Schematic representation of the sacrum and coccyx. The coccyx is the final, rudimentary part of the spine, which is a continuation of the lumbosacral region. Despite the fact that in the process of human evolution this formation has lost most of its functions, it is an important part of the skeletal system to which ligaments and muscles are attached. The coccyx consists of 3-5 rudimentary vertebrae, motionlessly connected to each other. The size of the latter decreases towards the end of the process, due to which the formation has the appearance of an inverted cone. Damage to the appendix can cause serious discomfort in the sacrococcygeal spine, which sometimes extends to the pelvic organs.
A comprehensive diagnosis of the condition of the area in question is only possible with the use of a computer or magnetic resonance imaging scanner. As a result of the influence of a special field of the latter, sectional photographs of the sacrococcygeal region are taken, on which pathologies of the vertebrae and surrounding soft tissues are visualized. Below we will tell you what an MRI of the tailbone shows, how the procedure is done, and what you need to consider when preparing for diagnosis.
Anatomy
If in all other parts of the spine the number of vertebrae in all people is the same, then the question of how many vertebrae are in the coccygeal region cannot be answered unambiguously. It is formed by three or four (less often five) fused vertebrae. This part of the spine looks like a wedge with a concave back surface, and is shaped like a bird's beak.
It is believed that where the tailbone is located, the distant ancestors of man had a tail. In the process of evolution, the need for this organ disappeared, and the final part of the spinal column of modern humans is, in a sense, a residual part of the “tail”, indicating kinship with primates.
The coccygeal vertebrae are tightly fused with each other by puberty (at 12–13 years). The sacrum and coccyx are connected by the sacrococcygeal joint. It is located between the fifth sacral and first coccygeal vertebrae, which are connected to each other through the intervertebral disc.
The articulation is strengthened by paired ligaments: deep and superficial dorsal sacrococcygeal, ventral and lateral sacrococcygeal. In women, the mobility of the sacrococcygeal joint is much higher than in men. This is due to the need to expand the pelvic openings during childbirth to ensure normal passage of the fetus through the birth canal.
The muscular apparatus is represented by the paired coccygeal muscle and the external anal sphincter (the muscle that controls the closure of the anal canal). In the coccygeal region there is a fairly large coccygeal nerve plexus, which is involved in the innervation of the external and internal genital organs and pelvic organs.
The structure of the male and female sacrococcygeal region is different
How to prepare for an MRI of the tailbone?
After you have learned how to do an MRI of the tailbone, you need to find out what preparation for the procedure includes. No specific measures are required before diagnosing the area in question. Preparing for an MRI of the coccyx includes a number of necessary actions:
- directly in front of the room where the MRI scanner is located, you need to take off your clothes with metal elements, leave your accessories (hairpins, jewelry, watches, bank cards, flash drives, smartphones);
- if you are afraid of closed spaces, first find ways to solve the problem with your doctor: it is possible that sedatives will be prescribed before diagnosis;
- it is necessary to refuse MRI if there are metal objects in the body (plates, pins, clips on blood vessels, etc.), built-in implants or non-removable devices for maintaining vital functions (pacemakers, etc.);
- for girls, exclude the possibility of pregnancy (first trimester).
Why is the coccyx needed?
Despite the fact that this part of the spine is considered a remnant of the caudal vertebrae, it performs many important functions in the body. He:
- participates in uniform distribution of the load on the spinal column;
- fixes the pelvic organs in the correct physiological position;
- ensures the formation of the birth canal;
- takes part in the work of the hip joints, since part of the fibers of the gluteus maximus muscle is attached to the tailbone;
- is the location of the coccygeal nerve plexus, which ensures the functioning of the pelvic organs and the final section of the intestine.
Causes of dorsopathy of the lumbar sacral spine
The pathological process can be caused by various factors:
- Excess weight, especially if a person has low physical activity
- A harmful diet that leads to dystrophic changes in the intervertebral discs
- If you have frequent episodes of hypothermia
- Weakened immune system (frequent colds).
- Professional need to carry heavy loads
- Incorrect stereotype of body position during sleep
- Sedentary lifestyle typical of office workers
- History of spinal injuries
- Serious diseases of the central nervous system, heart, blood vessels, digestive system disorders
- Complications of infectious diseases (syphilis, tuberculosis) or tumors (for example, cancer metastases)
Why might pain occur?
Pain in the area of the final part of the spine can be caused not only by diseases of this part of the spinal column itself, but also by a fairly large list of pathological conditions. The main reasons are given in the table.
| Cause | Manifestations |
| Osteochondrosis | It is one of the most common causes of pain. This is due to the fact that the resulting osteophytes (bone growths) compress the nerve endings, causing pain, numbness, a burning sensation or crawling sensations. |
| Injury | Injury (bruise, crack, fracture, dislocation) can occur when falling and landing on the buttocks or in the event of a direct blow to the coccygeal area. It is rarely possible to determine what kind of injury it is based on clinical signs. All injuries are accompanied by pain, local swelling and bruising. An examination is necessary to make an accurate diagnosis. |
| Pathological birth | Excessive posterior deviation of the tailbone is possible with a large fetus or if the woman has a narrow pelvis. |
| Epithelial coccygeal tract | Such a cyst is a congenital pathology, which is a narrow, blindly ending canal in the subcutaneous tissue of the intergluteal region. Under unfavorable circumstances (decreased immunity or direct infection), suppuration of the contents may occur. If the disease is started, an abscess or secondary fistula forms. |
| Inflammatory processes in the pelvis | Diseases of the pelvic organs (urethritis, salpingitis, endometritis, oophoritis, prostatitis) can be accompanied not only by nagging pain in the lower abdomen, but also in the coccyx area. |
| Tumors | Pain in this area can be caused by bone tumors (sarcomas) or cartilage tumors (chondrosarcomas), as well as metastases of malignant neoplasms of the ovaries and prostate gland. |
| Colon diseases | Diseases of the rectum and sigmoid colon (hemorrhoids, proctitis, anal fissures, rectal tumors) quite often lead to pain in the coccygeal region. |
| Scars and adhesions | The formation of adhesions and scars after operations on the pelvic organs, anus, sigmoid and rectum can cause pain in the tip area. |
| Pregnancy | The cause of pain is the tension of the ligaments of the pelvic bones as the uterus grows. Typically, such pain is also accompanied by discomfort in the groin area. |
| Sciatica | If the sciatic nerve is pinched, pain may appear in the tailbone, buttocks and the back of the thigh. |
Symptoms of pain in the tailbone
Pain in the coccyx has a variety of manifestations. They can be aching, convulsive, sharp, braining, burning, pulling, bursting, etc. They often radiate to the sacral, gluteal region, genitals, and thighs.
When changing body position, the intensity of pain decreases or disappears without taking painkillers. Attacks can be either rare and mild or frequent and painful. There may be constant negative sensations over a long period of time, which are characterized by a sudden beginning and the same ending.
In most cases, attacks occur at night, during sneezing, coughing, physical stress, sports training, or intimacy. Pain in the coccyx is most severe when sitting on hard surfaces and decreases when walking. Gases and feces put pressure on the rectum, so bowel movements are sometimes painful, followed by temporary relief.
Localization of pain
The main symptom of coccydynia is pain, which is localized in the following places.
- Directly in the tailbone. As a rule, pain in the tailbone occurs when sitting, standing up and bending. It intensifies with strong pressure on the lower spine and after physical activity.
- In the anus. Pain occurs suddenly, mainly at night or during sexual intercourse, as well as during bowel movements.
Movements become constrained and cautious, the gait becomes slow and waddles (like a duck). This is fraught with scoliotic changes in the spinal column, joint deformation, and muscle strain. It is possible that constipation, difficulties with deurination, and sexual dysfunction may occur. The result is a deterioration in the emotional state: the emergence of fears, irritability, depression, fatigue, insomnia.
Possible autonomic reactions of the body to pain in the tailbone: increased sweating, peripheral incoming vasospasm (vasospasm), intestinal upset, vomiting.
The disease is characterized by a chronic course. It worsens mainly in the autumn-winter period, after stressful situations, general hypothermia, excessive or unusual physical activity.
If the cause of pain in the coccyx is an injury, the pain syndrome is severe, and the appearance of hematomas, swelling and swelling in the damaged area cannot be ruled out.
Diagnosis of pathologies
If your tailbone hurts, you should consult a general practitioner. He will conduct an examination and prescribe an examination. If not necessary, the therapist will refer you for consultation to a specialist (vertebrologist, neurologist, proctologist, surgeon, urologist, gynecologist).
Inspection
In order for the doctor to examine the sacrococcygeal area, the patient must lie face down on the couch, with his feet shoulder-width apart. A small cushion is placed under the abdomen to lift the pelvis and relax the gluteal muscles. An examination may reveal:
- anal fissure;
- external hemorrhoids;
- paraproctitis;
- external fistula;
- the presence of edema and hematoma.
Normally, palpation in the area of the sacrum and coccyx should not cause pain.
If the examination is carried out by a proctologist, he can do a digital examination of the rectum. To do this, the patient takes a knee-elbow position, and the doctor inserts a finger into the anus. Such a study can detect internal hemorrhoids, changes in the wall or the presence of a tumor of the rectum, muscle spasm or weakness of the anal sphincter, paraproctitis.
X-ray examination
Images of the sacral and coccygeal regions are taken in direct and lateral projections. X-rays can detect the presence of traumatic or degenerative changes, spinal curvatures, and metastases.
In order for the study to be informative, the day before the patient should not eat foods that promote gas formation (fruits, vegetables, dairy products)
Computed tomography (CT)
This method allows using a tomograph to obtain a layer-by-layer image of anatomical structures. Unlike conventional X-rays, CT scans can evaluate not only bone structures, but also muscles and cartilage.
Magnetic resonance imaging (MRI)
The method is accurate, informative and does not cause radiation exposure to the body. It allows not only to identify changes in the spine, but also to assess the condition of blood vessels, nerve bundles and soft tissues.
Coccyx: cyst, inflammation, lump, fracture - exercises for the coccyx
Modern medicine is paying more and more attention to diseases of the musculoskeletal system, as well as injuries and various anomalies that may arise during life.
This is due to the emergence of such innovative techniques as, for example, magnetic resonance and computed tomography, which allow for a complete and comprehensive diagnosis of diseases in a matter of minutes.
Also, one of the reasons for the development of musculoskeletal medicine is the increasing number of requests from patients who have injured one or another area of the spine.
The current way of life, the complete lack of free time caused by the accelerated rhythm of activity, causes neglect of some safety measures. For example, during icy conditions, a person’s tailbone often suffers due to haste.
The structure of the coccyx
The structure of the coccyx is one of the characteristic features of the anatomy that distinguishes it from other mammals.
The coccyx is a fused rudimentary vertebrae of the coccygeal region, which form a solid bone and are tightly connected by 20-25 years of life.
Treatment
Therapy is prescribed only after undergoing an examination and establishing a final diagnosis. If pain in the tailbone is caused by pathology of the abdominal or pelvic organs, then the emphasis is on treating these diseases. If the cause of pain is the tailbone itself, then the doctor can make the following prescriptions.
Nonsteroidal anti-inflammatory drugs
Subluxation of the coccyx
These drugs are used to relieve inflammation and pain due to osteochondrosis, the consequences of injury or sciatica. NSAIDs eliminate the symptoms, but not the cause of the disease.
Drugs in this group include:
- Nimesulide.
- Ortofen.
- Indomethacin.
- Ibuprofen.
Due to the fact that the drugs have many side effects, it is not recommended to take them for a long time.
Local treatment
Ointments and gels with anti-inflammatory and distracting effects are most often used for chronic pathological conditions. They help get rid of low-intensity pain without carrying a general medicinal load on the body. The use of warming ointments in the presence of an inflammatory process is strictly prohibited.
Physiotherapy
The following methods are used:
- Phonophoresis with drugs.
- Magnetotherapy.
- Laser therapy.
- Ozokerite.
- Acupuncture.
- Massage.
Physiotherapy
The selection of exercises is carried out individually depending on the severity of the disease and the general condition of the patient. The goal of gymnastics is to strengthen the muscles of the back, abdominals and pelvic floor. The exercise therapy (physical therapy) complex for the tailbone often includes exercises performed with a ball.
The ball absorbs the load, making movements smooth and rhythmic
Surgery
Surgery is performed only according to strict indications. The basis for the operation are:
- Fistulas and abscesses
- Severe pelvic injuries with damage to bones and internal organs.
- Tumors.
Thus, although the coccyx in humans is considered a rudiment (remnant) of the caudal part of the spinal column, it ensures uniform load on the spine and fixation of a number of internal organs. Its pathology can lead to significant pain and significantly affect the quality of life, so timely diagnosis and treatment are necessary.
Where is the coccygeal region located?
The tailbone completes the spine. Its location can be ignored for the rest of your life.
However, the resulting pain in this part of the spine can give a clear idea of this honor of the human skeleton. Quite often the coccyx is confused with the sacrum, but these are different parts of the spine. The sacrum is located higher.
A few words about the structure of the sacrum. It consists of 5 vertebrae, which fuse into one bone by age 30. It is also shaped like a pyramid with the base at the top. The sacrum has openings through which the motor nerve roots pass. Below, the sacrum connects to the coccyx.
Anatomy of the sacrococcygeal joint
This joint is also called the sacrococcygeal joint. This articulation is formed by the 5th sacral and 1st coccygeal vertebrae. These vertebrae are united using a modified intervertebral disc with an expanded cavity. The composition is strengthened by a number of ligaments: the lateral, anterior, superficial posterior and deep posterior sacrococcygeal ligament.
How does dorsopathy of the lumbosacral spine manifest?
- Dull pain in the lumbar region, which only increases when walking
- Frequent muscle cramps in the lower leg
- Sharp pain and discomfort when moving
- Lameness associated with a person’s reluctance to load the leg or forced postures associated with impaired biomechanics due to significant pain.
- Pain in the buttocks that does not go away even after taking medication
- Constant intense pain, mostly localized in the center of the lumbosacral spine
- Increased pain during sudden movements, when straining, sneezing, coughing
- Increased pain when standing
- Feeling of numbness, pain in the legs
- Muscle weakness, paresis
- Lumbodynia (dull pain)
- Low back pain that radiates to the muscles of the buttocks and thighs
- Bowel and bladder problems (occurs when cauda equina syndrome develops, and this condition requires emergency surgery)
Treatment of dorsopathy of the lumbosacral spine
Basic principles of treatment
- The American College of Physicians (ACP) recently published its guidelines for treating different types of low back pain, from short-term attacks of pain to debilitating chronic pain. The focus is primarily on exercise, stress reduction, and integrative therapy, with medications recommended only when conservative therapy does not relieve pain.
Based on long-term clinical observations, the basic principles for the treatment of dorsopathy of the lumbosacral spine were formed:
- Reducing or eliminating back pain
- Improved spinal function
- Improving health-related quality of life
- Increased ability to work
- Managing the number of episodes of back pain
- Improved patient satisfaction
Treatment recommendations:
- Different types of pain may require different treatments. The medical community has developed a treatment system of 3 recommendations that address 3 different types of back pain: acute, subacute and chronic back pain.
- Acute back pain: pain that lasts less than 4 weeks.
- Subacute back pain: pain that lasts 4 to 12 weeks.
- Chronic back pain: pain that lasts more than 12 weeks.
Recommendation
#1
: Patients with acute or subacute low back pain often experience a decrease in symptoms over time, so ACV recommends that doctors first treat with massage, acupuncture, or manual therapy before prescribing medications. If drug therapy is necessary, AKV recommends the use of non-steroidal anti-inflammatory drugs (NSAIDs) and/or muscle relaxants.
Recommendation№2:
For patients with chronic lower back pain, AKV recommends comprehensive rehabilitation, including exercise therapy, tai chi exercises, physical therapy (laser therapy), acupuncture, cognitive behavioral therapy or manual therapy (osteopathy).
Recommendation #3:
When non-drug treatments do not help patients with chronic low back pain, then drug therapy is an option. The first-line treatment should be an NSAID, followed by tramadol or duloxetine as second-line therapy. Opioids should only be used if the potential benefits outweigh the risks, and doctors should discuss all risks and benefits with patients before starting treatment.
Surgery
Unfortunately, conservative treatment of dorsopathy of the lumbosacral spine is not always very effective. In the absence of effect from conservative treatment and resistant, in the presence of persistent neurological symptoms or with the development of progressive symptoms, surgical treatment is recommended.