Even though it is quite small, the coccyx has a number of important functions. In addition to being the insertion site for multiple muscles, ligaments, and tendons, it also serves as one leg of the tripod-along with the ischial tuberosities-that provides weight-bearing support to a person in the seated position. The incidence of coccydynia (pain in the region of the coccyx) has not been reported, but factors associated with increased risk of developing coccydynia include obesity and female gender. This article provides an overview of the anatomy, physiology, and treatment of coccydynia. Conservative treatment is successful in 90% of cases, and many cases resolve without medical treatment. Treatments for refractory cases include pelvic floor rehabilitation, manual manipulation and massage, transcutaneous electrical nerve stimulation, psychotherapy, steroid injections, nerve block, spinal cord stimulation, and surgical procedures.
The study concluded that a multidisciplinary approach incorporating physical therapy, ergonomic adaptations, medications, injections, and, possibly, psychotherapy results in the greatest chance of success in patients with refractory coccyx pain. Although new surgical techniques are emerging, more research is necessary before their efficacy can be established.