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.
4. Follow our pregnancy stretching video. Found on our IGTV and website at https://hertsosteopathy.co.uk/pregnancy-and-pgp as the muscles and mobilisations in this are also super helpful for this type of pain.
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 PGdip in Women’s Health Osteopathy
Principal Osteopath, Women’s Health Specialist, Pregnancy and Postnatal care and rehab/clinical pilates practitioner.
Herts Osteopathy, St. Albans, Hertfordshire.
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