Some people can suffer from coccyx pain. We all know how painful it is to fall on your coccyx! Coccydynia is ongoing pain in the coccyx. This may be because of a fracture, dislocation, bruising or damage to some of the surrounding tissues. The coccyx can become damaged during delivery, especially if assisted (such as with forceps). Some pregnant women can suffer from pain and inflammation at the coccyx due to the pressure and weight of the pregnancy. During pregnancy everything is more lax due to the hormone relaxin and this can make the coccyx more vulnerable to injury due to becoming more mobile.

Pelvic floor muscles attach to the coccyx and these can become affected too. They may tighten and grip creating excess lactic acid, and this in turn can create pain as well as weakness through the pelvic floor muscles.

The coccyx is a triangular bone at the base of the sacrum it is named after its’ shape resembling the beak of a Cuckoo bird (from Greek and latin roots). It has between three and five segments that may move slightly when the pelvic floor is lifted. Which is why I like to cue the lift of the pelvic floor in Bridging as then you can imagine the entire spine moving initiating right from these tiny bones!

Ligaments and muscles attach to the coccyx including the Coccygeus and Levator Ani that make up the pelvic diaphragm. Gluteus maximus attaches at the back.

With inflammation at the coccyx it is important to stretch the surrounding muscles to try and relieve gripping muscles and build up of lactic acid. These stretches include gluteal, piriformis, hamstring, and hip flexor stretches, as well as mobilising further up the spine into rotation. So enjoyable rotational stretches at the thoracolumbar junction such as side to side.

The most painful position to exercise in is in a seated position. So avoid seated exercises and any move that rolls back onto the sacrum such as half roll downs and full roll ups. It is important to explain correct sitting positions though – so not sitting with a posterior pelvic tilt.

The coccyx is the remains of a tail in humans, so one way I like to think of releasing pain in this area is to wag the tail! My fav exercise for this is the standing cat with the push through bar on the Caddie, standing on a rotator disc (on the floor) and ‘wagging the tail’ in the hips flexed position with slightly bent knees.

What are the causes of Coccydynia? There are several factors which could contribute to coccyx pain. Certain causes may include:

• The ligaments or the surrounding tissues of the coccyx are damaged
• Pregnancy releases a hormone Relaxin that cause the ligaments that stabilise the coccyx to become more lax, this makes this joint vulnerable to misalignment, especially during delivery
• Ligaments may become overstretched during pregnancy and delivery causing pain
• Falling and landing on the coccyx
• Repetitive Strain Injury from taking part in sports such as rowing or cycling
• Sitting with poor posture in a posterior pelvic tilt (car seats and plane seats are not great)
• Being overweight or underweight
• Ageing
• Infection
• Cancer

In my experience, movement heals. Coccydynia needs a specialised Pilates program, and consultation with a specialist in this area. Pilates programs need to focus on strengthening all the muscles around the pelvic girdle, working the pelvic floor with eccentric and concentric muscle activation and stretching all the muscles around the pelvic girdle as well as thoracic mobility into rotation. Also all the muscles around the pelvic girdle need to be stretched for optimal function, including the pelvic floor - so include pelvic floor relaxation cues. 

The best position to work in, I find, is 4 point kneeling, as this takes all the load away from the coccyx. Think regressed push up, quadruped/pointer, hand weights in 4 point kneeling, thread the needle, cat stretch, wag the tail and child pose. Remember to strengthen all the muscles around the pelvis: think squats, clams, scooter, bridging, side lying footwork on the Reformer. You will feel 1000 times better if you do!