Which Xray Views are Best for Evaluating Tailbone Pain, Coccyx Pain?
I recently did a video explaining which views are best when doing x-rays (radiographs) for coccyx pain (tailbone pain).
Here is the text from that video, and the actual video itself is down below.
(The actual video is at the bottom of this page.)
Hi. I’m Dr. Patrick Foye.
I’m an M.D., or Medical Doctor, and I am the Director of the Coccyx Pain Center or a Tailbone Pain Center here in the United States, online at www.TailboneDoctor.com.
And here I’m going to explain the difference for x-rays of the front view and the side view and why that’s important if you have tailbone pain.
So just to sort of orient you… For starters here this is a plastic model of the pelvis and this is looking at the pelvis from the front.
Here you’re looking at it from the side.
And now you’re looking at it from the back.
And the tailbone is right down here.
And the larger bone above that is the sacrum and the easiest way to show this is without showing the entire pelvis, but just showing here the sacrum and then down below that is the coccyx or tailbone.
So now you’re looking from the back and this is from the side and that’s from the front.
So I’m going to draw these here just to give you a sense of what you’re looking at when you look at the sacrum and coccyx.
So the sacrum (and I’m no great artist) but the sacrum is sort of like that and then the tailbone is down below it.
The sacrum has five segments (one two three four five) and the sacrum is essentially fused together into one solid bone.
And then the tailbone is more variable.
It’s much smaller than the sacrum as you can see here.
The **TAILBONE** is much smaller and it’s usually anywhere from three to five bones they may or may not be fused.
Now if you look at it so that’s basically looking at it sort of from the front we’re back in that particular plane.
How about if we look at it from the side well that’ll look something a little more like this: it has a curve to it and it’s bigger at the top and gets more narrow down at the bottom.
And then we’ll draw coccyx down here roughly continuing that curve.
I’m going to move this camera because there may be a little glare there okay.
(I think it made it worse!) Alright, there we go.
Alright, so basically that and again the sacrum (with its five segments) and the tailbone (with anywhere from three to five segments).
Again the tailbone being much smaller.
So how is this relevant when it comes to getting the proper x-rays?
Well, if you get x-rays that are done in the in the “front” view…
So basically in medicine they call that a “frontal” view, or they may call it an “A-P” view for “Anterior to Posterior”.
Then there’s some things that can come in the way of getting a good view of the tailbone.
So let’s take a look at those.
So basically if we look at our front view here, well in that view because we’re taking the x-ray like this, number one you can see here how the pubic bones up in the front of the pelvis can block the view of the coccyx.
So right now from your vantage point of the camera or your eye you can’t see the tailbone at all.
So, the first thing that the radiology technician needs to do is to tilt the camera angle so that now you can see the coccyx back here whereas without that tilt if they do a straight AP view or front view they can see most or all of the sacrum but would not be able to see the coccyx.
So that tilt becomes very important.
Even if they do the tilt, there’s still problems with the front view and I’ll show you that here.
Well, what’s up in the front of the pelvis that’s going to be in front of the coccyx? Well, there’s the urinary bladder (the bladder where we collect urine before we pee).
So that’s going to be up here and you’ve got some urine in there so that’s going to sort of block the view.
The other thing that’s in front of the tailbone is the uterus in women and in men and women there’s the rectum or colon (the part of the large intestine where stool collects, feces collects before having a bowel movement).
So basically now you’ve got your stool collecting in that area and now you can see why you’re going to have a tough time on that front view really getting any decent detail in your imaging of the coccyx.
So now let’s take a look…
[I’m going to change this camera angle to avoid the glare a little bit] So now let’s take a look from our side view.
Well on our side view (which is over here this is behind you and this is in inside of your pelvis)…
Well the bladder would be all the way up front of you here and then your colon would be here with its stool and you can see now with that unlike the view here from the FRONT where it’s BLOCKING the view of the tailbone, here at the view from the SIDE this is NOT blocking the view of the tailbone.
The tailbone is still nice and clear.
So I would say probably 99 times out of 100 (maybe more) the SIDE view is going to be much more helpful and much more important when it comes to showing the coccyx.
So again this is our front view, where in medicine we call that a frontal view some which is sometimes referred to as a AP view which stands for anterior to posterior view.
So that’s there.
As opposed to over here where we have our side view, which in medicine, medically we call that a “lateral” view.
Now this is different now I’m talking about x-rays.
It’s different if we are looking at MRIs and CT scans because those take images and slices.
There are some corollaries for those but I’ll probably go into that in another video because it’ll just get too long to say it all on this one.
So the take-home message really is that unfortunately there’s lots and lots of times where people have tailbone pain and the only view that they order in the emergency room or when they see their primary care doc or even their musculoskeletal doctor (if the doctor is not experienced in treating tailbone pain) is that they’ll get this front view which doesn’t really show the tailbone very well at all, either because they didn’t tilt to have the tailbone included so then it’s blocked, or they did the tilt but even so you’re looking through the bladder or the uterus the stool within the colon or rectum all of that and you really can’t see the tailbone very well.
And then unfortunately people are told we didn’t see anything abnormal so your tailbone must be fine, which is sort of misleading…
it may be true that they didn’t see anything abnormal but they didn’t see anything abnormal because they didn’t get a good view of the tailbone in the first place!
So really then what becomes much more important is to get this side view or lateral view for people who have tailbone pain, because that will typically show a lot more detail.
Now beyond this there’s also having that lateral view done sitting versus standing which we can talk about in another in another video, because that’s really important as well, because there’s lots of times where people may look normal while they’re standing up but when they sit and put their body weight onto the tailbone (which is usually when they’re most painful) then they may have an abnormality or dislocation that only shows up on the sitting x-rays.
But that’s for another video.
So on this one just simple things first: frontal view can help with some things but really what’s most important for people with tailbone pain usually is that SIDE view or LATERAL view.
And I see this very very commonly: patients fly in to see me from around the country and sometimes internationally and there’s unfortunately lots and lots of times where people bring with them their CDs (which I appreciate) and we look at the imaging that were done that’s on the CDs of their x-rays, that they were told was were normal years ago when they first started having tailbone pain when the imaging were done.
And we realize there’s not a decent view of the tailbone to begin with.
And that can be very frustrating of course for patients.
So, anyway, I hope this information is helpful for you.
Tailbone X-rays, Side-View versus Front View, for Tailbone Pain, Coccyx Pain,
Sitting x-rays:
Note: This video, above, does not address the SITTING x-rays, which is even better. Most of local radiology centers will never have even heard of sitting-versus-standing x-rays, and will not be able to do those. But they should at least be able to do the front views and side views that I describe in this video above.
Falls on Snow and Ice can Cause or Worsen Tailbone Pain, Coccyx Pain
In the video below, Dr. Patrick Foye (Director of the Coccyx Pain Center, Tailbone Pain Center) discusses how slips and falls on the snow and ice can cause or worsen tailbone pain.
Here is the text, and the video is below.
Hi. I’m Dr. Patrick Foye and I’m an M.D., or medical doctor, and I’m the Director of the Coccyx Pain Center (Tailbone Pain Center) here in New Jersey, online at www.TailboneDoctor.com
And I’m standing here in a bit of a snowstorm, not too much although it’s pretty cold, maybe in the 20s Fahrenheit [minus 6 Celsius].
I’m here to talk about one of the things that causes tailbone pain or flares it up for people that have tailbone pain is people who slip and fall on the snow and ice.
So I guess this is a bit of a public service announcement.
If you have tailbone pain or even if you don’t then you want to avoid having tailbone pain, you definitely want to do what you can to avoid slips and falls.
Things you can do:
make sure that you have good footwear that has good traction.
Go slowly.
Go cautiously.
And keep an eye out for snow and ice. [He says, while being pelted by snow and ice!]
I have had many many patients over the years who their tailbone pain was initially caused by a slip and fall on the snow and ice.
Or, they had tailbone pain and did very very well when they came for treatment here and then did well for years and then had a slip and fall and the tailbone pain came back as bad as it was before.
So, again, just to caution you to watch out for the snow and ice if you are someone who has had tailbone pain in the past.
Okay. Hang in there.
Stay warm.
And if you are looking for more information on tailbone pain you can find me online at www.TailboneDoctor.com.
Or if you’re looking for a copy of my book, the easiest place to find that is if you go to www.TailbonePainBook.com.
Okay. Thank you. Bye-bye now.
Here is the video:
The snapshot below shows the moment in the video when Dr. Foye was pelted by a gusty wind of snow:
Falls on Snow and Ice can cause Tailbone Pain, Coccyx Pain. Photo shows Dr. Foye pelted by wind and snow while making the video. 🙂
The video is at the bottom of this page. Here is the text:
I’m going to tell you a story that’s crazy, but true, of how I used a yellow highlighter to cure cancer in my father-in-law and then I’ll tell you how it’s related to tailbone pain.
I’m Dr. Patrick Foye. I’m an M.D., or medical doctor, and I’m the Director of the Coccyx Pain Center or Tailbone Pain Center here in New Jersey.
About 20 years ago, shortly after I first got married, we got a phone call from my wife’s family in the Midwest, Chicago area, that my father-in-law, who was in the hospital in Chicago (he’s a former Notre Dame football player) and unfortunately they saw on his imaging studies what looked to be a cancer in his lungs.
And it was actually pretty clear that it looked pretty bad, pretty destructive.
It showed up incidentally on some imaging studies that he had done while he was at in the hospital for something unrelated.
And the plan was for him to have a biopsy where they would basically make a small surgical incision in the skin and they would go in and take a sample of tissue so that they could send it to the pathology to do slides to take a look and figure out exactly what type of cancer it was and all of that.
And he told them at the hospital, he said “well, you know, my son-in-law is a doctor.
He’s in new jersey and my and my daughter is there. Can you fax them a copy of the imaging results?” And the hospital did.
Now what I did when I got the imaging results was the exact same thing I pretty much always do when I get imaging results, which is I take a yellow highlighter and I highlight the important factors in the report.
It’s something I’ve been training medical students and residents.
It’s incredibly simple, right? It’s not rocket science.
And the very first thing that I typically always highlight is the patient name.
So I get the fax and I highlight the patient name.
But it’s not his name.
It wasn’t his imaging results.
And it turned out that somehow someone else’s report got mixed up into his chart.
And they were planning this whole diagnostic workup the family was sort in a in a whole kerfuffle worried that he had cancer when indeed he had no cancer at all.
It was somebody else’s report that happened to make it into his chart.
And apparently the medical team there hadn’t noticed and they thought it was his.
So they were consulting other doctors to do the biopsy and everything else.
And so that was basically a very very simple step of using a yellow highlighter to you could sort of say “cure” cancer.
At least in his case, that he was thought to have cancer and with one stroke of a yellow highlighter no longer had cancer when we called the team out there and got that all straightened out.
Now, how is this related to tailbone pain, which is what I treat?
I’m the Director of the Coccyx Pain Center (Tailbone Pain Center) here in new jersey, online at www.TailboneDoctor.com and it’s related to tailbone pain because patients come in to see me from all over the country and occasionally internationally.
And we typically tell them to bring with them any reports that they have from previous imaging studies that they’ve had of the tailbone, procedures they’ve had from surgeries or injections at the tailbone.
But even for patients who can’t make their way here to New Jersey to see me in person, my recommendation would be collect your medical records, your radiology reports from your x-rays your MRIs, your CT scans, bone scans, whatever studies you may have had done.
And take a simple yellow highlighter.
And what I recommend is that you highlight number one your name (to make sure that it’s actually your report), the date for when it was done, and highlight (if your main symptom is coccyx pain or tailbone pain) highlight the word coccyx or tailbone or coccygeal anytime that that appears in the report.
And I guarantee many of you will be shocked to find out that your x-ray report, or your MRI or CT report, never even includes the word coccyx or tailbone! That the radiologist never made any comment whatsoever on the appearance of your coccyx, the appearance of your tailbone, even though that was the presenting symptom the main reason that you went in for the evaluation in the first place.
I know that that probably sounds really crazy, but i see this practically every single day here at the coccyx pain center when patients come in and we look through their reports.
And they’re shocked to realize they’ve had this pain going on for years and years, they had the imaging studies done years ago, they were told everything was normal and in fact the radiologist never actually looked at the tailbone at all.
And often the imaging studies never even included the tailbone at all! It was done of the lumbar spine.
So it’s a really really simple tip that often can pay big dividends because you can then go back to your doctor and say “hey, the imaging studies that were done for my tailbone did they even include the coccyx? The radiologist didn’t make any comment on it.
Or the physical exam notes from the physician never included documentation of a physical exam of the coccyx..
Or the procedure note shows that the procedure that was done was an injection at the lumbar epidural space or at the sacroiliac joint or a caudal epidural, none of which are an injection specifically at the coccyx.
So, again, many of you will be surprised what you can find out just by reviewing your medical records.
Collect your medical records.
Use a yellow highlighter.
Yellow is really good because if you need to make photocopies the yellow is light enough that you’re not going to obscure or blacken out the information that you want.
So don’t use a blue or orange highlighter. They’re not as good for those purposes.
There’s a there’s a whole chapter in my book which is Tailbone Pain Relief Now! I have an entire chapter in the back about collecting and have how to handle your medical records and navigate the healthcare system and some of the caveats or the hurdles that are in place for people with tailbone pain.
Because it’s often sort of this black box that physicians, radiologists, pain management doctors, musculoskeletal physicians, don’t pay attention to some of those details.
So, again, use the yellow highlighter because it can really it can really help you to see what was missed on your imaging studies.
Or perhaps the imaging studies are not yours at all!
Okay, again, I’m Dr. Patrick Foye.
Online you can find me at www.TailboneDoctor.com
Or if you’re interested in getting a copy of the book “Tailbone Pain Relief Now!” which is 272 pages all about the tailbone (diagnostic workup, treatment, etc.) that is available: on Amazon is probably the easiest way to find it if you just put in “TAILBONE” and the word “FOYE” (my last name) (spelled “F as in Frank, O – Y – E”) you can find that there.
So anyway I hope that’s helpful for you.
Use your highlighter you’ll find it super helpful.
Wedge Cushions versus Donut Cushions for Coccyx Pain (Tailbone Pain)
I did a small research study evaluating whether patients with coccyx pain (tailbone pain) preferred wedge cushions versus donut cushions (doughnut cushions).
The abstract was published in 2009.
The results: Among patients with coccydynia who tried both types of cushions, many patients preferred neither. But patients with a preference were almost 5 times more likely to prefer wedge cushions as compared with donut cushions.
Abstract, as published:
OBJECTIVES: To assess which types of cushions are better at relieving tailbone pain for patients with coccydynia (coccyx pain). Specifically, the objective was to study these patients’ preferences comparing donut cushions (circular cushions with a hole in the center) versus wedge cushions (cushions with a triangular wedge shape cut out posteriorly to thus avoid coccygeal contact with the cushion).
DESIGN: A retrospective chart review.
RESULTS: At the time of the study, charts were available for 171 patients with coccydynia, all of whom had been evaluated by a single physiatrist at a university-based outpatient musculoskeletal/pain practice. Within the patients’ initial evaluation notes, there was documentation that 55 (32%) of these patients had tried using both coccyx wedge cushions and donut cushions, including 40 females and 15 males, with an average age of 49 years. Of these 55 patients who had tried both types of cushions, 19 patients (35%) preferred the wedge cushions, while only 4 patients (7%) prefer the donut cushions. 4 patients (7%) liked both types of cushions equally, while 23 patients (42%) preferred neither type of cushion.
CONCLUSIONS: Among patients with coccydynia who tried both types of cushions, many patients preferred neither. But patients with a preference were almost 5 times more likely to prefer wedge cushions as compared with donut cushions. This data may help guide patients and doctors regarding which cushions to try first.
Here is the abstract information, as published:
Journal: American Journal of Physical Medicine and Rehabilitation
Publication date, page: 2009 Mar; 88 (3): S56
Authors: Patrick M. Foye, MD, Sean O. Sanderson, BA, and Jason A. Smith, BS
Author contact information: Patrick M. Foye, MD, Director, Coccyx Pain Center, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, 90 Bergen St., DOC-3100, Newark, NJ 07103-2499. Phone: (973)972-2802. Fax: (973)972-2825. https://tailbonedoctor.com
Photos of a Coccyx Wedge Cushion and a Coccyx Donut Cushion:
Coccyx Wedge Cushion for Coccyx Pain (Tailbone Pain)
Donut Cushion (Doughnut) for Coccyx Pain (Tailbone Pain)
Coccyx Wedge Cushions for Tailbone Pain, Coccyx pain.
For most people with coccydynia (coccyx pain, tailbone pain), the best cushions to use are “wedge cushions”.
These are usually better than donut cushions (doughnut cushions).
See the video:
Transcription Text from the Video:
Hi. I’m Dr. Patrick Foye.
I’m an M.D. or medical doctor and I’m the Director of the Coccyx Pain Center or Tailbone Pain Center, online at www.TailboneDoctor.com.
And in this short video I’m just going to talk a couple of minutes about different types of cushions that people use for tailbone pain.
So there’s lots of different cushions that are available.
I’ve done an earlier video on this as well.
But in this one I’m just going to kind of update to show a couple of different types of wedge cushions.
So unlike doughnut cushions, which have a hole in the middle, those are typically not so great for most people with tailbone pain.
Most people do better with what’s called a wedge cushion, where it has a cutout in the back.
The idea that the cutout in the back is that the tailbone sort of hovers over that cutout, so that the tail bone does not make contact with a chair that you’re sitting on.
so if this is the cushion here, I’ll set it up here so that the cushion is closest to you the viewer, and if this was somebody who’s sitting facing that way, they’re basically sitting like this, so that you can see that the tailbone, or coccyx, is kind of hovering over the hole here so that it doesn’t make contact with the chair and then the person doesn’t have as much pain.
So it’s called a wedge cushion because it has that cutout or wedge.
Sometimes it’s triangle-shaped or u-shaped like this.
It also has a wedge because you can see from the side from the side view it has kind of a slope to it and what that slope does is that while you’re sitting it keeps you into a little bit of forward flexion, which also brings the tailbone forward so it’s not leaning back which is typically would be worse for the tailbone.
So that’s a typical wedge cushion.
A lot of times it will have a handle like this to make it relatively convenient for you to just carry along.
So that’s a wedge cushion… example number one. That one happens to be Car Cush.
This is a different one here.
This one is an Adiona and this one is actually a memory foam cushion because one of the problems sometimes with the cushions is that sometimes when you get them they seem fine, but then they if they’re not firm…
If they’re too firm then they’re going to cause other problems and pain at the areas that are taking pressure.
But if they’re too soft or if the sort of the firmness fades over time then it flattens out.
This one is still relatively new but sometimes they may flatten out and then it gets too thin and then it’s not lifting the tailbone up and then it’s not it’s not really working or performing doing its function.
So then what can be done is instead to use a memory foam cushion or a cushion that’s more firm.
This one happens to be a memory foam cushion.
Again you can see that it has that wedge shape or cutout and the idea there is that again that that the you know coccyx or tailbone sort of hovers over the area where the hole is so that your other sit bones which are basically (let me see if I can get the angle looking okay) your sit bones here (your ischial bones) are bearing the weight when you’re sitting down but not bearing the weight at the coccyx.
So this is another example of a wedge cushion.
Again this one has a handle is just on the side so again makes it convenient to hold and carry.
And this one in addition to the cutout here you can see that there is if you look here there’s a little bit of a bump up in the front so that can provide some additional support in the front.
So that can be helpful for some patients as well.
Other patients may actually want there to be not even a flat surface there in the front which would be something more like this.
So here you can see now that this is giving you space to sit on both sides, so basically you’d be kind of straddling these two areas.
How far you apart you want them you can adjust because this is Velcro and basically when you use that Velcro you can move these a little bit closer if you’re somebody who has a narrower pelvis or you can move them a little farther apart if you have a wider pelvis.
And this particular cushion I would say is not necessary for the majority of patients with tailbone pain.
However if you’re someone who has tailbone pain so you don’t want the pressure at the back at where your tailbone is but you also don’t want any pressure up in the front (let’s say if you’re a male patient and you’re having pain at the scrotum or testicular area or if you have perineal pain [which is kind of that area from the anus up front to the external genitalia in males or females] if that area is painful and sensitive, or if you’re a female patient who has pain in the external genitalia that’s worse with pressure in that area) then a cushion like this may be helpful because it takes the pressure off of that area as well.
Again this is I would say it’s less than five percent of my patients with tailbone pain that would need or want a cushion like this.
But for that subgroup this can be very very helpful.
This one happens to be… let me find the name for you… (and again has a as a handle) and this one is called “Cushion Your Assets” so “Cushion Your Assets” (if that’ll focus there).
And the thing about this it actually has two handles because you can actually fold it up like this and it almost looks like a small purse or reminds me kind of a the old fashioned doctor’s bag.
So that’s an option as well.
But again not for the majority of patients most people would do fine or better with a regular standard cut out in the back only you know where you have the coccyx there.
So anyway… All right so that is so that’s the scoop in terms of a couple of different types of wedge cushions specifically used for people with tailbone pain.
What did an early 1900’s Medical Book Say About Coccyx Pain, Tailbone Pain?
At an Irish restaurant in New Jersey, I noticed that the bookcase behind me had a bunch of medical books.
So, I looked through them and found a few pages specifically on the topic of coccyx pain (tailbone pain, coccydynia, coccygodynia).
The book had the name of the person who owned it 1960. It did not list the date printed, so I am guessing it was from the 1950’s, but it may be even older because when I got home and looked it up it seems that these “Harmsworth Home Doctor” medical book series were popular in the 1920’s. Printed in London.
I think it oversimplifies treatment of tailbone pain. One sentence says, “If the pain does not yield to treatment, removal of the bone is required and it is a comparatively simple operation that causes no subsequent inconvenience.”
Below is a video I made about this, along with photos showing the coccyx pages of that book.
Here is the video:
Here are the photos of the pages that discuss the coccyx, including tailbone anatomy and tailbone pain.
Book Cover from early 1900’s, Harmsworth Home Doctor
Title page for this volume of Harmsworth Home Doctor, from ~early 1900’s.
Coccyx Pain, 1950s, Page 1, Tailbone Pain
Coccyx Pain, 1950s, Page 2, Tailbone Pain
Here is the text from the video:
Transcription not yet available…
The book mentions ABC Liniment
I wondered… what ointments and liniments were applied to the skin ~70 years ago?
The book did specify “A.B.C. Liniment”.
So I looked it up.
ABC Liniment: Compound liniment of aconite, consisting of equal parts of the liniments of;
Aconite (a poisonous plant also known as ‘devil’s helmet’),
Belladonna (also known as ‘deadly nightshade’), and
Chloroform (which used to be used as an inhaled anesthetic, but now is mainly used to manufacture refrigerant freon).
Not something that we would use in the current century!
