Nurse who suffers chronic tailbone pain

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I am a Registered Nurse who has suffered with tailbone pain for over 8 years. Like all chronic pain, it is essential that sufferers get the correct support, diagnosis and treatment appropriate for them as an individual. This blog follows my journey with chronic pain, it expresses my personal opinions and thoughts. It is not intended as a replacement for advice or treatment from your normal Healthcare Provider.

Monday, 25 July 2016

My tails between my legs!

In March 2015 I blogged about what some refer to as 'tail between your legs' theory.

This theory suggests that when we are stressed, anxious or fearful, we tighten our vestigial 'tail' (our coccyx) as if pulling our tail between our legs. Using particular pelvic muscles in the manner described, especially if done for any length of time will cause painful, shortening and contraction of these muscles. This would tie in with the repetitive strain injury (RSI) that can cause coccydynia.

'Tail between your legs' courtesy of Coccyx.org (Wise, D.)

The book I am currently reading, 'A headache in the pelvis' (Wise and Anderson, 6th ed, 2015.) describes this 'tail between the legs' theory as a possible cause of chronic pain in the pelvis; coccydynia being one pelvic pain they refer to. Pelvic pain is described as a 'Functional Disorder', or 'Functional Somatic Syndrome'; they further explain that a Dr J Quentin Clemens discussed this term as "used to describe a pattern of persistent bodily complaints for which adequate examination does not reveal sufficient explanatory structural or other specified pathology".

According to Wise and Anderson (2015) chronic pelvic pain may be resistant to treatment because of the 'tension-anxiety-pain-protecting guarding cycle'. This cycle causes chronic pain to shorten muscles in the pelvis. Heightened states of anxiety or stress cause us to tighten up our pelvic floor muscles (ready for the 'fight, flight or freeze' scenario). In some the pelvis never fully relaxes, it is protectively guarding itself. We then get areas of tension, 'trigger points' both internally and externally.

Our tailbone is a vestigial bone- the remnants of a 'lost' tail. This tail is clearly present for 4 weeks while we develop inside the womb, but most prominently days 31-35 days of the embryos' development. As the embryo develops, the 'tail' is absorbed by the growing body as it develops into a foetus. When we are born we still have the tail 'bone'- or coccyx however. Although, in rare cases some people are also born with a tail of some kind. This tailbone/coccyx still serves to help with balance and stability, as well as the attachment of some muscles, tendons and ligaments. It is not really meant to be sat on, although it aids in 'supporting' us whilst we sit.

In humans the coccygeal, ileococcygeal and pubococcygeal muscles within the pelvis are attached to the tailbone. It can be seen therefore, that by continually tensing our 'tail' we are triggering our pelvic pain. The levator ani muscles insert onto the coccyx, these muscles also support the pelvic floor. A portion of the gluteus maximus also inserts onto the coccyx. The gluteus maximus extends the thigh during walking or running. There are also several ligaments attached to the coccyx. Knowing the involvement of these relevant and important muscle groups explains why certain exercises may help, but it would also explain why for many it may aggravate the condition. It may also explain why bad posture, repetitive strain injury's and prolonged sitting can aggravate coccydynia.

Tension in the pelvic muscles is often there without us even realising. Often (especially women) are told to strengthen their pelvic floor, but not taught how to relax it. A female physio I saw in the past showed me how to do both. This physio was trained in administering and teaching pelvic strengthening and relaxation:

Pelvic floor strengthening and relaxation

Simply put it is just feeling as if you are letting it all relax, as if you are about to have a wee, but don't. I confess I have only been doing the strengthening exercises for a while now, not the relaxation. You know what it's like, you start with good intentions and then you either forget how to do it, or just simply tell yourself you don't have time in your day.

I feel like I have come full circle, almost back to the beginning now. It was over a year ago that I explored the idea of trigger points and relaxation in the pelvis. I can totally see how some people (myself included) may inadvertently aggravate their pain state by being tense. My stress levels have been high lately due to moving house (still ongoing); and my pain has also been worse. When I think about relaxing my pelvic floor it does actually relax, I can almost feel it dropping. I can therefore safely assume I am a 'tail between my legs' tense, anxious type of person!


I do think the EMDR helped but the pain has definitely decided to revisit me. So I will return to what I was meant to be doing and practice my relaxation technique, along with strengthening exercises and gyming and walking..... and staying off my bum as much as is humanly possible.

3 comments:

  1. When I was working with a Physical Therapist on this matter, it was difficult to perform Kegels without also tightening my anus muscles also. I am reading a book, Heal Pelvic Pain, which concentrates on strengthening the core and relaxing vaginal muscles. I am not good about keeping up with exercises.

    Thanks for sharing your thoughts with us.

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    1. Thanks Leslie. There is so much available to read! I'm reading a normal book at the moment for a break (Kim by Rudyard Kipling). Your book does sound good though. maybe that should be my next read. Who is it by? Jill.

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  2. Thanks for sharing this profound awareness in this aspect.

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