It represents the last trace of the presence of the tail of mammals in man: it is the coccyx, the final stretch of the spine, with 4-5 vertebrae fused together and motionless, unlike the other vertebrae of the spine.

The coccyx is articulated with the sacrum in the sacrum-coccygeal joint and may be the site of pain, either as a result of trauma or in its absence. What can be the reason for the pain in the coccyx and how can one intervene? Lara Castagnetti, an osteopath and specialist in Physical Medicine and Rehabilitation at Humanitas, spoke about this topic.

A trauma to the sacral area is one of the main factors responsible for coccodinia, or pain in the coccyx: “It is a trauma often linked to a backwards fall, as it can happen to those who practice activities such as horseback riding, snowboarding and ice skating,” says the doctor.


An acute pain that may persist and become dull

The pain is at first acute and the trauma can also leave a bruising. “The impact can be very strong and cause, for example, a fracture of the tailbone, but also a subluxation, with the last stretch of the tailbone moving inwards.

The X-ray will make it possible to observe and assess the outcome of the trauma, while the detection of inflammation of the bone will require a resonance that will make the edema of the bone visible,” emphasizes the specialist.


Pain in the absence of trauma

In the absence of a fall, identifying the causes of coccyx pain is more complicated. Dr. Castagnetti continues: “Pain could be caused by postural problems, as for example in cases with patients who have the sacral bone in a more horizontal position than the physiological vertical position. The deviation of the sacrum, with an alteration of the curve of the rachis, can also have repercussions on the coccyx. Sedentariness and a spoiled posture, with the pelvis forward, sliding towards the edge of the chair, promote pain. In other cases, however, this may be the result of compression of a nerve root.

Pelvic floor muscles are also involved in the onset of coccyx pain: “These muscles fit onto the coccyx and therefore a coccygeal dysfunction can cause problems, through the pelvic floor, even during defecation or sexual intercourse,” added Dr. Castagnetti.

The type of pain is a distinctive feature of coccyx pain: “Pain is first acute, but then it tends to persist over time as dull pain. The mechanisms of chronic pain are activated and in the area you continue to feel discomfort, for example when you are sitting for a long time.


An aid from osteopathy

Osteopathy is one of the most valid treatment options: “The specialist will perform tractions and maneuvers on the spine and bones of the pelvis to rebalance posture, but also to release all other structures. The osteopath performs an overall evaluation and also intervenes on the release of the ligaments and muscles that are inserted on the coccyx,” explains Dr. Castagnetti.

In the acute phase, anti-inflammatory medications may be indicated to relieve pain. It is also advisable to use special cushions to sit down, to limit the chances of experiencing pain, or, if you are forced to sit for a long time, it is good to get up and walk for a few meters.


The role of shock waves

In synergy with osteopathic treatment, shock waves, particular acoustic waves, are also effective: “This is a non-invasive procedure that serves to eliminate inflammation. A contraindication could be the presence of post-traumatic hematoma, so it is advisable to wait for its reabsorption before proceeding with the shock waves.


Another possible physical therapy that can be used in case of coccyx pain is laser therapy,” concluded Dr. Castagnetti.