Coccygeus Trigger Points

Introduction

The coccygeus is a small but essential muscle of the pelvic floor that provides support to the pelvic organs and contributes to sacrococcygeal stability. When trigger points develop in this muscle, they can cause tailbone pain (coccygodynia), lower back discomfort, and deep pelvic pain, often mimicking conditions like sciatica or sacroiliac joint dysfunction.

Name and Area

  • Name: Coccygeus

  • Area: Posterior pelvic floor, spanning from the ischial spine to the sacrum and coccyx.

Indications

Coccygeus trigger points may contribute to:

  • Tailbone (Coccyx) Pain (Coccygodynia)

  • Deep Pelvic or Rectal Pain

  • Pain While Sitting (Especially on Hard Surfaces)

  • Pain Radiating to the Lower Back and Gluteal Region

  • Discomfort During Bowel Movements or Sexual Activity

  • Pain When Rising from a Seated Position

Pain from coccygeus trigger points is often misdiagnosed as coccydynia, hemorrhoids, or sciatica.

Muscle Action

  • Pelvic Floor Support: Stabilizes the sacrococcygeal region.

  • Flexion of the Coccyx: Assists in tailbone movement.

  • Helps Close the Pelvic Outlet: Supports the function of the levator ani and sphincter muscles.

The coccygeus works in conjunction with the levator ani, forming part of the pelvic diaphragm.

Signs and Symptoms

Individuals with coccygeus trigger points often report:

  • Aching or Burning Pain in the Tailbone

  • Pain that Worsens When Sitting, Cycling, or Driving

  • Difficulty or Discomfort with Bowel Movements

  • Pain that Extends to the Lower Back or Glutes

  • Increased Discomfort During or After Sexual Activity

Pain is often described as deep, aching, or burning, and may increase with prolonged sitting or sudden movements.

Perpetuating Factors

Common causes of coccygeus trigger points include:

  • Trauma to the Tailbone (Falls, Direct Impact, Childbirth)

  • Prolonged Sitting (Especially on Hard Surfaces)

  • Pelvic Floor Dysfunction or Muscle Imbalance

  • Chronic Constipation or Straining During Bowel Movements

  • Lower Back or Sacroiliac Joint Dysfunction

  • Emotional or Psychological Stress (Pelvic Floor Guarding Response)

Trigger Point Referral Pattern

Trigger points in the coccygeus muscle can refer pain to:

  • The tailbone and sacrum

  • The lower gluteal region

  • The deep pelvic floor and rectal area

  • The inner upper thigh

Pain from this muscle is often mistaken for hemorrhoids, prostatitis, or pudendal neuralgia.

Differential Diagnosis

Coccygeus trigger points can mimic or be mistaken for:

  • Coccygodynia (Tailbone Pain Syndrome)

  • Pudendal Nerve Entrapment (Pelvic Pain and Numbness)

  • Sacral Dysfunction (SI Joint Pain and Instability)

  • Hemorrhoids or Rectal Pain Syndromes

  • Sciatica (Lower Back and Gluteal Pain)

A thorough pelvic floor assessment is essential to rule out these conditions.

Associated Trigger Points

Coccygeus trigger points often co-exist with:

  • Levator Ani (Pelvic Floor Tightness and Dysfunction)

  • Piriformis (Gluteal Pain and Sciatica Symptoms)

  • Gluteus Maximus (Lower Back and Sacral Discomfort)

  • Obturator Internus (Deep Pelvic Pain and Hip Dysfunction)

Anatomy and Innervation

  • Origin: Ischial spine

  • Insertion: Coccyx and sacrum

  • Innervation: Branches of the sacral plexus (S4–S5)

The coccygeus is one of the smallest pelvic floor muscles, but its role in pelvic stability and coccyx movement is critical.

Patient Examination

A comprehensive examination should include:

  • Pelvic Palpation: Assess tenderness in the coccygeus and surrounding muscles.

  • Postural and Gait Analysis: Check for sacral misalignment or pelvic tilts.

  • Sitting and Standing Pain Response: Evaluate discomfort when transitioning from sitting to standing.

  • Internal or External Trigger Point Examination: For deep pelvic trigger points, an internal rectal or vaginal examination may be necessary by a trained specialist.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply sustained pressure over active trigger points (internal or external techniques).

  • Myofascial Release: Loosen fascial restrictions in the pelvic region.

Stretching

  • Pelvic Floor Relaxation Stretch: Lie on the back and gently pull the knees toward the chest.

  • Tailbone Stretch: Perform a seated forward lean with deep breathing to relax the pelvic floor.

Strengthening Exercises

  • Pelvic Tilts: Improve sacral mobility and stability.

  • Glute Bridges: Strengthen the glutes to reduce compensatory coccygeus tension.

Postural and Lifestyle Adjustments

  • Use a Coccyx Cushion: Helps relieve tailbone pressure while sitting.

  • Avoid Prolonged Sitting: Stand and move frequently to reduce stress on the coccyx.

  • Improve Bowel Habits: Use proper positioning to reduce pelvic floor strain.

Field Details
Name & Area Coccygeus; Posterior pelvic floor, spanning ischium to coccyx
Indications Tailbone pain, deep pelvic discomfort, lower back and sacral pain
Muscle Action Pelvic floor support, coccyx flexion, pelvic outlet closure
Signs & Symptoms Pain when sitting, rectal discomfort, difficulty rising from a seated position
Perpetuating Factors Falls, prolonged sitting, childbirth trauma, pelvic dysfunction
Trigger Point Referral Coccyx, sacrum, lower glutes, deep pelvic region
Differential Diagnosis Coccygodynia, pudendal neuralgia, sacral dysfunction, sciatica
Associated TrPs Levator ani, piriformis, gluteus maximus, obturator internus
Anatomy & Innervation Sacral plexus (S4–S5)
Corrective Actions Manual therapy, stretching, strengthening, lifestyle adjustments

Summary Table: Coccygeus Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.