Addressing Pain in the Clavicle and Tailbone: Rehabilitation Insights

Issues with the muscles on the right side of the coccyx and below the clavicle?

Hello Doctor, I have two issues that have been bothering me for a long time.
I visited a physical therapist in mid-July and saw an orthopedic doctor last week, but the problems remain unresolved.

The first issue is pain below my clavicle (I'm not sure if it's my pectoral muscle).
This has happened frequently in the past, usually starting after I go for a walk.
I'm uncertain if this is related to rounded shoulders causing the muscles near the clavicle to compensate when my arms hang naturally, leading to shoulder shrugging or the shoulder sinking down (especially when the shoulder is pushed forward and then down).
In the past, this pain would typically subside after about 3 to 4 hours, and I wouldn't feel it upon waking up.
However, about six months ago, while using a fitness ring, I performed a downward push motion (reference: https://www.youtube.com/watch?v=aOQb6om_MKY).
After some time, my right shoulder began to shrug and gradually became painful, and it would feel stuck halfway with abnormal pain, preventing me from shrugging it as high as my left shoulder.
Additionally, when I lower my shoulder, pinch my shoulder blades together, raise my arms to my ears, or lift my arms backward with my thumbs facing my body, I experience pain near my clavicle.
Although this issue tends to lessen after a period of activity during the day (heat therapy also helps), I still experience mild pain when performing the aforementioned movements, and my range of shoulder shrugging is still limited.
The troubling part is that this issue is most painful in the morning after waking up (possibly due to shoulder shrugging while sleeping on my side), so it remains unresolved.
I've also noticed that when I contract my right pectoral muscle, it often makes a sound near the sternum, while my left side does not have this issue.
The second issue is related to the right side of my coccyx.
Due to poor sitting posture in the past, I often found myself half-lying and half-sitting.
Sometimes, when I try to change positions, I realize I'm putting pressure on the right side of my coccyx, which causes significant pain when I get up.
Currently, the problem is that bending over (including getting up from a lying position) or tilting my pelvis backward while lying down causes pain.
Similar to the first issue, the pain is less noticeable after walking, standing, or sitting for a while (even with correct sitting posture, there is still a dull sensation on the right side of my coccyx).
However, if I lie down for about 10 to 20 minutes and then try to perform these movements, I start to feel significant pain.
I also experience the most pain upon waking up, and I feel pain even when getting up.
I've tried placing a pillow under my knees while lying on my back and using a pillow between my legs while lying on my side, but these methods have been ineffective.
This is the area I'm referring to: https://i.imgur.com/xzvRRII.png.
Last month, during my physical therapy session, I had muscle relaxation around my shoulders and lower back, and I also performed stretches for my pectoral muscles (https://i.imgur.com/meyfBzi.png), biceps (https://i.ytimg.com/vi/t7aV1XH9vyU/maxresdefault.jpg), and neck (https://img.edh.tw/c1/5/4583/38268858112_1c3f3d3b2e_o.jpg).
I also used a massage ball to roll on the area behind my armpit (https://i.ytimg.com/vi/85h0uVo_6DQ/maxresdefault.jpg) and did these two leg relaxation exercises (https://i.imgur.com/epce3Vf.png, https://i.imgur.com/ebN7eH1.png).
However, after following this routine for about a month and adjusting my posture, I can say there has been no improvement.
A few days ago, I consulted an orthopedic doctor at National Taiwan University, and after taking X-rays, he only mentioned that my bones are fine and that I have muscle inflammation, advising me to rest and stretch more, which left me feeling somewhat lost.
I have recently scheduled another physical therapy session for next month, so I would like to ask you, Doctor, what could be the underlying issues, or are there any methods to alleviate these two symptoms? I hope to at least find some relief before next month.
Thank you.

ah, 20~29 year old female. Ask Date: 2023/08/06

Dr. Lin Ruixiang reply Rehabilitation

Hello, based on your description, your symptoms are very similar to anterior humeral translation.
Performing these stretching exercises is generally appropriate and should not pose any issues.
Additionally, for the clavicle pain, it is important to consider the possibility of subclavius muscle pain, which may be associated with first rib subluxation.
It would be prudent to initially focus on the anterior humeral translation and the subluxation of the clavicle and ribs.
The second issue is a bit more complex, but you have already provided the answer.
Since we typically load the right side, it can lead to the pelvis being stuck in an anteriorly tilted position.
The primary exercises should involve stretching the iliopsoas muscle and strengthening the gluteal muscles to enhance the corrective force on the pelvis.
Note: The concept of subluxation in rehabilitation medicine differs from that in orthopedic medicine, so they should not be conflated, and there is no need for excessive concern.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2023/08/06

More Info

Hello,
Thank you for sharing your concerns regarding the pain in your clavicle and tailbone. Based on your description, it seems that you are experiencing two distinct but potentially related issues: pain in the area beneath your clavicle (possibly involving the chest muscles) and discomfort in your tailbone, particularly on the right side. Let's address each issue separately and explore potential rehabilitation insights.

Clavicle Pain
The pain you describe under your clavicle, especially after activities like walking or specific movements, may be related to muscle strain or overuse, particularly involving the pectoral muscles or the rotator cuff. Your mention of "rounded shoulders" suggests a postural issue that can lead to muscle imbalances. When the shoulders are rounded, the muscles around the shoulder girdle, including the pectorals and trapezius, may become tight, while others, like the rhomboids and rotator cuff muscles, may weaken. This imbalance can lead to pain and restricted movement.

The fact that you experience pain when lifting your shoulder or during certain movements indicates that there may be some underlying muscular or tendinous irritation. The popping sound you hear when contracting your right pectoral muscle could suggest a tightness or a minor issue with the muscle or tendon itself.

Tailbone Pain
Regarding your tailbone pain, it seems to be exacerbated by poor sitting posture and specific movements like bending or transitioning from lying down to sitting. This discomfort could be due to coccydynia, which is pain in the coccyx (tailbone) area, often resulting from prolonged sitting, trauma, or poor posture. The fact that you feel more pain in the morning may indicate that your sleeping position is contributing to the issue, possibly by placing undue pressure on the tailbone.

Rehabilitation Insights
1. Postural Correction: Addressing your rounded shoulders is crucial. Engaging in exercises that strengthen the upper back (like rows and reverse flys) and stretching the chest muscles can help restore balance. Consider working with a physical therapist who can provide tailored exercises and monitor your progress.

2. Strengthening and Stretching: Incorporate a routine that includes both strengthening and stretching exercises. For your shoulder, focus on rotator cuff strengthening exercises, such as external rotations and scapular retractions. For your tailbone, pelvic tilts and gentle stretches for the lower back and hips can be beneficial.

3. Ergonomics: Evaluate your sitting posture. Use supportive chairs that promote proper alignment, and consider using cushions designed for tailbone pain. When sitting, keep your feet flat on the ground and your back straight.

4. Heat and Ice Therapy: Applying heat to the shoulder area can help relax tight muscles, while ice can reduce inflammation. Alternating between the two may provide relief.

5. Physical Therapy: Since you have already scheduled a follow-up with a physical therapist, ensure that you communicate all your symptoms clearly. They can provide manual therapy, modalities like ultrasound or electrical stimulation, and a structured exercise program.

6. Activity Modification: While you are waiting for your next appointment, try to modify activities that exacerbate your pain. Avoid heavy lifting or movements that cause discomfort.

7. Mindfulness and Relaxation Techniques: Stress can exacerbate pain perception. Techniques such as deep breathing, yoga, or meditation can help manage stress and improve your overall well-being.

Conclusion
While it can be frustrating to deal with persistent pain, especially when previous treatments have not yielded results, it’s essential to remain proactive. Continue to communicate with your healthcare providers about your symptoms and progress. If your pain persists or worsens, further imaging studies or referrals to specialists may be necessary to rule out any underlying conditions.

I hope this information helps you find some relief and clarity regarding your symptoms. Please take care, and I wish you a speedy recovery.

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