A coccyx fracture or broken tailbone is a painful injury with uncomfortable consequences. A broken coccyx will be painful with any pressure, like sitting for a while, rolling up in your Pilates class or bathroom visits. A tailbone injury is notorious for how long it takes to heal. Broken coccyx treatment includes physiotherapy, rest and activity modification, like introducing a doughnut cushion to your office decor.
The Anatomy of your Coccyx
Your coccyx is the Latin anatomical name for your tailbone. It is derived from the Greek word “kokkux”, which means cuckoo, because it resembles the bird’s bill. Funnily, it now describes your opposite anatomical end.
The last four vertebrae of your spine are fused together to form your triangular tailbone. On average your coccyx is between 3 – 5 cm in length. Your tailbone articulates with your sacrum right above it. Viewed from the side, the surface of these two bones is concave, opposite to the convexity of your lower back. This provides more space for your pelvic cavity which contains your bladder, rectum and reproductive organs.
Normally your coccyx has between 5 – 25 degrees of available movement. This is tested with an internal anal exam, as we don’t wag our tails anymore.
Coccyx shapes differ from person to person. Postacchini and Massobrio describe four different coccyx shapes:
- Type I: coccyx curved slightly forward
- Type II: more marked forward curvature
- Type III: sharp anterior, hook-like shape
- Type IV: subluxation (where the coccyx is partly or entirely not contacting the sacrum above)
What can my tailbone possibly do?
This small bone serves as an attachment site for important ligaments and muscles.
From the front, closer to your organs, the anterior and lateral sacrococcygeal ligaments attach your coccyx to your sacrum. The dorsal sacrococcygeal ligament, closer to your skin, provides this anchorage in three dimensions. This is an important landmark for epidural anaesthesia. The sacrospinous ligament attaches your sacrum and coccyx to your ilium (part of your pelvis), while the sacrotuberous ligament attaches your sacrum and coccyx to your ischium (another part of your pelvis.) These ligaments are found on both your left and right sides to provide stability.
The levator ani muscle group forms your pelvic floor muscles that enable you to control bladder and bowel movements and maintain a healthy pressure system for your pelvic organs. Part of this muscle group, the iliococcygeus muscle attaches to the front of the tailbone. Contracting this muscle lifts your pelvic floor and comes in handy when you need to hold it in. It also ensures soft padding for your rectum, that there is no direct friction of the organ to the bone.
Your coccygeal plexus is a group of nerves from S4, S5 and Co. Nerves are named from the spinal segment that they originate from. S4 = fourth sacral nerve. These nerves supply the coccygeus muscle, the sacrococcygeal symphysis and the skin between the coccyx and anus.
With so many different structures attaching to such a small bone, the symptoms of a broken tailbone can be debilitating and embarrassing to talk about.
How can my tailbone break?
When the force applied exceeds a bone’s ability to deform, a bone can break. Like bending a stick, our bones have the ability to deform slightly, children more than adults, but if the force applied is greater than the bone’s ability to deform your tailbone fractures.
- External trauma
Coccyx fractures can happen with a direct fall on your tailbone, like slipping on a tile floor and landing on your buttocks. Or during tackles in contact sports where you land on your tailbone.
- Internal trauma
Normal vaginal child delivery can cause injury or fracture of the coccyx, depending on the size and position of the baby and the angle of the mother’s coccyx.
- Osteopenia & Osteoporosis
When bones loses density, like what happens with osteoporosis or osteopenia, the risk of a fracture increases for all your bones. This can result from hormonal imbalances or nutritional deficiencies.
Causes of Tailbone Injury
- Injury
Falling and landing on your tailbone in a seated position, like:
slipping on a wet surface, or
stumbling on a stair.
- Labour
Normal, vaginal delivery can cause injury or a fracture to the mother’s coccyx.
- Repeated strain on coccygeal ligaments
Poor posture, excess weight and chronic constipation can cause ligamentous strain on the levator ani muscle attachments.
How bad is my tailbone injury?
- Subperiosteal bruising
This is the most minor form of tailbone injury where you heal completely within a week of your fall. The injury causes bruising to the bone, but not a break.
- Undisplaced fracture
With an undisplaced fracture, the bony ends are well aligned and still in contact with one another. With rest, activity modification and treatment you should make a full recovery within 6 weeks.
- Displaced fracture
The bony fragments have moved away from one another and are only making partial contact, if at all. A manipulation under anaesthesia can be considered by your doctor to align the bony segments. More pronounced soft tissue injury to the coccygeal ligaments and the levator ani muscle can be expected with a longer recovery time.
- Coccygodynia
This refers to pain of the coccyx without any visible injury. The risk of developing coccydynia after a displaced fracture is higher than with subperiosteal bruising. The longer you wait to seek treatment after your tailbone injury the higher your risk of developing chronic coccyx pain.
Don’t get stuck in a cycle of pain because you are too embarrassed to discuss you symptoms.
Diagnosis of a broken tailbone
Physiotherapy diagnosis of a Coccyx Fracture
Our physiotherapists are experts in anatomy, physiology and pathology. We understand the agony you’re going through. Our aim is to create the ideal healing environment for your tailbone fracture to heal and we have the experience to guide you through your treatment. We can accurately diagnose a broken tailbone, send you for x-rays and make sure you recover as fast as possible.
X-rays
X-rays will show the integrity and alignment of your coccyx. Muscles and ligaments cannot be seen on an x-ray. A standard lateral or AP view can be used to diagnose a coccyx fracture.
Your physiotherapist can refer you to get x-rays taken if necessary.
MRI
An MRI can be used for complicated, displaced coccyx fractures to visualise the muscles, ligaments and nerves too. If your physiotherapist suspects any onther structure was damaged with your tailbone fracture you will be referred to the right specialist.
Why is my tailbone pain not going away?
The longer you wait to seek treatment, the bigger the risk that you become stuck in a cycle of pain, not knowing if it is safe to move or not. You now risk compensatory movement patterns becoming permanent, like pulling a face and bracing yourself when you sit down because you anticipate pain, even long after your symptoms have healed.
Because of the sensitive nature and nerve endings around your coccyx, getting the right treatment from the beginning is important. Unconsciously “protecting” your tailbone can cause biomechanical problems in your lower back over time.
Your body is resilient and capable of healing. We aim to encourage healing and enable you to get back to what you love doing in as little time as possible. You want to address all the facets of your broken coccyx to prevent long term complications.
Problems we see when patients come to us with a coccyx fracture
- Waiting too long
The longer you wait, the bigger your chances of developing chronic pain. A lot of people feel uncomfortable discussing the intimate nature of their symptoms and therefore wait too long to seek help.
- Misconceptions about treatment
The internet is a wonderful resource, but can lead to unrealistic expectations of treatment. Trying out, but not completing different forms of treatment will only lead to frustration. There is no quick fix, you need to do the work.
- Continuous use of oral medication
Pain medication only masks the symptoms and can cause constipation which will worsen your symptoms.
- Rest alone will not solve the problem
Rest is necessary, but will not heal you in itself. Slow, paced reintroduction of movements and exercises will enable you to get back to the training you love.
Physiotherapy broken coccyx treatment
Our physiotherapists have years of experience in diagnosing all types of injuries. Our physios can diagnose a coccyx fracture after we’ve done a clinical assessment. We’ll guide you through your recovery by implementing the correct broken tailbone treatment techniques, giving you a lot of advice to ease the pain and a home program to make your recovery as comfortable as possible.
Phases of rehabilitation for broken coccyx treatment
1st Phase for broken coccyx treatment: Symptom relief (week 0 – 2)
During this phase the aim is to answer all your questions and set the road map for your recovery journey. After a thorough clinical assessment we’ll be able to give you a time line of what to expect. Your treatment will include electrotherapy modalities, like laser and TENS, to decrease pain, soft tissue mobilisation and neural mobilisations while incorporating small movement to encourage muscle contraction.
To progress to the next phase of your broken coccyx treatment you should be able to do pelvic tilts, a bridge and sit down slowly on a soft surface.
2nd Phase for broken coccyx treatment: Contraction control (week 3 – 5)
We expect the bone to have formed a callus, the scab around a bone where the connection site is formed. You will have less pain, but experience a fair amount of stiffness. Your rehabilitation program will include more pelvic floor exercises, like kegels, diaphragmatic breathing and bigger movements of tilts.
To progress to the next phase of your broken coccyx treatment, you should be able to do pelvic tilts in sitting through full range of motion.
3rd Phase for broken coccyx treatment: Long lever movements (week 6 – 8)
During this phase of your treatment we will incorporate bigger movements and longer levers that require more strength and endurance. Now your rehab will resemble a conditioning program with stair climbing, lunges and balance work.
You should be able to comfortably navigate stairs, lunge deeply and balance on one leg to progress to the next phase of your broken coccyx treatment.
4th Phase for broken coccyx treatment: Endurance (week 8 – 10)
During this phase of your treatment the aim is to get comfortable with more reps to build up your endurance to enable you to get back to your everyday life. If that includes a lot of stair climbing, standing or sitting, that’s what we’ll aim to strengthen.
You should be able to comfortably do around 70% of your activities that was part of your day before your tailbone fracture.
5th Phase for broken coccyx treatment: Paced return to training (week 11 – 12)
Now we can include functional activities and sport specific drills, like hops, skips and jumps to get you back on the road, track or field. You should be able to run 3 km on a flat surface to be get back to team training.
Healing time for a coccyx fracture
All things worthwhile take time. Your tailbone fracture can take between 8 – 12 weeks to heal completely. Your tailbone injury physiotherapy treatment will be spread over the course of 4 months to introduce modalities that align with the phase of rehabilitation you are in at that time. How fast you recover will greatly be up to your compliance with treatment. A full recovery and return to sport will take longer and should not be confused with the healing period.
Other forms of treatment medical treatment for a tailbone injury
- Your doctor (GP) will prescribe oral analgesics and anti-inflammatories to relieve your pain.
- Remember that these medications can cause constipation, which can cause pain when emptying your bowel, discuss this with your doctor to find an alternative if necessary.
- Increasing fibre in your diet, stool softeners or laxatives may be helpful to decrease constipation and make bowel movement easier.
- Investing in a doughnut cushion will decrease pressure when you are sitting, limiting pain while working and driving.
Is surgery an option for my coccyx fracture?
A coccygectomy, where part of or the entire coccyx is removed, can be considered after failure of non surgical treatment. This option will only e considered after three months of non surgical treatment. This includes activity modification, medication and physiotherapy.
Coccygectomy is rarely recommended. Although it is a straightforward procedure, the recovery is lengthy and painful. Sitting should be limited and special care taken to wound care to avoid the risk of an infection.
What else could my tailbone injury be?
Nerve pain down your leg can be caused by compression on or irritation of your sciatic nerve.
One sided lower back pain that gets worse when standing on one leg can be caused by sacroillitis.
- Pilonidal cyst
Ingrown hairs on the tailbone or gluteal cleft can lead to a cyst forming underneath the skin. If this becomes infected it can cause pain and drain puss.
- Piles
Pain when voiding your bowel around the anus can be caused by piles and may include blood in your stools.
- Cluneal nerve entrapment
Burning like pain on the lower back or buttocks can be an indication of cluneal nerve irritation.
Also known as
- Broken tailbone
- Coccyx fracture
- Broken coccyx
- Tailbone injury
- Coccydynia
