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.
How do you heal the body with nutrition after having a baby?
Guest blog written by Michele Kingston from TNM Clinic, St. Albans.
Hello, I am Michele Kingston, I am a registered nutritional therapist and functional medicine practitioner. Nutritional and functional medicine addresses the root cause of health problems and uses natural therapies such as diet, supplements and lifestyle to support the body back to optimum health and wellness.
I have been practising for 11yrs, both in private practice and on staff at an environmental medicine clinic working alongside doctors and other clinicians. I have worked with both adults and children, from all around the world with a variety of different illnesses and needs, such as IBS, hormonal imbalance, weight issues, skin problems, autoimmune disease, fatigue, depression and more.
I also work with clients who want to prevent health problems, or wish to switch to a vegan diet or need support whilst pregnant and post-natally. I have consistently seen amazing results and I am living proof that nutritional medicine can have a powerful impact on health. It’s something I am so passionate about.
So you’ve just given birth?
I often get women asking… What should I eat?
After giving birth we need to nourish our bodies. They have done a magical, miraculous thing and are often left rather nutrient depleted and exhausted from their efforts.
Especially in the first 3 months postnatally, also known as the 4th trimester, this is not the time to worry about losing weight and dieting, but helping the body heal and nourishing yourself back to full health.
Specific needs the body has in the 4th trimester that can be accomplished with a nutritious diet:
Extra requirement for nutrients
After pregnancy you can be deficient in some nutrients, micro-nutrients like vitamins and minerals and macro-nutrients like carbs, protein and fat, because of a few reasons:
During pregnancy you were literally building a human being from scratch and it is built from the nutrients you provide, the baby gets priority and uses your stores and what comes in through the diet and supplements.
Labour and 4th trimester are mentally and physically exhausting and this drains nutrients.
Healing requires extra nutrients, all pregnancies and labour will require some level of tissue healing. So, the diet needs to provide the constituent parts of collagen, muscle and skin, which are essentially protein, fats and micronutrients.
If you are breastfeeding, nutrients are prioritised to make good quality milk so you have an even higher need.
Inflammation is a necessary response that occurs naturally during pregnancy and labour. Inflammation can also occur in the 4th trimester due to lack of sleep and stress experienced at this time and we need to help the immune system bring this inflammation back under control to be able to heal. So we don’t want our diet and lifestyle to exacerbate inflammation, but rather heal the damage that inflammation can inflict and allow it to naturally reduce.
Post-natally you are in the midst of a symphony of hormones, your body is creating and reacting to an abundance of oestrogen, oxytocin, prolactin, prostaglandins, insulin, adrenaline and cortisol. Good nutrition is required so you can:
make these hormones, many of them are made from cholesterol and essential fats
detoxify and eliminate the hormones once they are used, otherwise they can accumulate and cause issues
keep blood sugar balanced so as not to cause cortisol and insulin spikes.
What is optimal nutrition in the 4th Trimester?
Keep things simple, there is no pressure for a perfect diet just do your best and try to do as much of the below as you can manage and think about what you should be including rather than excluding.
3 balanced meals per day, which are 50% vegetables, 25% protein, 20% complex carbohydrates and 5% good fats from nuts, seeds, olives, oily fish and avocado. A meal balanced like this provides good amounts in the right ratios of the nutrients you need to balance blood sugar, keep you feeling full and satisfied and rebuild and heal tissues in the body.
At least 5 servings of veg and max 2 of fruit and try to eat a rainbow of different colours. Eating an abundance of veg and some fruit provides good amounts of vitamins and minerals, lots of fibre and calms inflammation.
Fresh, wholefoods rather than processed as much as possible
Careful with the sugar and refined white carbohydrates as these have zero nutrients, increase inflammation and actually increase fatigue.
Try to include the specific foods mentioned below that are rich sources of nutrients
Eating like this provides 5 key things your body needs to heal:
1. Vitamins (really you will need all vitamins and minerals), but those to really focus on are:
Vitamin C is excellent for healing and rebuilding collagen, aiding iron absorption, antioxidant protection and supporting immunity. Foods rich in vitamin C are peppers, herbs especially chives, parsley and coriander, kale, broccoli, kiwi, strawberries and oranges.
Vitamin D is important for bone development so especially important if you are breast feeding to have good levels to pass on to baby, supporting immunity and alleviating inflammation. Vitamin D production is stimulated by sunlight on the skin so the best way to get this is being in the sun without spf. It is also a nutrient that often needs to be supplemented to get optimal levels. There is a small amount in some foods like fish, mushrooms and fortified foods.
Vitamin E is great for healing, antioxidant protection and reducing inflammation. Foods rich in vitamin E are nuts, seeds, avocado and olive oil
Zinc is essential for healing, antioxidant protection, thyroid and hormonal health. Foods rich in zinc are seafood, meat, nuts, lentils, soya beans and oats.
Magnesium is used up when you are stressed. It is required to relax muscles, required to make energy and aids sleep. Foods rich in magnesium are cocoa (craving chocolate can be due to low magnesium), dark green leafy vegetables, nuts and seeds.
Selenium is necessary for healing and hormonal balance. Foods rich in selenium are brazil nuts ( 1 contains enough for whole daily intake), fish and seafood.
Iron is crucial, especially if you suffered with blood loss. It is needed for energy and detoxification. Haem iron is found in red meat and non-haem iron is particularly found in dark green leafy vegetables and apricots.
3. Protein is absolutely essential for healing, it provides the building blocks for collagen and tissues like skin and muscle. Quality complete proteins are only found in animal products like meat, fish, eggs and dairy. You can get protein from vegetable proteins like beans, chickpeas, lentils, grains, nuts and seeds, but they are incomplete and therefore lower quality. If these are your only source of protein ensure you combine them adequately and eat them in abundance.
4. Fats are key for healing and dampening inflammation, aim to consume each day several tablespoons of anti-inflammatory fats like olive, flax, avocado, hemp, walnut, sesame oil and omega 3s from oily fish. Do not be scared to eat fat, remember fat doesn’t make you fat, it heals and builds the body. Did you know that baby brain is caused by the body taking fat from your brain to give to the baby? So it is crucial we replace that lost fat as soon as we can post-natally. Also, if we don’t eat fat we can’t absorb fat soluble vitamins like Vitamin A and E.
5. Healthy calories in abundance, are needed right now to provide the energy for healing and coping with the stress and busyness of your new normal. Weight loss is not the objective right now and so please don’t restrict calories. Something low calorie doesn’t necessarily mean it is healthy, likewise something high calorie doesn’t mean it is unhealthy. Focusing on eating 3 balanced meals that are high in veg, low in sugar and minimally processed will naturally provide the right amount of calories you need. Please note that if you are breastfeeding and/or finding you are getting extra hungry add in some snacks and/or increase portions at mealtimes.
So there you have it, some of my key nutrition tips to help you to heal and nourish your body back to optimal health after having a baby. I really hope this has been useful.
If you would like to know more on this subject or perhaps you have a health issue you would like some help with, do get in touch, I would be delighted to help you. I offer a 15min complimentary discovery call so you can ask me any questions you may have before you book. Consultations are currently over zoom and the initial consultation is 60-90 minutes.
After the consultation I create for you a bespoke nutrition, supplement and lifestyle programme. The first consultation plus the programme is £130 and follow ups are £65. I look forward to hearing from you and nourishing you back to health. Thank you for reading, Michele.
OK so we all know that working from home can really take a toll on your body. With increasing amounts of neck, shoulder pain, headaches and jaw ache coming in to the clinic… I have been asked by many patients WHAT CHAIR DO I BUY????
So in terms of chairs, it’s actually really important to think about the chair’s relationship to the desk. And getting a desk set up where you can just as easily stand as you can sit is probably THE most important thing. So if you’ve done this, then ideally you will only be sitting for 30 minute periods before moving around and going to a standing position. Sometimes it is just about moving more than anything else, but getting the right chair can help too.
I think seats where you have the ability to sit upright with your back supported, bottom right back in the seat, sitting evenly on both sitting bones so you don’t have to lean forwards and away from the back of the chair are the best ones you can find. So if the chair’s back slopes backwards then this really doesn’t help. Use a pillow to help support you if needed.
The seat needs to be able to come right in and under the table. So that your wrists and arms can rest, rather than having to over stretch or reach. Particularly with the mouse hand. That is vital. If you are too far away, your head neck and shoulders are in a compromised position, and this then causes compression of your ribs and diaphragm, and abdominal cavity, particularly when working for long periods of time without a break. There is a significant relationship between sitting for long periods and abdominal cramps, congestion, pelvic pain and constipation, and from this picture you can really see why.
If you have arm rests that can then be moved so you can get closer to the desk this is really beneficial. Being able to be square on to the computer or desk is also important, if you are always rotating one way then this will aggravate rib, shoulder, neck issues.
Then every 30 minutes do a check in on yourself.. Ears over shoulders, chest lifted, torso long rather than folded forwards. Almost like a chin tuck.
If you are standing, you can even add some squats in there. Set an alarm and do 10 squats every 30 minutes. Your legs, pelvis, hips, and entire body will love you for it. Even if you set yourself an alarm and change posture or position every 30 minutes, this can make a significant difference to you and your body. Making sure you can breathe a full deep breath, and not be in pain. Standing rather than sitting can positively influence your metabolic state, and use more muscles, burn over 120 extra calories, and keep your pelvis, spine and hips more open. You can breathe better, and have a happier gut too. 😊 Your stomach, and bowels are able to move more fluidly, and are not stuck in a compressed position for so long. Constipation can be a severe issue with sitting down for prolonged periods. Our immune system is found in our gut, so we need the whole of the abdomen to be happy, and not compromised.
No posture is necessarily a bad posture, unless you are there for too long! Allowing the fascia and muscles, ligaments and joints to change positions means that fatigue never gets a chance to set in, and our bodies are happier, more fluid, and less negative impact on our bowels, gynae, abdomen, heart and lungs, spine and pelvic floor. So keep moving 😊😊
If you want more individual advice, or a hands on treatment to help get your body more able to adapt to a more comfortable posture, then book in to see us. Sometimes we have restrictions in our neck, ribs, spine, hips, and pelvis, or anywhere else through the chain which can impede your body from being able to sit or even stand in a more comfortable balanced position whilst you work. If you are still in pain, or finding some of these positions difficult to get into, then you may well benefit from a full osteopathy assessment and hands on treatment. We are here to help.
You can book online to see one of our osteopaths, or email us on firstname.lastname@example.org
So there’s a huge load of info out there on calories and the obesity epidemic. More recently the research has been looking at how obesity might actually be an infectious disease rather than a lifestyle based disease.
For years we have had the base idea that our weight is solely a product of calories in vs calories out. But we now have so much more understanding that this is not truly the case, and there are far greater mechanisms at play, pretty much all of which reside in our beautiful and super intelligent guts!
It’s all about the microbiota!!
So, we each have our own bacteria which live in different areas of our gut for very different reasons. We cannot survive without these amazing little beings. So worth reading “10% human”, it will give you the most wonderful insight into all things microbiota and guts. And we are only 10% human, everything else is bacteria living on us and in us!
The diversity of our microbiome is significant in all things immunity which we have known for years, but even more interestingly it plays a massive role in our metabolism.
So, when is a calorie not a calorie???
When we look into calories in food this is done on the assumption that fat gives us 9kcals per gram, and both protein and carbohydrates give us 4kcals per gram. But what researcher are finding increasingly is that how many calories we extract from that is very different and very individual, and may be completely determined by our bacteria.
The findings which started in mice, found that specific bacteria were more increasingly found in mice that were “obese”, and other bacteria found in more lean mice. The difference in the amount of calories taken in can be up to 2% which is HUGE over a month….year…lifetime…
So one person could take in 2% less calories per day than another, when both consuming the EXACT SAME AMOUNT of food. They soon realised that the calories written on packs of food were just a guide and that the differences were thought to be specifically determined by our guts and bacteria make up.
We all know that for the best microbiome we need DIVERSITY in our foods. Plant based, beautiful colours… All known to be what our body really wants to be consuming. Now we know this is true for metabolical health too!
Eat more donuts, your body then learns to extract more calories from donuts….
Yes it’s true!!!!!!
So the more of a certain food we eat, our body learns to adapt its bacteria accordingly, and therefore a donut/biscuit /chocolate every day… Your body alters the gut bacteria to be able to get every single iota of fat and calories out of that food, the Bacteria adapts accordingly. So people who regularly eat biscuits have been found to take on way more calories from eating those biscuits than someone who rarely eats biscuits.
So if you mostly don’t eat sweets, chocolate, cakes, then your body doesn’t have the bacteria to absorb all of the calories. Therefore a rare biscuit or donut, you probably will not take on all of the calories of this and they will end up in your stools.
So an occasional donut will barely touch the sides in terms of calorific consumption in someone who day to day eats well, but regular consumption, means you will reap the calories and likely store as fat in the process.
So we can change how we chemically and metabolically deal with food by feeding our body with the fab stuff, colours, raw, plant based where possible, and then your gut will love you for it. Improve the diversity of your microbiome and help improve your metabolic health alongside everything else!!