Tailbone Pain: The Pelvic Floor Connection

This episode of the Marrón Pelvic Health Podcast, hosted by Dr. Kari Roberts, explores the often overlooked issue of tailbone pain and its connection to pelvic floor function issues today. While many people think tailbone pain is only due to injury or prolonged sitting, it can also be linked to pelvic floor tension, muscle imbalance, or postpartum changes over time. The podcast highlights how understanding tailbone pain can reveal important pelvic floor dysfunction and why early attention to symptoms matters over time. Dr. Roberts explains that pelvic physical therapy can address tailbone pain through assessment, manual therapy, education, and exercises aimed at restoring comfort and mobility.

Book a call with Dr. Kari Roberts today.

• Episode Transcript

  Dr. Kari: Have you had tailbone pain and wondered where it's from and how to get over it? If so, then stay tuned for this episode.

  Welcome to the Maroon Pelvic Health Podcast. Hi, I'm your host, Dr. Carrie Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education,

  personal experiences, and a blend of tips you can apply to have a healthier pelvis.

  The goal of this show is to normalize conversations around pelvic health and help women stop suffering in silence.

  And today I want to get into the conversation about tailbone pain.

  Let's first talk about the simple definition of what is tailbone pain?

  So when you think about your, your, your spine, your skeletal system, you've got your vertebra, which most people know what that is.

  Below your vertebrae you've got a triangular shaped bone called your sacrum. And the sacrum attaches the left side to the right side through your hips. And then below the sacrum is a really small triangular shaped bone called your coccyx.

  Now, when you have pain at or around the coccyx, it's called coccydynia.

  And the,

  the layman's term for coccyx is tailbone.

  So,

  so tailbone pain and coccydynia mean the same thing, basically. So as long as we can get that out of the way.

  And what are some of the common symptoms with coccydynia or tailbone pain?

  One of them is pain at the, you know, it's like the very tip of your crack, your butt crack. Pain when you've been sitting for a long time,

  pain with transitional movements like going from standing to sitting or from sitting to standing.

  Also, some people have pain with intimacy and other people have pain with bowel movements. Now, we're going to get into why those symptoms are the way they are in a minute, but let's first talk about, why are we thinking about pelvic floor when we're thinking about coccydinia?

  Well, the interesting thing about the pelvic floor is most muscles attach to the coccyx. You've got multiple muscles in your pelvic floor. We've got a right side. Everything on the right side, you've got on the left side.

  And when you get into pelvic health, if you've ever gone to pelvic physical therapy, you'll know there are three layers of pelvic floor muscles.

  And the deepest layer is known as the levator ani muscles. And they do a lot. They help with support,

  stability,

  sexual function, they do a lot of things. But the interesting thing about those levator ani, or the layer three muscles is most of them,

  if not all of them, attach to the coccyx.

  So just like if you're thinking of another bone of our in our potty,

  if you broke your, your humerus, right, your upper arm bone,

  duh, of course we would think about your shoulder muscles because that bone is part of the shoulder joint and those shoulder muscles attach to that bone.

  So the same thing is true with the pelvic floor. Those pelvic floor muscles attach to the coccyx. Something else that's interesting is we have a left side and a right side.

  Both sides attach to the coccyx because the coccyx is right there in the middle.

  Now, those muscles, when they work, they contract and they generate force. So if we think about your bicep muscle, these muscles are not shaped like the bicep. But most people know where the bicep is located and what it does.

  Most people know that the bicep bends your elbow.

  So if you're activating your bicep, you're going to get some activity. Those, those bones are going to move. That joint is going to move.

  Same thing is true with the coccyx. When those pelvic floor muscles activate,

  they generate force and they can move or have input or impact on the coccyx bone.

  So the two go hand in hand.

  If your pelvic floor muscles have increased tension, that can put increased tension on that coccyx bone. If the pelvic floor is overactive, it can put increased tension on that coccyx bone.

  If that pelvic floor is turning off and on when it's not supposed to, it's not coordinated like it's supposed to,

  it can have an impact on that coccyx bone. And then since the pelvic floor also,

  it does a good job with generating stability in our lower hip area.

  If those pelvic floor muscles, let's say they're a little weak, that could have an impact on the stability of the coccyx. The coccyx is not a fixed joint. It does kind of move in and out.

  I like to think of it kind of like a doggie door. When a doggie door, when a dog goes through the doggie door, it flips one way or the other.

  And that's kind of the same type motion, that flipping motion that the co does.

  So like I said, there are three layers of the pelvic floor muscle. And I was really Specific, that layer three attaches directly to the coccyx. Layer one does by connective tissue with the external **** sphincter.

  But layer two, it doesn't. And the anterior portions of layer one doesn't. You can have those similar pelvic floor dysfunctions in layer one and layer two,

  and they can still refer to the coccyx region because it's a very small area.

  They share some of the same nerves. Nerves. And they share a lot of the same connective tissue. So just like sometimes you might sleep on your neck wrong. And you get maybe some shoulder pain, some upper back pain, that pain is referring.

  The same thing can happen with the pelvic floor.

  Now, this tailbone or coccyx pain, a lot of times with people, it can become chronic.

  It can become chronic. If those muscles that are working on that coccyx, they are not working the way that we want them to, they're not as efficient with their activity.

  Those muscles can start guarding. So they're kind of tensing up without us realizing it. Sometimes we can develop muscle spasms in those pelvic floor muscles.

  And sometimes those pelvic floor muscles can actually have like a protective response. If you're anticipating something, those muscles can tighten up. And if they tighten up for a long period of time, that can translate into increased tension on the coccyx, which can result in coccyx pain or coccydenia.

  Another way that people can have coccyx pain is if they sit for a long time and their sitting posture is not correct. So if they're really slumped and they're putting all this pressure on the coccyx.

  The coccyx is not designed to be a weight bearing structure like some of our other bigger bones. But if you're bearing a lot of weight, I think about people that are in a slouch position for hours, just with poor body mechanics,

  or let's say they're gamers and they're sitting in those really soft, cushy chairs and they're really rolling their lower back and they're putting all that pressure in their lower spine and into the coccyx, that can create pain, chronic pain.

  Of course, our pelvic floor goes through all sorts of changes while women are pregnant and while they're going through labor and then postpartum. So that whole continuum of growing a baby, delivering a baby, and recovering from said birth of baby, whether it's a C section or a vaginal delivery,

  can have a major impact on the coccyx because those muscles have to stretch in order for the baby to come out and. Or those muscles, you know, they get shifted, things get switched around.

  They're. They're stretched for months and months and months,

  while not them, but the muscles that they work with are stretched for months and months and months as the baby is growing, which puts more pressure on the pelvic floor muscles.

  And then the pelvic floor muscles themselves have to stretch to allow a baby to come out. And if you have a C section, the coordination between the abs, the lower back, and the pelvic floor muscles can also be impacted because you've had an abrupt situation with cutting the woman open and taking the baby out.

  The last thing that can have an impact on the pelvic floor, or excuse me, on coccydynia, is if you have a body that's kind of. Your nervous system is kind of trapped in a protective mode.

  So when you're thinking about this, it's actually called central sensitization.

  It's when your nervous system, part of its job is to protect us. And when it gets caught in that protective mode, kind of in that fight or flight mode, then we can develop chronic pain in a variety of places in our body, really anywhere in our body.

  And one of those places can be in the pelvic floor and the coccyx.

  Let's say you're dealing with this and you're like, okay, I'm gonna go to a pelvic physical therapist. Or you wanna know, what is the pelvic physical therapist gonna do? Of course, the first thing we're gonna do is we're going to do a head to toe assessment, see how your body is moving.

  We're also gonna do a pretty in depth medical history because so much impacts that area. We're thinking spine, hips, low back. What affects the spine, the hips and the low back, the knees, the feet, the shoulders, the arm, the neck.

  All of that stuff needs to be addressed when you come to pelvic physical therapy.

  Also, we really want to see how that sacrococcygeal muscle or how that sacrococcygeal joint is moving.

  We can do this externally or we can do this internally, but we want to be able to see how is that joint moving?

  Is it leaning to one side? Is one side overactive more than the other?

  Is the mobility increased more than it should be? Is the mobility decreased and a little bit stiffer than it should be? All of those things make a difference. And of course, we want to do a pelvic floor muscle examination.

  So we're going to look at how the muscle is working,

  how much force that those muscles are providing. Are they turning on and off like they're supposed to? Are they working with their friends, the abdominals and the back muscles, like they're supposed to to.

  And the diaphragm also is a very key factor in pelvic floor function. So we're going to want to look at all of that and then we're going to. How we do that is we look at your postures, your range of motion, your balance,

  weight shifting. We also spend a lot of time looking at your breathing, your diaphragm, your rib mobility. All of that stuff matters.

  Then we put all of that together,

  put with your goals,

  and we create your plan.

  Now, once we create your plan,

  what can your plan entail? Well, this is where it gets very personalized and every person is different.

  But a variety of things, the kind of going with what I just mentioned about your nervous system, if your nervous system is really overactive, then we might do.

  When the nervous system is overactive, we call that an upregulated nervous system. So sometimes the treatment is going to be different down regulating the nervous system so it's not so overactive.

  If the joint doesn't have enough mobility, then we're going to do a lot of things to help increase that range of motion. If the muscles are too are overworking, we're going to help the muscles calm down.

  If the muscles are discordinated, we're going to help them coordinate with their friends. If the muscles aren't strong enough, aren't generating enough power, then we're going to do some strengthening exercises.

  And all of this facilitatory stuff could be done with manual impact with us as a therapist using our hands and different spots of your body.

  Also, we can use other things like dry needling to impart some change. We can do stretches and strengthening exercises in homework and lifestyle changes. We might be talking about cushions and your sitting posture and how to rise and all of that stuff.

  So your pelvic floor physical therapy treatment plan. Plan could really encompass a lot of things, or it might only encompass one or two. But that's where you really need the physical therapy assessment.

  So then that way you can get the proper plan.

  Oh, I almost forgot. There is a component with some people where they have discomfort when they're having a bowel movement or when they are engaging in intercourse. So we're going to want to do some troubleshooting, maybe some treatments to help with that.

  Lots of education around those lifestyle changes so that way we can optimize that pelvic floor function so we can help reduce that tailbone pain.

  When should you seek out help? Of course I'm biased, so I'm going to say definitely check out a pelvic physical therapist. The it's going to be a low. It's low risk.

  We aren't going to be dealing with medications.

  The biggest side effect that you deal with both pelvic physical therapies is you might deal with a little bit of soreness, but you know, that's normal whenever you're doing a new physical activity.

  So. So I'm always a proponent of pelvic physical therapy. Also. We're not just looking at you as far as your ****** or as far as your coccyx. We're looking at the whole picture.

  We're taking a full body approach. And so I just,

  I just think you should definitely try out pelvic physical therapy if you wanna look at. For a professional. But to answer the question, when should you look for a professional?

  If this is hanging on more than a couple of weeks, just like anything else, you wanna seek medical attention or you wanna seek attention from a healthcare professional.

  So if you sit a lot for work or for leisure, and you're noticing tailbone pain that you just can't shake, or you're noticing this tailbone pain after you've given birth to your baby or even during pregnancy, or if you're noticing this tailbone pain while you're being intimate with your partner or while you're having bowel movements,

  then that's when you want to say, okay,

  this is not just a little fluke. It's been more than a couple of weeks. It's not going away on its own,

  then that's when you definitely want to seek out help.

  So if you or someone you know is dealing with pelv,

  look at if you or someone you know is dealing with tailbone pain. First of all, it's probably more common than you realize. People just probably are not talking about it.

  Number two, there are professionals out there to help you.

  Number three,

  the that part of the body responds very well to conservative treatment, I. E. Pelvic physical therapy.

  And so I just say, you know, if you think that you need it or someone you know would need it, you know, don't hesitate because you probably could potentially be sucking it up and dealing with it for a time, that that's unnecessary.

  So I hope this conversation was helpful. I hope you can see if you have tailbone pain. Yes, the bone is involved, but muscles are involved a lot, your nervous system is involved a whole lot, and the rest of your body is involved a lot.

  So I hope this was helpful.

  Come back next week where I'll be in your earbuds with another episode. Episode thank you for listening to this episode of the Maroon Pelvic Health Podcast.

  Please do me a favor and leave a review so that more people can find this content.

  And make sure you like and subscribe yourself so you never miss another episode.

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