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!
Yesterday, I really enjoyed teaching medical students about my field: Physical Medicine and Rehabilitation (PM&R).
Throughout the year I teach medical students where I work, at Rutgers New Jersey Medical School.
But this once-a-year “Medical Student Fair” brings in medical students from many different medical schools from around the country.
The students learn about PM&R and they rotate through stations to learn about different areas of practice within the specialty. My station was the fluoroscopy suite, where they learned about evaluating and treating patients in pain, including the use of fluoroscopically-guided spinal injections for back pain, coccyx pain (tailbone pain), etc.
It is great to teach these students, since they will be our next generation of physicians. They were a terrific bunch.
Patrick Foye MD (center) teaches about PM&R, Spinal Injections, and Fluoroscopy
Patrick Foye MD teaches Medical Students about PM&R and Fluoroscopy
Group Photo, Medical Students learn about PM&R. Awesome group!
Dr. Foye recently attended the Pain Medicine Symposium 2017, which is a medical conference for pain management physicians.
The conference was run by the New York Society of Interventional Pain Physicians (NYSIPP) and the New Jersey Society of Interventional Pain Physicians (NJSIPP).
There were physician experts speaking and attending from around the world. Modern treatments were covered, including regenerative medicine (Platelet Rich Plasma [PRP] injections, stem cell injections, etc.), neuromodulation procedures, nerve ablation, injections and other procedures done under fluoroscopic guidance, injections and other procedures done under ultrasound guidance, etc.
It was a terrific conference and a great chance to network and reconnect with other physicians who also specialize within the field of pain management.
Conference, NJSIPP, NYSIPP, New York Society of Interventional Pain Physicians and New Jersey Society of Interventional Pain Physicians, 2017
Patrick Foye MD at NYSIPP NJSIPP New Jersey Society of Interventional Pain Physicians, NYC skyline
Patrick Foye MD, Fluoroscopy Lab at NYSIPP NJSIPP New Jersey Society of Interventional Pain Physicians, Conference 2017
Patients sometimes ask me whether the “spinal cord” is located at their coccyx.
It’s a reasonable question, since the spinal cord does extend through most of the human spine.
What is the Spinal Cord?
The spinal cord is a dense, relatively tightly packed collection of nerves.
The spinal cord is almost like a big, thick electrical cable, with lots of electrical wires (nerves) going through it.
But it’s more complicated because there is also a complex system of connections that work like relay switches (synapses), where electrical signals get turned on and off.
Where is the Spinal Cord and the Spinal Canal?
In general, the “spinal cord” itself goes from the base of the brain down to the upper lumbar region.
Usually the lowest part of the spinal cord is at about the level of the 1st or 2nd lumbar vertebral bone, which, for reference, would be a few inches ABOVE your belt line or waistband.
So, the spinal cord is relatively far away from the tailbone in the vast majority of patients.
(A small percentage of patients may have a spinal cord that is “tethered” down, sometimes seen in people with spina bifida, for example, but even then it would not be so far down that it would be expected to be down at the level of the coccyx).
However, the spinal CANAL extends downward through the sacrum.
The coccyx does NOT have a spinal cord within it, and the coccyx does NOT have a spinal canal within it.
The “Meninges” are “Lining” for the Spinal Canal
The walls on the inside of the spinal canal are mostly made of spinal bones.
But there is a lining inside the bones. It’s sort of like the way that there is a plastic lining inside of the walls of a swimming pool. This lining keeps the spinal fluid from leaking out.
The lining of the spinal canal is called the “Meninges” or meningeal lining or meningeal layers. It includes the dura mater, arachnoid mater, and pia mater .
The meningeal lining is almost like Saran wrap or whatever you call plastic wrap in your part of the world
Although the coccyx does not have any spinal canal within it (unlike the rest of the human spine)… BUT… some of the meningeal fibers that line the spinal canal do extend down through the sacrum and a few of those fibers attach at the top of the coccyx. This is probably not clinically significant in the vast majority of patients, but it rare cases patients may have tension or tugging or tightness of those fibers, where movements or tightness at other levels of the spine may cause tension/tugging on the coccyx, and vice versa. It’s uncommon, but possible.
OTHER Nerves at the Coccyx
Since there is no spinal cord at the coccyx, does that mean that there are no at the coccyx region???? …… No! Definitely not!
There are lots of other nerves at the coccyx.
Examples include normal somatic nerve fibers that carry pain and other sensation from the coccyx and surrounding tissues.
The skin over the coccyx is innervated by nerves.
Importantly, the ganglion Impar is located at the level of the upper coccyx.
In summary, the spinal cord itself is NOT located at the coccyx. But other nerves ARE located at the coccyx.
There are many reasons why doctors choose to specialize in a given area of medicine.
The video below was done by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) regarding why doctors choose to specialize in Physical Medicine and Rehabilitation (PM&R). It features Patrick Foye, M.D., and other PM&R physicians.
