Pain Management:

• Education: Advice on posture, seating modifications (e.g., coccyx cushions, donut pillows), and activity modification.
• Heat/Cold Therapy: Application of ice packs or heat packs to the area.
• Ergonomic Advice: Guidance on proper sitting posture at work and home to reduce pressure on the tailbone.
• Pelvic Floor Muscle Rehabilitation: Addressing hypertonicity or weakness in the pelvic floor muscles, which directly attach to the coccyx.
• Core Stability Exercises: Strengthening the deep abdominal and back muscles to improve spinal stability and support.
• Stretching: Gentle stretching of tight muscles in the hips, glutes, and lower back (e.g., piriformis, hip flexors, hamstrings).

Advanced Physiotherapy Techniques and Modalities

Manual Therapy

• External Coccyx Mobilization: Gentle, rhythmic movements applied to the coccyx from the outside to improve its mobility and alignment. This can help release restrictions in the surrounding ligaments and muscles.
• Internal Coccyx Mobilization (Intra-rectal mobilization): This specialized technique involves the physiotherapist inserting a gloved finger into the rectum to directly palpate and mobilize the coccyx and surrounding pelvic floor muscles (levator ani, coccygeus). It is considered highly effective for many cases of coccydynia, especially when external approaches are insufficient or when there’s significant muscle spasm internally. It requires specific training and patient consent.
• Sacroiliac Joint (SIJ) Mobilization: If there is associated SIJ dysfunction contributing to the pain, specific mobilization techniques for the SIJ can be applied.
• Soft Tissue Mobilization/Massage: Deep tissue massage, effleurage, and friction massage applied to the gluteal muscles, piriformis, hamstrings, and lower back extensors to reduce muscle spasm, improve circulation, and release trigger points.

Myofascial Release (MFR)

• Purpose: To address restrictions in the myofascial system, the connective tissue that surrounds muscles and organs. In coccydynia, the fascia in the pelvic floor, gluteal region, and lower back can become tight and restricted, contributing to pain and dysfunction.
• Application: Sustained, gentle pressure applied to restricted areas of the fascia to release tension, improve tissue elasticity, and restore normal mobility. This can be performed externally on the gluteal muscles and lower back, and internally on the pelvic floor muscles.

Dry Needling

• Purpose: Involves inserting thin, solid filament needles into myofascial trigger points (hyperirritable spots in taut bands of muscle) to alleviate pain, reduce muscle tension, and improve muscle function.
• Application in Coccydynia:
  • Can target trigger points in the gluteal muscles (e.g., gluteus maximus, medius), piriformis, and particularly the pelvic floor muscles (e.g., levator ani, coccygeus) which can be accessed through specific external or internal (with specialized training) approaches.
  • It aims to elicit a “local twitch response,” which helps to release the muscle contraction and reduce pain.
  • Can help to normalize muscle tone and reduce compensatory muscle guarding around the coccyx.

Kinesiology Taping

• Purpose: Elastic therapeutic tape applied to the skin to provide support, reduce pain, decrease swelling, improve circulation, and facilitate or inhibit muscle activity.
• Application in Coccydynia:
  • Support and Pain Relief: Can be applied to provide gentle support to the coccyx area, reduce tension, and potentially lift the skin to decompress nerve endings, offering pain relief.
  • Muscle Facilitation/Inhibition: Taping can be used to either facilitate the activity of weakened gluteal muscles or to gently inhibit overactive or spastic muscles in the lower back or pelvic floor.
  • Proprioception: Provides sensory feedback to the brain, which can help improve awareness of posture and movement patterns.
  • Edema Reduction: Specific lymphatic drainage taping techniques can help reduce localized swelling if present.