A Tailbone of Two Injuries


The Coccyx (Tailbone)

The coccyx, colloquially referred to as the tailbone, is a small, often overlooked anatomical landmark that sits below the lumbar spine and sacrum.  Despite it’s tiny size, it is extremely clinically significant.  Think of it as the Grand Central Station of your pelvic floor, so to speak.  The coccyx serves as the attachment site of the gluteus maximus and levator ani muscles (which include the coccygeus, iliococcygeus, and pubococcygeus muscles) and ligaments (including the anterior, posterior, and lateral sacrococcygeal, sacrotuberous, and sacrospinous ligaments).  Injury to the coccyx can affect the aforementioned muscles and/or ligaments.  Conversely, injury to the muscles and/or ligaments can affect coccyx alignment.  Symptoms of coccyx dysfunction include coccyx pain (referred to as coccydynia), pain with defecation, pain with intercourse, pain with prolonged sitting, pain with transitional movements (such as sit to stand), coccyx pain, low back pain, and even neck pain.

As per the title of this blog, the tailbone is often injured in one of two ways.  It can either involve a traumatic onset, which involves a sudden and easily identifiable injury (ex. a sharp or painful fall), or an insidious onset, which is harder to pin point and often due to cumulative repetitive trauma.  These traumas may include a history of chronic pelvic floor muscle tightness which can pull the coccyx out of alignment, or it may be related to a history of multiple minor falls or sports injuries (even during childhood) which seemingly “healed on their own over time.”  As I often tell my patients, our musculoskeletal systems have a better memory than our brains, and what seemed at the time to be insignificant may in fact have a large impact down years later.  My goal in stating this is NOT to produce fear or nervousness over waking up tomorrow with symptoms of tailbone pain due to unresolved previous injuries.  Rather, my goal in sharing this information is to raise awareness and broaden your thinking; if you already DO experience any of the aforementioned symptoms, please consider that it may be due to the often overlooked coccyx.

Now that we have identified the importance of the coccyx and how it can become injured, let’s move onto the fun part…the part where physical therapists enter the scene…treatment and fixing the pain.  The most common direction of coccyx injury is a “flexed” coccyx, or the coccyx becoming stuck in an anterior/forward position.  Treatment of the coccyx involves external and internal mobilization of the coccyx to move it back into the proper position.  Internal work can be accomplished through vaginal or rectal approach, depending on the patient’s comfort level and preferences.  If the coccyx is deviated to either the right or left (in addition to or instead of a flexed coccyx), appropriate directional mobilizations are also indicated.  In addition, the therapist may choose to tape the coccyx into the newly corrected position after treatment to help maintain the correction.  Furthermore, as mentioned previously, the coccyx is attached to other structures, and therefore should not be treated in isolation.  Any muscle or ligament tightness needs to be addressed in order to maintain the improved alignment.  The final component of treatment is patient education about proper sitting posture, appropriate rest breaks to avoid prolonged sitting, and possible use of a donut or a different cushion initially for decreased pain.

If you or someone you know may benefit from pelvic floor physical therapy to treat an injured coccyx, please contact Revitalize Physical Therapy.  I would love to have the opportunity to help you along your healing journey!

Dare to Fail

Thomas Edison failed 1,000 times before he created the first successful light bulb

My avid blog readers will recall a post from June 2015, entitled “Transplant-astic””, which was about the first successful uterine transplant in Sweden (October 2014).  On February 24, 2016, The Cleveland Clinic attempted to replicate Sweden’s success; a uterine organ transplant was performed by Dr. Andreas G. Tzakis and her team on 26 year old Lindsey, the organ recipient.  The surgical team was initially positive about the transplant, which they hoped would be the first of ten successful uterine transplants.  Unfortunately, a simple fungal infection to Lindsey’s immunosuppressed system resulted in post-surgical blood loss and subsequent transplant failure.

Shortly after Lindsey’s media debut, which was greeted with initial excitement at the prospect of success, she began experiencing tachycardia (increased heart rate), dizziness, and decreased blood pressure.  She was brought back to the Cleveland Clinic where it was determined that she required emergency surgery to remove the uterus.  Apparently, candidiasis, a Candida albicans infection, had developed at the attachment site of the transplanted uterus.  According to the Centers for Disease Control and Prevention, Candida albicans is the most common of the 20+ species of candida yeasts which can infect humans.  Candida yeasts typically reside on mucous membranes and skin without causing infection, however proliferation of the fungus can create organ specific symptoms.  For example, overgrowth in the vagina results in a yeast infection, overgrowth in the mouth/throat results in oropharyngeal candidiasis (thrush), and overgrowth in the bloodstream is referred to as invasive candidiasis.  In Lindsey’s case, the infection resulted in blood loss and the other aforementioned symptoms.  Fortunately, Lindsey is in good medical condition, however she will not be an appropriate candidate for a repeat surgery in the near future.

I chose to highlight this medical milestone in today’s blog.  And yes, I refer to it as a “milestone” despite the fact that others might prefer to call it a “failure.”  The reason I have chosen to do so is because medical research follows the same principal as the one taught to many children learning to tie their shoelaces for the first time.  Namely, “If you don’t succeed at first, try, try again.”  Many successful medical advancements come on the heels of previous unsuccessful attempts.  Confucius has aptly stated, “Our greatest glory is not in never failing but in rising every time we fail.”  Similarly, Thomas Edison, inventor of the light bulb, failed 1,000 times before he finally succeeded.  When asked how it felt to fail 1,000 times, Edison responded, “I didn’t fail 1,000 times.  The light bulb was an invention with 1,000 steps.”  On that note, I give much credit to the Cleveland Clinic, who is already planning for future transplants with modified protocol to decrease the chance of future similar occurrences.  In addition, I applaud Lindsey for boldly going where no American woman has gone before.  May all her hopes and dreams regarding family planning come to fruition in a safe and satisfying manner.