Pain on direct coccyx area pressure: coccydynia or nerves? What to do?

[physiobob]

HI Frankie, thanks for your post.

Reading between the lines your issue seems like hypersensitivity to the coccyx region. i.e. nothing wrong with the coccyx itself nor the joint between it and the pelvic bones. I would say it is mostly caused by prolonged sitting on a hard or narrow surface, perhaps in combination with generalised, age related, degenerative joint changes. My wife for example suffered from this for over a year simple due to sitting on the same saddle chair for several years that fixed her lumbar position for hours on end. Eventually connective tissue became 'annoyed' and sensitivity arose.

The important thing to take on board here is that episodes insidious onset coccygeal pains are a long time in the making (much like many many shoulder impingement issues) and they only become painful at the end. So reversing it also takes a loooong time. And you and your therapist need to look for the source of the provocation, likely to be a chair or perhaps a car seat if you drive a lot. If your chair has a tilting seat section you could look to modifying the seat angle just a few degrees to see if that helps. If there is a long back on it that would allow for a lumbar support to help change the lumbopelvic position in sitting then that too could help. Ideally an assessment of your desk/chair height too if you are still working in that way.

Performing ALSR exercises is not something I would prescribe for this condition. Squats might help however deep lunges in several variations would be a lot more specific. In my experience people need some flexion in their spines (excluding people with canal stenosis) and also a lot more lumbar (low back) rotational release exercises. Instead of paying for physiotherapy I would be more inclined to take a course of at least 10 Pilates Studio based exercises in a one-to-one environment. Having access to an exercise regimen called 'Gyrotonic' would also be very useful.

Physiotherapy/Osteopathy/Chiropractic would of course be good to help release any pelvic asymmetries but those would be one or two sessions only. From there you need to get on to the whole body movement rather than pretty simple, static type exercises that you might currently be doing. Your overview looks to me some things that won't really hurt you but at the same time won't help.

Do feed back with your comments and I can add more information as required.

Best regards

PB

[Frankie913]

PB, thanks for your response!

Thank you for the new hypothesis that I wasn't aware of: hypersensitivity of the coccyx.

Thank you the explanation of the possible causality of this thing, probably by long time sitting patterns.

Thank you for addressing "prognosis", which is that this thing takes a loooong time to go away.

I've finally found a physiotherapist in my area "with 25 years of clinical experience and particular expertise in the management of hip, groin and lumbo-pelvic pain and dysfunction" (from website). I will mention to look for pelvic asymmetries. I expect there will be an overall pelvic musculoskeletal assessment and overall pelvic musculoskeletal fitness recommendations. I have to wait another six weeks before this appointment.

If I could ask one question, it would be: is there any stretch, mobilisation movement, trigger point therapy, or strengthening exercise that I could do at home as part of my fitness routine. Even if we can't be exactly sure of what will help, I'd welcome to know the types of things that often may help. If you give me a name of something, I will websearch it to get a more detailed description of how to do it. By the way, I am now doing glute trigger point therapy as part of my fitness routine, as recommended by my personal trainer, which sitting on a large trigger point ball starting with "outer, upper back pocket area" and then to middle side of glute. I am finding significant tension in these glute areas.

Frankie