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I'm not aware of any major muscles that attach to it, so movement shouldn't be an issue.

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Au contraire.

There are several ligments and muscles of the pelvic floor which attach to the coccyx (or "tailbone"). These include:

- ventral sacrococcygeal ligaments
(two sheet-like structures that form part of the hammock-like pelvic floor, constituents of the pelvic diaphragm which provide support for the rectum)

- coccygeus muscle; aka the levator ani and the piriformis
(supports the dorsal organs of the pelvic floor so that they don't extrude downward during forced bowel movements or sneezes)

- sacrotuberous and sacrospinous ligaments
(alignment of lower vertebrae and dorsal support for the gluteus maximus muscle)

- the tendon of the sphincter ani externus
- the anococcygeal raphe
(maintains continence)

I'm sure there is surgery available to help correct pelvic floor problems if one were to lose one's coccyx, but I'm betting that resetting it would be less involved. The problem is that the coccyx is both a site of attachment for many muscles and ligaments that get tugged while supporting the pelvic floor through day to day activities and can't really be splinted because of its position.

So, healing after a coccyx break is long and painful. I sympathize, beverly -- I bounced down 3 iced wooden stairs directly on my coccyx one Urbana winter and snapped it, and it was agonizing. So much pain I couldn't even cry out. Took years to get back to a normallish state.

Maybe your physician (GP or esp a gynecologist, I'd think) could give advice about whether physical therapy might be helpful.

[ December 17, 2004, 06:05 AM: Message edited by: Sara Sasse ]

Posts: 2919 | Registered: Aug 2004  |  IP: Logged | 

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From a few surgeons (?probably) who have written in, mostly from Europe, as far as I can tell):

"As a consultant treating coccydynia regularly I have read your site with interest. Few doctors seem to recognise the altered mechanics of the sacro-coccygeal joint or coccyx joints when sitting compared with standing. Conservative treatment should be multi-disciplinary. I use a combination of oral NSAIDs, regular ice packs, pelvic ligament stretching exercises, manipulation of sacro-iliac joint and coccyx, back school training and a special wedge shaped cushion for sitting on. The treatment does not work for all, but the majority demonstrate improvement with the cushion alone. The course of the condition is usually chronic and recovery slow. Injection therapy should be reserved for those who have been through a conservative course of treatment lasting 3-6 months or for those in acute pain.

Another:

During my orthopaedic training, I was told never to excise the coccyx as it seldom cured the patient; most of them were female and neurotic anyway. I saw at least one patient who had had pieces excised on 2 separate occasions and still not cured, and was in fact worse. This tended to reinforce my teachers' point of view.

Then I did 1 or 2 operations myself (because patients begged me to do something) and the patients were some of the most grateful I have ever treated. I have now done around 14. Most but not all have been female. I must admit 1 or 2 of them still seem a bit flaky. But all got some help from the procedure. None would say they were made worse.

It seems careful selection and counselling are the keys to a good result. You must avoid surgery in a patient with a complex medical history. I do usually advise steroid injection as a first measure. This can be done in outpatients but is not very pleasant! Can also be done under anaesthesia which gives an opportunity for a good manipulation. Injection works best if the symptoms have not been present for too long ([less than]3 months). Less reliable if a long standing problem. The operation is NOT particularly difficult but experience does reduce the collateral damage to soft tissues and adjacent nerves. My patients seemed to recover in weeks rather than months.

And another:

Treatment. For me, the first treatment is an anti-inflammatory injection (steroid) in the affected joint, as demonstrated by the dynamic films. This can only be done under fluoroscopic control. The result occurs within one week and provides a two to four month relief in 60 to 70% of the patients and full recovery (at one year) in 30%. Despite there is a theoretical risk of local infection, I have performed more than 500 injections in 8 years without any problem. In 10% of the cases, there is a marked post-injection pain for a couple of days.

We have completed a study (not published yet) comparing three manual treatments (manipulation, massage of the pelvic muscles and stretching of these muscles) with a placebo. These treatments work in only 20% of the cases and are actually more efficacious than the placebo.

The last specific treatment is surgery. We have also a study (submitted for publication) on this topic. Our success rate is 93% of good and excellent results, provided only patients with luxation or frank hypermobility are operated on. In other cases, the results are not so good. This is a very demanding surgery. It may take three to ten months for recovery.

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Posts: 2919 | Registered: Aug 2004  |  IP: Logged |