Coccyx pain is really common postnatally, after birth and sometimes for a long time after birth. Although this is not a normal part of the postnatal period, and you really don’t have to live with it. Often called coccydynia (which just means coccyx pain), this can present itself as pain on the tip of the tailbone as you sit down, or for prolonged sitting, and then many can experience it at its worst when getting back up from sitting. You will feel it differently depending on what is causing and driving your pain.
I have decided to write this blog, as I have had a number of women come to see us with coccyx pain, and not knowing why they had it, what they could do, or that osteopathy can help with this. It is not a normal part of the postnatal period, and can absolutely be helped. Below you will see I have given you some information about the condition and why you may get pain at your tailbone, but I have also included a COCCYX PAIN HELPSHEET, and also some information on postnatal osteopathy and what we do.
The coccyx is the anatomical name for your tailbone, and often there can be disruption to the sacrum too (just above the coccyx).
As you can see on this picture by the amazing @duvet_days, the coccyx is the end of your spine, and it connects to the rest of the pelvis through the sacrum and the sacroiliac joints. It is surrounded by ligaments and an overlying connective web called fascia. Your entire pelvic floor attaches to the coccyx in some way, so there are deep connections through the whole pelvis, which can be affected by movement and forces below, from the foot up, and then above, from the head down.
The coccyx can commonly be injured or disrupted during birth, this is far more common with labours where you are lying on your back, or in the semi-sit position particularly, labours that have been going on for a long time, prolonged pushing, or with epidural, episiotomy, forceps and ventousse deliveries.
During labour the lower back (lumbar spine), sacrum and coccyx have to move and tip to allow baby to engage and then come out. Therefore anything which prevents this from happening ie. lying on your back, can cause the coccyx and sacrum to get stuck in its position, and drag through the associated ligaments and soft tissues. This causes pain and dysfunction in this area.
Scar tissue as a result of episiotomy or pelvic floor and perineum damage and tears, can also cause coccyx pain. The altered load, strain or damage through the Pelvic Floor is a huge contributor to coccyx pain.
The pelvic floor attach from the pubis at the front to the sit bones and coccyx at the back, and therefore any disruption to this hammock of muscles, ligaments and fascia will cause an altered push or pull or strain to the coccyx. I often find imbalances through the pelvic floor are a big contributor to sacrum and coccyx pain.
If you had PGP (Pelvic Girdle Pain) during pregnancy which wasn’t addressed, then this can also feed into coccyx pain postnatally, because the compensation we do through the body which cause PGP, or that we do because of having PGP, can also cause altered load through the pelvis as a whole, and can significantly affect the healing process.
So what can be done? The answer is POSTNATAL OSTEOPATHY 💜💜💜💜
In your postnatal Osteopathy appointment, your Osteopath will spend time going through your medical history, birth and labour history, injuries and previous pain that you may have experienced in your life. All of this information helps to build a picture of what may be causing your issues and your pain, and what may be impeding your healing mechanism.
We will assess how you move, globally and locally. Globally for a full body picture: so we can see from head to toe what may be maintaining your pain for example how you walk, or move through your foot and hip…
And we will also assess locally, to see if your sacrum and coccyx move as you breath, or are they stuck? Is your tailbone pulled under or to one side? Are there muscles overworking, or in spasm?
This will affect the tension and strain pattern through the entire area. Are there areas of the coccyx that are particularly painful? We will rule out any more serious conditions, and then work on treating everything which may be impacting your pain, and your life!
There are often some simple things to help you day to day with management of this pain, alongside treatment to get to the root cause.
COCCYX PAIN HELPSHEET
1. Sit on frozen peas (5 minutes at a time is ample). By sitting on frozen peas it can help reduce local inflammation at the tip of the coccyx.
2. Avoid sitting on a donut/ring cushion as this will allow your pelvic floor to drop, and increased pressure to build up and push downwards. Instead, a wedge cushion which leaves a space for your coccyx only is more preferable.
3. Trying to sit more upright and even on both sitting bones. Most coccyx issues are exacerbated by slumping due to the pressure and inflammation at the sacrum and coccyx, and won’t help with the healing process. This is the same as sitting over on one buttock or hip rather than the other, as this will disrupt the healing mechanism too.
5. BREATHE!!! The diaphragm and ribs are directly related to the pelvic floor, so by focusing on sitting or standing upright (or lying flat on your back), focus your breath, deep into your ribs, feel them move outwards slowly as you inhale and slowly in as you exhale.
6. Avoid gripping or squeezing your pelvic floor muscles. This may be slightly controversial to some of you, but kegals, and pelvic floor squeezing and gripping, especially without the letting go and lengthening part of the process, will actually feed more pain into the area. So lie on your back, take a deep inhale, and feel your pelvic floor muscles relax, and drop to your feet. Feel if they feel even…?? Then as you exhale, slowly feel like you are lifting your pelvic floor up towards your sit bones again. The letting go part of this is so important, and will lead to longer lasting pelvic floor function, and less pain.
7. Avoid being constipated Talk to a nutritionist about ways to help you individually. Your osteopath can also use some lovely abdominal techniques to help with this too, and give you individualised advice. And when you go to the toilet, sit with your knees higher than your hips, to allow for an easier smoother passing of stools, and less straining.
I really hope this has all helped you, please feel free to share with your friends.
As osteopaths we can help you get to the root of your problem, working on scar tissue, pelvic and spinal mechanics, abdominal visceral and fascial release work, ribs, diaphragm, and direct work on your coccyx, pelvic muscles, to get you rebalanced, out of pain, and back to optimal healing. Then we can help you to start rebuilding, rehabbing and restoring postnatally.
We have a number of wonderful osteopaths here who have specialism in postnatal osteopathy, but also have many links with fantastic women’s health osteopaths across the country, so let us know if you would like a recommendation for someone to help you closer to home too.
Thank you so much for reading.
Jo Day BSc MOsT PGCE
Principal Osteopath, Women’s Health, Pregnancy and Postnatal specialist and rehab/clinical pilates practitioner.
“The quantitative analysis shows a statistically significant and clinically relevant improvement when the osteopathic intervention was compared to an untreated group. ”
YES WE CAN HELP!
I have found promising responses to osteopathy in women who have told me, usually in passing, that they have an increased urgency to go to the toilet, that they have had issues with leaking, irritable bladder, not able to empty a full bladder, and many more urinary symptoms besides. This often arises during pregnancy, postnatally or during the menopause, and often progressively worsens.
The nerves that supply the bladder primarily originate from the sacrum, the triangular bone right at the base of the spine, and so often there can be neurological issues related to the bladder and the muscle that controls it (the detrusor muscle). But also there can be mechanical reasons as to why there are issues. The pelvis may be misaligned, twisted, loading weight incorrectly, the lumbar spine may be compressed or restricted, the muscles and soft tissue around the pelvis could have been affected, and thereby preventing the viscera including the bladder, uterus and lower bowels, from being where they should be, with the freedom of motility that they need in order to function optimally.
Often there are pelvic floor issues associated with this, which the article also touches upon. Therefore a full appointment with us would assess the ability of the pelvic floor muscles to contract and work properly, along with the deep “core” abdominal muscles. Often if the pelvis is not mechanically functioning as it should, this can put different strains and stresses on the pelvic floor muscles, meaning we are not able to use them effectively. Bringing back the function and capabilities of the mechanics of the pelvis and associated soft tissue and muscles, can then allow the pelvic floor muscles to work properly.
At whatever stage in life, we can usually have a beneficial impact on bladder and pelvic floor health. One of my patients went from having to go to the toilet every hour day and night, to being able to sleep through the night without having to urinate more than once, this was in one session, so there are lots of ways we can try to help.
Increased urination, leaking, and inability to fully empty a bladder are not “normal” issues, and do need addressing. If we feel we cannot help, then we will always refer you to where we feel is needed.
Written by Jo Day, Principal Osteopath at Herts Osteopathy
When I was pregnant for the second time I really struggled with pelvic pain, lower back pain and sciatica from around the 36 week mark. It became acutely painful extremely quickly to the point where I couldn’t even put one foot in front of the other without being in agonising pain. I have HSD (hypermobility spectrum disorder), which means that my connective tissue is too lax, which causes me problems daily anyway, but I had always been able to keep this in check with the right weight training and exercise plan, and various other lifestyle changes. However, by 36 weeks with my second baby, my body just couldn’t cope with the excessive amounts of relaxin in my body as pregnancy progressed, and started to give up!! This coincided with the fact that my baby was engaged from 32 weeks, and pretty much stuck right down in the right side of my pelvis. Yup, I had become a waddler!! I don’t think things were helped by the fact that I had a preschooler who I was running around after, and carrying into her cot, and all the other stuff we do as mums on a daily basis. I also carried on working as an osteopath until 35 weeks, so had been on my feet quite a lot.
So here I am, at 36 weeks pregnant and in agony. I walk everywhere, I couldn’t put one foot in front of the other without pain, and I couldn’t even walk 100 metres downhill to where I was living, so needed to catch a bus. It really was THAT BAD. The pain was all consuming, and I just looked and felt grey, I just was not functioning.
I then booked myself in for regular osteopathy appointments along with acupuncture, every two to three days. I also had fascial release through my bump to allow for optimum foetal positioning, which helped to give baby more space, and untuck her from being so far down and on the right. This automatically had the most “lifting” effect, and no longer did I feel that she was stuck in there. After three weeks of intense osteopathy and acupuncture, alongside getting myself insoles for my trainers to help stabilise my ridiculously hypermobile feet I was fixed!! And seriously I went from being in more pain than childbirth, to being completely pain free, it was incredible, miraculous, and simply why I love osteopathy more than I can put into words!!
I went on to have THE MOST AMAZING birth, quick, easy, and in the water, she popped out on the first push, and seriously the quickest recovery ever. I put it all down to osteopathy.
I had always loved osteopathy, this was why I went into it in the first place. But after experiencing first hand the most significant change in my life over such a relatively short period in time, and allowing me to have the birth I wanted, I have truly found even more passion for osteopathy. I feel I am a better osteopath, with more empathy and compassion for my patients who walk in the room for the first time; grey with pain and not being able to function, not being able to sleep or work or hold their baby….. I feel their pain with them, I know how it gets in your head, and becomes all consuming. I then see them the next week, and they look like a different person, they can sleep better, they can work, play with their children…. This is why I love what I do. Osteopathy Rocks!!!! And osteopathy really does change lives.
It makes me so sad when I hear from patients that they have been told that they can’t be helped. Pregnant ladies on a daily basis are being told by midwives and doctors that they will have pain all the way through their pregnancy, and they may end up on crutches or even in a wheelchair. They are also told it will go away as soon as they give birth. Unfortunately, neither of these statements are true. Pain can be eased whilst pregnant, and in many cases can be entirely eradicated with osteopathy and the correct advice from your osteopath about how to move, stand, rest etc… But also, it is so important to know that lots of pelvic pain and SPD doesn’t miraculously go away after labour. Mechanical changes in the body and compensation for old injuries and issues, as well as systemic issues like hypermobility, can all affect your pelvis. A thorough postnatal osteopathy appointment to help ease your pelvis back into alignment, and to reduce any spinal restrictions that may be getting in the way, can massively help bodies to recover faster and more effectively post birth, and can allow your body to heal in the right way and in the right place.
Osteopathy in pregnancy Ribs and upper back release
Thankfully we have bundles of evidence to support the use of osteopathy throughout pregnancy and labour (take a look at some of the articles sited below):
“Pregnant women receiving osteopathic care reported experiencing physical and mental health benefits both during pregnancy and in the post-natal period”.
………..But we also have real life stories from mums every day telling us how osteopathy changed their life, and allowed them to enjoy their pregnancy, and have the birth they wanted. Here are some testimonials taken from our Facebook page:
“I started [osteopathy] after suffering with SPD in my second pregnancy. I could hardly walk and was in tears but she has changed everything around for me. I was dreading birth but am excited for it again as I am pain free”.
“I suffered badly with SPD during my first pregnancy so when the pain started again at 14 weeks during my second pregnancy, I braced myself for a miserable time……. During the first session [she] had identified the root cause of the problem (hypermobility), something no other physio or osteopath had done…..I felt the benefits of her treatment within 48 hours. I continued…throughout my third trimester and was genuinely amazed and so grateful to make labour mobile and practically pain free”.
Cranial osteopathy has been used for years by parents of newborns and toddlers for a whole variety of different reasons. Although we do not have a lot of evidence to support the mechanisms in play as we do with more structural osteopathy, the internet is flooded with stories from parents detailing how it has worked for them. Here at Herts Osteopathy we have had lots of positive feedback from mums, and I myself have used it for my children at various stages of their lives with positive outcomes.
“Sarah Ockwell-Smith, Director of BabyCalm Ltd, deals with stressed and over-tired parents on a daily basis, and has no qualms with recommending cranial osteopathy as an effective treatment…..Make no mistake, cranial osteopathy is not the miracle cure for restless babies: but it can help correct the aches and pains that newborns and young ones might struggle to tell you about, which cause them discomfort in the middle of the night. Sarah often hears positive feedback from people like Karen, who are enjoying a better night’s sleep”.
Cranial Osteopathy is a very gentle form of osteopathic treatment. Cranial osteopaths are trained to feel subtle movements present in the body called ‘involuntary motion’. The skull, made up of 26 small interlocking bones, changes shape slightly to allow for the involuntary movement to occur. These movements may be restricted if stresses and strains are present. The osteopath uses very light manipulative pressure to release them with a view to help restore the natural equilibrium.
Cranial osteopathy can be used by people of all ages but as it is so gentle it is very suitable for treating babies and children. During the birth process the soft bones in the baby’s skull overlap to make the head smaller. Some babies are born with less spherical shaped heads but this is usually undone through the processes of feeding, crying and yawning. If it is retained this is thought to lead to problems such as crying, feeding difficulties, sickness, colic and sleep disturbances. As the child grows it can lead to ear infections, sinus problems, headaches and behavioural problems. Cranial osteopathy can help by reducing the tensions in the body and relieving pressures on the nerves. Some patients may feel sleepy after the treatment others have a burst of energy often followed by a good night’s sleep.
In my own experience as a parent, I have used cranial osteopathy for a variety of reasons with positive outcomes, these have included: teething, bumps to the head, excessive crying, and congestion to name but a few.
Cranial Osteopathy – Babies
Here is a paper which provides some evidence to support cranial osteopathy: ‘
This study reported a “progressive, highly significant reduction between weeks 1 and 4 in crying…in treated infants; similarly, there was a significant improvement in time spent sleeping. Overall decline in crying was 63% and 23%, respectively, for treated and controls; improvement in sleeping was 11% and 2%. In conclusion, this preliminary study suggests that cranial osteopathic treatment can benefit infants with colic; a larger, double-blind study is warranted”.
So if you feel that you would like to try cranial osteopathy for yourself then please give us a call, you never know, it may just make a difference to your life.
We treat ladies at every stage of their pregnancy with lots of wonderful success stories.
“During our first session Jo identified the root cause of the problem…. something no other physio or osteo had done….. I felt the benefits of her treatment within 24 hrs! I continued to see Jo throughout my third trimester and was genuinely amazed and so grateful to make it to labour mobile and practically pain free.”
“Whilst pregnant I developed severe SPD and girdle pain to the extent I could hardly walk… Jo used her vast experience and skills to rid me of all pain during pregnancy and enable me to have the type of birth I wished for.”
Osteopathy in pregnancy looks at addressing the cause of the pain. Of course hormones have an influence, but a lot of the pain experienced is mechanical in nature. Often old injuries come to the fore during pregnancy; where we have been compensating for an old injury or a postural/biomechanical issue, we are on a very line of homeostasis (balance through our bodies). So pregnancy can be the “straw that broke the camel’s back”, and old issues have a high prevalence of reoccurrence when our regular compensatory mechanisms break down.
We look globally at how the body is moving and adapting to the pregnancy, then look more locally at the tissues causing pain. Often this is myofascial (muscles and soft tissue/ligaments/tendons/fascia), so some gentle release of these tissues to reduce inflammation and tension, as well as realigning the pelvis, and aiding the body to find a more neutral and comfortable way of moving and carrying baby works a treat.
We give advice on postural changes, sleeping position, work set up, footwear, exercises, breathing mechanics and stretches to enable you to continue without pain after treatment. All in all a holistic approach to bringing you out of pain so you can enjoy your pregnancy, and hopefully more chance of the birth you want!
Headaches are also common during pregnancy, again these tend to be more mechanical in nature due to the changes in upper body posture as pregnancy continues. Osteopathy can treat these mechanical issues so you can get rid of headaches without any need for medication.
Here is a fab table illustrating some of the proven benefits of osteopathic treatment during pregnancy:
Osteopathy has been proven to have many benefits during pregnancy, as well as improved quality of life and levels of pain, there is also research to support that it can reduce time in labour by almost half, reduce chances of intervention, and also reduce risk of meconium in the waters.
*Symphysis Pubis Dysfunction, and *Pelvic Girdle Pain.
With pregnancy comes numerous mechanical and hormonal changes which significantly influence the pelvis and lower back (and the rest of the body!!). For many these changes can cause debilitating pain. Unfortunately many health professionals, and many women are under the assumption that they have to deal with the pain, and that it is a “normal” part of pregnancy, they are told that SPD and PGP are untreatable.
Above shows the two main areas of pain experienced by women with either of these issues. These seem to be the most problematic during pregnancy and postnatally as they are rich in ligaments. With the hormonal changes of pregnancy, ligaments become more lax (elastic), and therefore do not support the joints as needed. The pelvis will shift out of alignment, which causes all the associated structures to have to work harder than normal, in the wrong position, causing strain, inflammation and pain.
Any changes of gait will influence the amount of load through these joints. So this can be as simple as a change in shoes, but more significantly, the mechanical changes of pregnancy can place more pressure through these areas, which are already vulnerable due to the ligament laxity.
Osteopathy and its effectiveness of treating these conditions has been well documented. This article in the Guardian describes the torturous pain of SPD as her “body felt as if it were splitting in two”. She also explained that many failed “to take SPD symptoms seriously”, which is the exact feeling I have had from most of my patients. She felt “let down by conventional medicine because it spun … the line that SPD was untreatable”, this echos exactly what I have been told by my patients, so ladies lose all control in the management of their pain. She found the only treatment to work was osteopathy. Here is the link.
Osteopathy works wonders for these conditions. We take a thorough medical history, this will determine any preexisting conditions or old injuries which may predispose you to these issues in the first place. Mostly we find that old injuries tend to resurface in pregnancy. We compensate for old injuries and pain for years, and quite often these mechanisms break down in pregnancy. Quite often we see ladies years after they have had their children, still experiencing the same pain as they did in pregnancy, but it may have affected other areas of the body due to being out of alignment for so long, and having compensated for that. We commonly see neck and shoulder pain, jaw pain, lower back and knee pain emanating from pelvic misalignment.
A thorough biomechanical assessment will show us exactly how you move, and why the pelvis has shifted out of alignment in the first place. I will tend to follow a three pronged approach in treatment. I will address the overall issues which have caused the pelvis issues/misalignment in the first place, I will go locally to the structures at the pelvis which are causing the pain (mostly these are soft tissue/muscular structures that have become inflamed or in spasm due to overworking, or being slightly in the wrong place), and then I will look at long term solutions to prevent the pain coming back. This approach seems to work really well in getting back to being pain free more quickly and for longer. I have also produced an SPD HELPSHEET which gives longer term management and advice for SPD and associated conditions.
Take a look at our testimonials page to see how we have helped numerous mums with this condition to become pain free. There are lots of different techniques that can be used in pregnancy, and after, to help. Do email us if you have any questions about how we can help.