PAINFUL SITTING: A PAIN IN THE BUTT

Dr. Nicole Freitas, PT

Sitting is one of the most important and frequently performed daily activities. Whether it be sitting at work on the computer, driving to and from home to the grocery store, sitting on a bleacher watching your child’s sporting event, or enjoying your favorite television show on the couch, coccyx pain is a frustrating condition that can lead to chronic pelvic pain and additional neuromuscular dysfunctions.

Suffering from pelvic pain when sitting is common, however many individuals and healthcare providers do not mention it, leaving those suffering feeling alone, embarrassed and with no way out. Often, physical therapists that are not specialized to treat the pelvis disregard the coccyx (tailbone) as a possible pain generator, simply because they are fearful of assessing it, have no idea where it is, or have never learned about it being a pain generator in their education.

Although a very small bone, the coccyx can contribute to very large amounts of pain. Many muscles and ligaments attach to the coccyx, making this anatomical structure of great interest to pelvic physical therapists. To better gauge the importance of the coccyx, here are some muscles that share this small bone as an attachment site:

• Anteriorly: the levator ani muscles and sacrococcygeal ligament
• Laterally: the coccygeal and gluteus maximus muscles, sacrospinous and sacrotuberous ligaments
• Inferiorly: the iliococcygeus muscle

You might be wondering what causes coccyx pain. Most commonly trauma to the tailbone, such as a fall, childbirth, deliveries with use of forceps or a vacuum assisted delivery can all contribute to impairments. Some non traumatic causes that can leave one suffering from painful sitting is rapid weight loss (in which the coccyx loses its cushioning in sitting), infections, and pelvic floor muscle dysfunction.

Pelvic physical therapy is a conservative treatment route one can take to improve their pain with sitting. Some treatment approaches pelvic PTs commonly take for individuals suffering from coccyx pain are:

• Assessing sitting posture- the coccyx is a weight bearing bone when in sitting, however one’s posture can be impaired and causing more aggravation/ stress to the area. Addressing one’s posture and perhaps even prescribing a seated cushion to unweight the aggravated bone can work wonders for those with pain during sitting
• Manual manipulation/ mobilization of the coccyx bone and its surrounding structures- as stated above, the coccyx is an important anatomical structure with many of muscle and ligament attachments. At times the coccyx causes pain because it is not aligned or moving properly. Pelvic PTs have many ways to help get that bone moving the way it should, increase blood flow to that painful area and allowing for further recovery. Not only can a pelvic PT perform this on you, but we have plenty of ways to teach you how to perform it on yourself to be performed as necessary for pain relief.
• Taping- just like taping an ankle injury, the coccyx and surrounding structures can be taped in order to reduce stress, and aide in removal of inflammation and swelling as the area heals. The tape pelvic physical therapists use is comfortable, not noticeable through clothing, and lasts for several days to weeks, while allowing the area to recover.
• Soft tissue mobilization- not only is the coccyx affected when one is suffering from painful sitting, but the pelvic floor muscles surrounding the coccyx become aggravated, as they are trying to muscle guard around a pain provoking area. Pelvic physical therapists are specialized to assess the pelvic floor musculature and provide treatment to target the aggravated pelvic muscles, bring blood flow to the area, and send signals to your nervous system that these muscles should not be pain provoking.
• Relaxation techniques- for both the pelvic muscles and your entire nervous system. When experiencing chronic pain, not only are the muscles that are injured altered, but the nervous system responds differently to movement/positions that were once not perceived as painful. By approaching the musculature impairments while addressing the nervous system’s impairments, we are able to get you back to doing the things you love without worrying about discomfort!

Want to try to relax your pelvic floor muscles right now? Try to perform a Reverse Kegel which is the opposite of a pelvic floor muscle contraction (Reverse Kegel). Here’s how to perform a Reverse Kegel:

• Lay down in a comfortable position.
• Inhale through your nose allowing your abdomen to rise and your diaphragm and pelvic floor to expand. Think of your pelvic floor muscles lengthening and widening with each inhalation. Imagine a flower blossoming or an umbrella opening.
• Breathe out through your mouth and allow the pelvic floor to return to resting state.
• Practice this exercise 3 times per day for 3 to 4 minutes at a time.
• Avoid pushing with this motion!

• Strengthening- as mentioned above, coccyx pain can be caused by rapid weight loss, in which cushioning surrounding that weight bearing bone in sitting is decreased. Not only is it crucial to strengthen the pelvic floor muscles, but the surrounding hip muscles need to be strengthened in order to allow for less stressors on the tailbone and allowing for your body to heal optimally.

If you are hesitant about beginning pelvic physical therapy to address your painful sitting, the PTs here at Inner Dynamics Physical Therapy want to remind you that conservative treatment is successful in about 90% of cases for those experiencing painful sitting.