Anatomy of the Pelvic Region
To grasp why tailbone pain is prevalent postpartum, it is essential to understand the anatomy of the pelvic region, particularly the pelvic floor muscles and their connection to the tailbone.
The Pelvic Floor Muscles: These muscles stretch like a hammock from the pubic bone at the front to the tailbone at the back and from one sit bone to the other. The pelvic floor muscles play a crucial role in supporting the pelvic organs, including the bladder, uterus, and rectum. They also assist in urinary and fecal continence, sexual function, and stabilization of the core. The key muscles that connect to the coccyx are what’s called your iliococcygeous, pubococcygeous, and coccygeous muscles. They connect onto and support your coccyx.
The Tailbone (Coccyx): The coccyx is the small, triangular bony structure at the bottom of the spine. It consists of three to five vertebrae fused together. Several muscles and ligaments, including the pelvic floor muscles, attach to the coccyx, contributing to its stability and movement. The typical angle of the sacro-coccygeal joint ranges between 30-45 degrees for the average person.
Causes of Postpartum Tailbone Pain
Tailbone pain can occur for several reasons, particularly after childbirth:
Hormonal Changes: During pregnancy, the hormone relaxin and estrogen is produced to relax the ligaments and joints in the pelvic region to facilitate childbirth. This can lead to instability in the pelvic area, including the tailbone, making it more susceptible to movement that can cause pain.
Delivery Trauma: The process of childbirth can exert significant pressure on the tailbone. With vaginal birth the tailbone and sacrum must extend posteriorly to allow baby to move out of the pelvic outlet. In some cases, the tailbone may experience mild bruising, slight dislocation, or even a minor fracture during delivery. In other cases, the pelvic floor muscles around the tailbone maybe had a tear in them with child birth that causes uneven pulling and can contribute to pain around the tailbone itself.
Pelvic Floor Dysfunction: The strain of carrying a baby postpartum and the process of childbirth can impact the pelvic floor muscles, specifically the posterior pelvic floor muscles of the iliococcygeous, pubococcygeous, and coccygeous muscles as these are the ones that open and stretch the most during vaginal delivery. When these muscles are compromised, they may not support the pelvic organs effectively or are attempting to not allow for any urinary or bowel leakage, which can lead to muscular imbalance around the tailbone causing pain and discomfort in the tailbone area.
Reducing Tailbone Pain: Strategies and Techniques
Addressing tailbone pain requires a multifaceted approach, including proper sitting mechanics, stretches, and self-release techniques.
Sitting Mechanics
Use a Tailbone cut out cushion: Sitting on a tailbone cutout-shaped cushion can help alleviate pressure on the tailbone. This type of cushion distributes weight evenly, preventing direct pressure on the coccyx. Avoid donut cushions as they can cause a tourniquet effect that holds excess blood and sometimes even more pressure onto your coccyx.
Maintain Good Posture: Sit with your back upright, a small curvature to your lower back, and your buttocks touching the back of the chair. Ensure that your feet are flat on the floor and your knees are at a right angle, avoiding your knees too high or below your hips. Avoid slumping or leaning back excessively as this can place extra unnecessary pressure onto your tailbone. Make sure when you are sitting you have both your sit bones flat onto the chair you are on and can even roll forward onto your sit bones to bring your pubic bone toward the chair and move your tailbone farther behind you.
Alternate Sitting Positions: Try not to sit for prolonged periods. Alternate between sitting, standing, and walking to reduce the strain on your tailbone. If possible, use a standing desk or take regular breaks to move around.
Stretches
Child’s pose with hips internally rotated: This yoga pose gently stretches the muscles of the lower back and posterior pelvic floor muscles that connect onto your tailbone. Kneel on the floor, widen your knees out comfortable and rotate your shins outward to the level of your knees, sit back on your heels, and then lean forward, extending your arms in front of you and resting your forehead on the ground. Hold for 30-60 seconds and repeat several times.
Gluteal Figure 4 Stretch: Your glute muscles work with your posterior pelvic floor muscles that connect into that coccyx. Learning to stretch and relax these muscles can help relieve tailbone pain. Lie on your back with your knees bent and feet flat on the floor. Cross one ankle over the opposite knee and gently pull the bottom knee towards your chest until you feel a stretch in the buttock. Hold for 30-60 seconds and repeat on the other side.
Piriformis Cross body Stretch: The piriformis muscle, located near the tailbone, can contribute to tailbone pain if it becomes tight. This stretch is best done on your back with one leg extended forward and the opposite leg knee and hip flexed up. Hug the flexed up knee into your chest and pull it across towards your opposite shoulder. Hold it here as you breath and feel a stretch in your outer and back hip.
Self-Release Techniques
Foam Rolling: Using a foam roller can help release tight gluteal muscles can help relax those posterior pelvic floor muscles around the tailbone. Sit on the foam roller and gently roll back and forth, focusing on the gluteal muscles. Be gentle and avoid putting direct pressure on the tailbone itself.
Trigger Point Release: Identify tender points around the tailbone and apply gentle pressure with your fingers or a massage ball. Typically this can be done by placing a tennis ball or lacrosse ball at the area just lateral to your vagina, between your vagina and anus. Sit on the ball here, avoiding any direct pressure onto your tailbone. Hold the pressure for 1-2 minutes until you feel the muscle release. This technique can help to alleviate localized muscle tension to relieve tailbone pain
Pelvic Floor Relaxation: Learning to relax your pelvic floor muscles through breath can be beneficial in relieving muscular tension. Use your inhale to imagine opening and relaxing through your pelvic floor. Great cues for this is inhaling and imagining a flower opening down and out of your vagina or anus or inhaling and imagining your pelvic floor muscles melting and opening.
When to Seek Professional Help
While self-care techniques can be effective, it is important to recognize when to seek professional help. If tailbone pain persists despite self-care measures, or if the pain is severe and impacting your daily activities, consult a healthcare provider. Physical and occupational therapists specializing in pelvic health can offer personalized treatment plans, including manual therapy, specific exercises, and feedback on muscular tensioning vs relaxation to find better relief with an individualized approach.
Promoting Postpartum Recovery
In addition to addressing tailbone pain, promoting overall postpartum recovery is crucial. Here are some additional tips:
Gradual Return to Exercise: Resume physical activity gradually and under the guidance of a healthcare professional. Focus on gentle exercises that strengthen the core and pelvic floor muscles while maintaining mobility and encouraging hip and pelvic stability.
Nutrition and Hydration: Maintain a balanced diet rich in nutrients to support tissue repair and bowel health. Bowel health is key preventing excessive pressure on your pelvic floor muscles which can help in relieving tailbone pressure and pain. Stay hydrated and get at least 25 g of fiber intake in daily.
Conclusion
Tailbone pain can be a significant source of discomfort for postpartum women, but understanding its causes and implementing effective strategies can lead to relief and recovery. By incorporating proper sitting mechanics, stretches, and self-release techniques, you can manage and reduce tailbone pain. Remember to be patient with your body during the postpartum period and seek professional help when needed. Prioritizing your health and well-being will not only alleviate pain but also support a smoother transition into motherhood.
