pain dramatically. All you need to do is to place ice or a cold pack on the affected area for around thirty minutes every few hours.

·         Walking : It has a powerful relaxing effect on the spasms that tend to build up around the coccyx.

·         Leg exercises

·         Swimming

·         Anal lock : This exercise is done in bed, morning and evening. It involves the same muscles you use to "hold on" when you need to go to the toilet but can't get there right away. The muscles are tensed and held for 10-15 seconds, repeatedly.

·         Weightless squats : Repeatedly go from this position to standing.

·         Inversion therapy : This method involves hanging upside down at an angle on an inversion table, with the feet fastened in position. This applies traction to the spine.

·         Breathing and relaxation exercises : Reduce  coccyx pain using breathing and relaxation exercises combined with deep massage.

• Yoga : Getting rid of coccyx pain using yoga like Shalbasana, Bhujangasana and Ardha shalabh asana.

The Acupuncture Point Formula for Relieving Low Back Pain : GB 30, BL 30 and ST 30 SI 3, CV 3, KI 12, CV 4 and KI 13 BL 62, BL 40 (54) and "surround the dragon" are usual points of application.