By Catherine Lewan, PT, DPT, CYT

Are your patients at risk for coccyx pain?

Having tailbone pain after childbirth is quite literally a pain in the butt. Pain with sitting can make feeding, childcare, travel, and social events less enjoyable and even downright miserable. New moms already have enough to worry about.  Thankfully, pelvic physical therapists provide treatment to relieve pain, and educate your patients so they can heal faster and function better!  

How do you know which patients need a referral for coccyx pain? They may eventually complain of symptoms that just won’t go away: pain with sitting, pain with bowel movements, tailbone clicking/popping, or inability to resume sexual intercourse due to pelvic pain.

A recent study found that the women with coccydynia reported immediate postpartum pain in the coccyx with sitting. Other findings in patients with coccydynia included:

  1. 50.8% of the deliveries utilized forceps while 7% were vacuum-assisted.

    • An additional 12.3% of the deliveries were spontaneous and were described as “difficult.”

  2. A subluxation of the coccyx was observed in 44% of the women who developed coccyx pain after childbirth as compared to 17% of the controls.

  3. A fractured coccyx occurred in 5.3% of the women.

  4. Body mass index (BMI) of more than 27 and having 2 or more vaginal deliveries was also associated with a higher prevalence of subluxation of the coccyx.

Often though, by the time a patient voices complaints of this nature, her symptoms have already become chronic. Patients (first time mothers especially) may simply assume that new painful sensations in the body are “all just part of childbirth,” and fail to recognize or describe any nuanced symptoms until their 6-week checkups or beyond.  What we Pelvic PT’s hear most often from our postnatal patients is “This is so helpful, I wish I had known this was available sooner.”

In the acute postpartum, we focus on pain relief and self-care to improve healing, and we ask that our patients bring in their newborns so that we can guide them toward the best body mechanics for feeding, carrying, and the rigor of childcare.  We teach a new mom to activate her transversus abdominus and pelvic floor to immediately improve LBP, pelvic stability, incontinence, and Diastasis Recti.

Illustration by Rob Donnelly for Slate

Illustration by Rob Donnelly for Slate

A 2015 Randomized Controlled Trial found that initiating basic Pilates exercises 72 hours after delivery (continued 5x/week for 8 weeks) had no adverse effects and improved maternal fatigue in the 8 weeks acute postpartum (Ashrafina et al, 2015.)

When a new mom receives a physical therapy referral at delivery we wait for your clearance to initiate moderate-to-vigorous exercise, and of course we will educate your patient on red flags signaling that they are overdoing their activity.

I hope you will consider routinely writing a referral for pelvic physical therapy at delivery with instructions to use as needed. We think your patients will thank you for offering them this valuable resource early on in the postpartum journey! New moms need all the support they can get, and we are happy to help.