The coccyx, sometimes known as the tailbone, marks the bottom of the vertebral column in humans. This area is comprised of three to five very small vertebra and is believed to be the remnant of a tail structure. Although these bones are no longer needed to support a tail, the coccyx helps bear weight and provide balance, especially when sitting or leaning backwards.
A normal tailbone is shaped like an upside-down triangle, roughly situated between and below the hip bones. The name, coccyx, is believed to come from the Greek word for "cuckoo," as the shape of the tailbone is similar to that of a cuckoo's beak. Unlike the rest of the vertebra, those in the tailbone are solid and do not contain a space for the spinal cord to run through.
Directly above the tailbone is the sacrum, a wedge shaped bone that fits between the hipbones. The sacrum and coccyx are connected by joints and ligaments that allow some small movement between the two bone sections. However, studies have shown that if the coccyx is surgically removed, it causes little or no effect on overall mobility.
Because of the largely vulnerable position of the tailbone, it is subject to a variety of injuries. Pain when sitting down is often the clearest symptom of bruising or damage to the area. If you are suffering from lower back pain when sitting, you may want to visit a doctor or chiropractor to see if the pain may be related to your coccyx. Tailbone pain is referred to as coccydynia, and damage is often confirmed using X-ray images or MRI scans of the lower back. There are many potential contributing factors to coccydynia, including traumatic falls, childbirth, or activities that require excessive sitting, such as bicycling or horseback riding. If you suffer from coccydynia, the condition may be aggravated by these types of sports, or simply by sitting for very long periods of time.
There are also some tumors associated with the tailbone region. Sacrococcygeal teratoma is a type of tumor often found in newborn babies that forms in the base of the coccyx. Although these tumors are often benign, surgical removal of the tailbone is a common procedure to get rid of the tumor. If the tumor is malignant, leaving the coccyx in place leaves the patient at risk for a recurring tumor. Because of the limited complications associated with removing the coccyx entirely, it is often the safest and most effective way to remove the teratoma and prevent a reoccurrence.
First of all, see a doctor. Unfortunately, many general practitioners do not take this coccyx pain seriously - here is what you can do about that. If possible, see a specialist with experience in this area. This is to check that your pain is not a symptom of cancer or some other disease (unlikely, but needs checking), and to start the ball rolling in case you need treatment. Coccyx pain often goes away within a few months after it starts. If the pain persists, it is important to establish whether the coccyx is really the source of the problem.
If the coccyx is identified the source of the pain, a number of people have reported good results from manual treatments of the coccyx, when applied by experts in this technique. Orthopedic specialists, on the other hand, will normally give an injection of an anti-inflammatory drug around the coccyx as the initial treatment. If such methods are not successful, the coccyx may be removed if the patient is regarded as a good candidate for surgery. Before going for this option, make sure that you are a good candidate, and that your surgeon has plenty of experience and success with this operation.
Controlling the pain by methods which don't affect the underlying condition has good and bad sides. The obvious good point about pain control is that it stops the suffering and depression that pain causes, and allows you to carry on a more normal life. The other good point about pain control is that it can prevent the changes in processing of pain messages in the central nervous system that chronic pain can cause. Unrelieved pain can put the system out of balance and lead to more widespread pain that is difficult to treat.
But controlling pain has its drawbacks as well. If your pain is caused by an unstable coccyx, for instance, and you can't feel the pain of that any more, then you may well cause further damage to it without realising. You therefore need to be careful not to make your condition worse. Another problem with pain control is that some methods, such as drugs, have side-effects which may be unpleasant themselves, or even have long-term consequences if continued for a long time.
The best first aid is to avoid what causes the pain. Unfortunately that means avoiding sitting down, and that's very difficult to do, especially if you're hoping that it's just a minor injury that will go away by itself, and you don't want to make a fuss. But it really is worth trying. Every time you sit down you're aggravating the injury. If you carry on as before, you're like a runner who has sprained an ankle, but insists on carrying on running.
If you do sit down, a cushion with a slot cut out under your coccyx can help. Start now - don't wait till you're desperate.
Some doctors recommend ice packs to reduce the inflammation. See if they work for you. Some people find a hot water bottle or heated pad relieve the pain. The doctor may also prescribe anti-inflammatory drugs (NSAIDS). Several people have reported that suppositories of diclofenac, an anti-inflammatory, help with the pain. If you use drugs to help with the pain, you need to be careful not to use them to mask the pain, sit longer, and aggravate the cause of the pain.
If the damage is minor and you're lucky, the pain may go away without further treatment.
Many of us hide our pain in everyday life, and carry on sitting down even though it hurts. But if you hide your pain at the doctor's, they will assume that it doesn't hurt much. If it hurts you to sit, then stand up in the waiting room and in the doctor's surgery. Or pull two chairs near to each other, and sit over the gap between them. If your feet hurt as well, ask the doctor if you can lie on his couch during the consultation. Don't exaggerate your symptoms, but don't play them down either.
Before you go to the doctor, look at the investigations page, so that you can discuss the tests the doctor might do. Your doctor may refer you to a specialist, usually an orthopedic specialist, sometimes a spinal or neurological specialist. Ask your doctor to send you a copy of the letter he or she sends to the specialist.
Most of the tests that doctors carry out are not much help, except to rule out cancer as a cause of the pain. There are two tests, injection of local anesthetic and dynamic sit/stand x-rays, that are really helpful in finding the cause of the pain. Unfortunately a lot of doctors are not familiar with them, so you may have to be very persuasive to get them to do the important tests.
Unfortunately you may have this pain for a long time, and try many different treatments. It is a great help if you keep a diary of how bad your symptoms are, what medicines or treatments you have taken, their effects and side-effects, visits to doctors and what they said, and anything else that may be relevant. When you visit a specialist you will be able to give an accurate history of your problems. I went as far as printing out a one-page history of my pain and presenting it to any doctor I was referred to.