Pain and Discomfort Near the Spine and Tailbone

Pain, tingling, or inflammation may occasionally occur near the spine close to the buttocks?

Hello Dr.
Kang,
I am 25 years old and have been experiencing pain, tingling, or inflammation in my lower back near the sacrum for the past two to three years.
The frequency of the pain has increased this year, with three episodes of more severe symptoms.
Each time, I initially felt soreness at two points near the sacrum for a few days, followed by an inability to stand up straight after getting out of bed the next day (as if my pelvis and the tail end of my spine couldn't support me).
I also have difficulty sitting for long periods, and during severe episodes, I have to walk bent over and spend the entire day lying down.
After resting for two to three days, I return to normal, but now I feel tightness in the back of my left thigh extending to the area behind my knee, and I want to stretch it out.
The two bony protrusions near my sacrum always feel sore.

When I try to sit and extend one leg straight with my toes pointing towards my body, I experience pain at the junction of my hip and thigh bone, regardless of whether I stretch my left or right leg, but it is more painful on the left side.
Initially, when this started in the first year, it wasn't as severe (it happened suddenly after running one day), and I only had lower back pain that prevented me from turning.
I consulted a pain specialist who administered an injection and prescribed medication, and I felt better the next day.
Over the next six months to a year, I occasionally experienced lower back pain, which initially improved with topical analgesics like Salonpas, but eventually, the patches became ineffective, and I had to get another injection (which I assume was a muscle relaxant).
There was a period when I would wake up with neck stiffness and an inability to turn my head, but after receiving a massage (commonly referred to as "muscle release" in Taiwanese), I felt better.

Last year, I consulted an orthopedic doctor who had me lie down, hug my knees, and push them towards myself, as well as squat, and I did not experience pain during those movements.
The doctor concluded that it was likely not a bone issue.
In late April of this year, I visited a surgeon who took two X-rays (around the tailbone and sacral area).
After reviewing the X-rays, the doctor also said there should be no issues with the bones.
However, I noticed some fine lines at the junction of the left bone (where the femur connects to the upper bone) on the X-ray displayed on the wall, but the doctor said it was not significant.
(I always visit the doctor after resting for two to three days when I can move around.)
Now, I am wondering which specialty I should consult next: neurology, rehabilitation, or rheumatology? I also cannot sit for long periods; what should I do? I have been getting up to walk every 30 minutes, but I still feel like my body cannot handle it.
My job requires me to sit at a computer desk for extended periods.
Thank you for your response!

Xznthe, 20~29 year old female. Ask Date: 2001/02/02

Dr. Pan Yingda reply Rehabilitation

Based on your description, I suspect it may be an issue with the sacroiliac (SI) joint (the area you referred to as the two bones in the upper buttocks).
If the pain is worst upon waking and improves with movement, it could indicate inflammation of the sacroiliac joint, and you should consult a specialist in allergy, immunology, or rheumatology.
If there is no pain during general activities or sitting, but pain occurs with specific movements or positions, it may suggest a misalignment of the sacroiliac joint that needs to be corrected.
Have you experienced a fall that caused you to land on your buttocks? Here are my recommendations: 1.
Adjust the height of your desk and chair; consider using a kneeling chair (this helps keep your spine straight and your center of gravity forward).
2.
Avoid maintaining the same posture or position for too long, including while sleeping.
3.
Avoid sleeping on a spring mattress.
4.
Improve your flexibility through regular exercise, such as brisk walking.
5.
Here’s an exercise for you: Sit upright with your spine straight, take a towel and wrap it around your thighs near the knees, then push your knees outward with force (this is called an isometric contraction exercise), hold for five seconds, then relax (that counts as one repetition).
Do this five times, and repeat whenever you have the opportunity.
6.
Manage your stress effectively.

Reply Date: 2001/02/02

More Info

Understanding pain and discomfort near the spine and tailbone can be quite complex, especially when it involves multiple symptoms and potential underlying issues. Based on your description, it seems that you have been experiencing a range of discomforts, primarily around the tailbone (coccyx) and lower back, which have progressively worsened over the past few years.
Your symptoms, including sharp pain, tightness in the hamstrings, and difficulty standing straight, suggest that there may be a combination of musculoskeletal and possibly neurological factors at play. The fact that you have had intermittent relief from injections and medications indicates that there may be an inflammatory or muscular component contributing to your pain.

Potential Causes of Your Symptoms
1. Coccygodynia: This is a common condition characterized by pain in the tailbone area, often exacerbated by prolonged sitting or certain movements. It can result from trauma, prolonged pressure, or inflammation of the surrounding soft tissues.

2. Muscle Imbalances: Given your description of tightness in the hamstrings and discomfort in the lower back, muscle imbalances may be contributing to your pain. Weakness in certain muscle groups can lead to overcompensation by others, resulting in pain and discomfort.

3. Nerve Compression: The symptoms you describe, such as the inability to stand straight and the sensation of tightness in the legs, may suggest some form of nerve involvement, possibly related to the sciatic nerve or other lumbar nerves.

4. Postural Issues: Long periods of sitting, especially in a non-ergonomic position, can lead to poor posture, which may exacerbate pain in the lower back and tailbone area.

Recommended Steps for Management
1. Consultation with Specialists: Since you have already seen orthopedic and pain specialists, it may be beneficial to consult a physical medicine and rehabilitation (PM&R) specialist or a neurologist. A PM&R specialist can help with musculoskeletal issues and may provide a comprehensive rehabilitation plan. A neurologist can assess for any nerve-related issues.

2. Physical Therapy: Engaging in physical therapy can be highly beneficial. A physical therapist can design a tailored exercise program to strengthen weak muscles, improve flexibility, and correct postural issues. They may also use modalities such as ultrasound or electrical stimulation to reduce pain.

3. Ergonomic Adjustments: Since your work requires long hours of sitting, consider making ergonomic adjustments to your workspace. Use a chair that provides proper lumbar support, and consider using a cushion designed for tailbone pain. Taking regular breaks to stand and stretch is also crucial.

4. Pain Management Techniques: Continue using non-steroidal anti-inflammatory drugs (NSAIDs) as needed for pain relief. Heat therapy can also be helpful in relaxing tight muscles. If your symptoms persist, discussing other pain management options, such as corticosteroid injections or nerve blocks, with your physician may be warranted.

5. Lifestyle Modifications: Incorporate regular physical activity into your routine, focusing on low-impact exercises such as swimming or cycling, which can help maintain fitness without putting excessive strain on your back. Stretching exercises for the hamstrings and lower back can also alleviate tightness.

6. Mind-Body Techniques: Techniques such as yoga or Pilates can improve flexibility, core strength, and posture, which may help alleviate some of your symptoms.

Conclusion
Your situation is multifaceted, and addressing it will likely require a combination of medical intervention, physical therapy, and lifestyle changes. It’s essential to communicate openly with your healthcare providers about your symptoms and how they affect your daily life. By taking a proactive approach and seeking the right specialists, you can work towards finding relief and improving your quality of life.

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