Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Coccydynia


Related Terms

  • Coccyalgia
  • Coccygeal Pain
  • Coccygodynia
  • Coccyx Injury
  • Tailbone Injury
  • Tailbone Pain
  • Tailbone Pain Syndrome

Differential Diagnosis

Specialists

  • Chiropractor
  • Orthopedic (Orthopaedic) Surgeon
  • Physical Therapist

Comorbid Conditions

  • Degenerative disc disease
  • Gynecologic disorders (e.g., endometriosis, fibroid uterus, ovarian cyst)
  • Obesity

Factors Influencing Duration

Factors that influence the duration of disability include the severity of symptoms and the individual's response to treatment for the condition. Presence of underlying disease such as cancer or gynecologic conditions requiring specific simultaneous treatment can increase duration.

Medical Codes

ICD-9-CM:
724.79 - Coccygodynia; Disorder of Coccyx, Other

Overview

Coccydynia is a throbbing or aching pain in and around the area of the tailbone (coccyx). The triangular coccyx is formed by three to five fused vertebrae (coccygeal vertebrae) at the base of the spinal column, connecting at the top to the fifth sacral vertebra (sacrococcygeal junction). In conjunction with the seat bones (ischial tuberosities), it is a weight-bearing structure for sitting positions. The coccyx also is an attachment site for muscles that support the pelvic floor (levator ani muscle group), muscles of ambulation (gluteus maximus), tendons, and ligaments (sacrococcygeal ligaments).

The pain of coccydynia can be constant and sometimes severe, limiting activity that requires sitting and reducing quality of life for those who experience it. Pain can be the result of local trauma, presence of a tumor, childbirth, or a medical procedure such as colonoscopy, but coccydynia is typically the result of traumatic injury to the coccyx such as a fall in which the individual lands on the buttocks in the sitting position. This may cause a fracture, bruise, or dislocation of the coccyx. It is thought that the majority of cases of coccydynia are caused by increased mobility (hypermobility) or an altered position (subluxation) of the coccyx (Patel). A common cause in females is trauma that occurs during difficult labor and delivery (parturition). In other cases, the disc between the fifth lumbar and the first sacral vertebrae (L5-S1) may cause referred pain to the coccyx. In addition, calcium crystals may be deposited in the coccygeal region, in some cases causing acute coccyx pain (Richette). Nevertheless, in up to one-third of cases of coccydynia there is no identifiable cause for symptoms (idiopathic coccydynia) (Lyons).

In the past, psychological problems (e.g., hysteria, anxiety, depression) were thought to be a factor in the development of coccydynia, but this is no longer believed to be the case.

Incidence and Prevalence: Coccydynia is rare, accounting for less than 1% of back pain conditions reported to physicians (Lyons). Because not all cases are reported, data are lacking on incidence and prevalence.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for coccydynia include prolonged sitting, poor sitting posture, difficult labor and delivery, any activity involving repeated blows to the coccyx such as riding a horse, motorcycle, bicycle, tractor, jeep, or snowmobile, and surgery that is performed with the individual lying on the back with knees flexed (lithotomy or dorsosacral position).

Coccydynia occurs 5 times more frequently in women than in men, with onset at a mean age of 40 years (Patel). The fact that giving birth puts substantial pressure on the coccyx is thought to be a factor in the increased risk for women (Foye). Individuals with coccydynia are 3 times more likely to be obese than individuals without coccydynia (Patel).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with coccydynia will complain of pain in the area of the sacrococcygeal junction and limited ability to sit for a normal length of time before pain dictates a change in position. They also may report pain when moving from sitting to standing, painful intercourse, persistent rectal pain and fullness, pain on defecation, reduced anal sphincter control, and constipation. The evaluating physician will ask about onset and duration, history of falls or traumatic injury, presence of lower limb numbness or weakness, obstetric history and menopausal status of females, and current illness or history of prior illness (e.g., intrapelvic cancer such as colon, prostate, ovarian, cervical, or testicular malignancy).

Physical exam: Body weight is measured and any recent gain or loss noted. Tenderness at the coccyx or sacrococcygeal junction may be tested by exerting gentle pressure on these areas (palpation). Palpation of other areas of the lumbosacral spine may reveal non-coccygeal pain. Bimanual rectal examination may be performed by placing one gloved finger in the individual's rectum and a gloved finger of the other hand on the skin (perineum) just underneath the tip of or just behind the coccyx. The coccyx is then palpated and manipulated. The individual with coccydynia usually will report a sharp pain in response to this maneuver. A complete neurologic examination may be appropriate to rule out other sources of pain. In addition to a complete physical examination, a gynecologic evaluation, or gastrointestinal evaluation may be appropriate.

Tests: No specific laboratory tests are performed except to rule out suspected causes or underlying conditions. X-rays of the sacrum and coccyx may be taken to reveal fractures, dislocations, or other spinal abnormalities, particularly if there is a history of recent trauma. Dynamic x-rays, in which the position of the coccyx is evaluated in sitting and standing positions, may reveal underlying instability. Magnetic resonance imaging (MRI) of the lumbar spine may be indicated if L5-S1 disc pathology is suspected. Ultrasound and computerized tomography (CT) scan of the pelvis and coccyx may be indicated. The stool may be tested for occult blood (guaiac test), a sign of colon cancer.

Source: Medical Disability Advisor



Treatment

Conservative treatment involves taking a nonsteroidal anti-inflammatory drug (NSAID), using a "doughnut" or coccyx pillow, sitting in a few inches of warm water (sitz bath), modifying chair height, and cushioning and tilting the seat. Individuals should be instructed in proper posture and body mechanics to minimize pain, including the importance of avoiding prolonged sitting. Individuals may be encouraged to weight shift from one buttock to the other during prolonged sitting to reduce direct weight bearing on the coccyx, and to lean forward, because the coccyx bears more weight when leaning back in a chair (Foye).

Individuals with persistent coccydynia may be treated with physical therapy including modalities such as ultrasound and heat. Osteopathic manipulation and mobilization techniques are sometimes performed if the physician determines that mobility of the sacrococcygeal segments is decreased. Three sessions of coccygeal manipulation via the rectum have been found to be twice as effective in reducing pain as external physical therapy for those with traumatic onset of pain and a stable coccyx (Maigne). Active exercises and a home exercise program to improve pelvic strength may be incorporated in the treatment regimen. Individuals may be advised to increase fiber intake or to take stool softeners to prevent painful constipation.

Failure of the individual to show quantitative and qualitative improvement with conservative treatment may warrant the use of enhanced diagnostic testing such as MRI or CT scan to rule out an occult lesion. Invasive pain management modalities (anesthetics, steroidal injections, manipulation, and / or surgery) may be appropriate. Anesthetic and steroidal drugs may be injected locally into the tissue surrounding the coccyx. This procedure may be repeated after 1 month, if necessary.

Surgical removal of the coccyx (coccygectomy) is rarely performed, but it may be considered in appropriately selected individuals who continue to experience pain following treatment. The essential functions of the important muscle groups, tendons, and ligaments attached to the coccyx should be carefully considered before the coccyx is removed as complications associated with damage to the levator ani muscle group can lead to sagging of the pelvic floor, and damage to the anal sphincter can lead to fecal incontinence.

Source: Medical Disability Advisor



Prognosis

Coccydynia may resolve spontaneously or be completely relieved in some individuals; in others it may prove difficult to treat, resulting in chronic pain syndrome of the coccygeal region. Early intervention makes more likely the decrease of pain, and improves the chances for complete recovery. Conservative treatment is successful in 43% of individuals (Patel). Individuals who do not respond to conservative treatment but go on to receive local injection of anesthetic and steroidal drugs in combination with conservative measures and coccygeal manipulation are relieved of their symptoms 85% of the time (Patel). Individuals with coccyx pain present for fewer than 6 months receive the best relief with coccygeal steroid injections (Mitra). Sympathetic nerve blocks using local anesthetics have been shown to provide pain relief immediately after the procedure, and many individuals report complete and permanent relief of pain (Foye).

Surgical removal of the coccyx may be considered if non-operative treatment methods fail to alleviate symptoms. This rarely performed procedure successfully treats pain up to 91% of the time (Patel). Nevertheless, it is associated with high rates of postoperative infection in as many as 27% of individuals (Hodges) and rectal injury that can lead to fecal incontinence (Foye).

Source: Medical Disability Advisor



Rehabilitation

The goal of the rehabilitation for coccydynia is to decrease pain symptoms and improve function. Rehabilitation may entail correction of posture and restoration of lower back mobility. Conservative treatment is indicated in the majority of individuals with coccydynia (Foye, Hodges, Lyons, Patel).

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistCoccydynia
Physical TherapistUp to 3 visits within 3 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Coccydynia-related symptoms usually do not result in complications. However, surgical treatment for coccydynia (coccygectomy) has a high rate of postoperative infection and can result in injury to the rectal musculature that may progress to fecal incontinence. Surgical damage to the levator ani muscle group attached to the coccyx can result in sagging of the pelvic floor.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations usually include avoidance of prolonged sitting. This can be accomplished, for example, by permitting 5-minute standing breaks every hour. If sitting is required (e.g., professional drivers, pilots), the individual may need to use a doughnut- or U-shaped pillow to protect the coccyx from further trauma. Modification of a chair may be appropriate. Standing, walking, and carrying generally are not affected. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual complain of pain in the tailbone (coccygeal) area? Have difficulty sitting comfortably?
  • Did a bimanual rectal exam reveal pain in the coccygeal area?
  • Was a full gynecologic examination performed on female patient?
  • Were x-rays of the sacrum and coccyx taken? Was MRI of the lumbar spine or CT/ ultrasound of the pelvis obtained? Was stool tested for occult blood (guaiac test)?
  • Were other conditions with similar symptoms ruled out?
  • Did thorough differential diagnosis reveal any underlying illness that required treatment?

Regarding treatment:

  • Were conservative measures, such as using a sitz bath, adding a doughnut or coccyx pillow when seated, modifying chair height, cushioning and tilting seat, learning correct posture and body mechanics, and taking a NSAID, effective in relieving the symptoms? If not, was physical therapy or injections of anesthetic or steroids tried?
  • Was surgery considered?

Regarding prognosis:

  • Did symptoms persist or recur after conservative treatment?
  • Was surgery indicated? Performed? Were there any postoperative complications?
  • Does individual have other conditions that may affect ability to recover and may lengthen disability?
  • Were appropriate accommodations made regarding individual's work?

Source: Medical Disability Advisor



References

Cited

Foye, Patrick M., and C. J. Buttaci. "Coccyx Pain." eMedicine. 29 Jan. 2009. Medscape. 1 Jul. 2009 <http://emedicine.medscape.com/article/309486-overview>.

Hodges, S. D., J. C. Eck, and S. C. Humphreys. "A Treatment and Outcomes Analysis of Patients with Coccydynia." Spine Journal 4 2 (2004): 130-140. PubMed. 1 Jul. 2009 <PMID: 15016390>.

Lyons, Michael J. "Coccygodynia." eMedicine. Eds. Daniel Riew, et al. 17 Nov. 2008. Medscape. 1 Jul. 2009 <http://emedicine.medscape.com/article/1264763-overview>.

Maigne, J. Y., et al. "The Treatment of Chronic Coccydynia with Intrarectal Manipulation: A Randomized Controlled Study." Spine 31 18 (2006): E621-627. PubMed. 1 Jul. 2009 <PMID: 15016390>.

Mitra, R. , L. Cheung, and P. Perry. "Efficacy of Fluoroscopically Guided Steroid Injections in the Management of Coccydynia." Pain Physician 10 (2007): 775-778. PubMed. <PMID: 17987101>.

Patel, R., A. Appannagari, and P. G. Whang. "Coccydynia." Current Review of Musculoskeletal Medicine 1 3-4 (2008): 223-226. PubMed. 1 Jul. 2009 <PMID: 19468909>.

Richette, P. , et al. "Coccydynia Related to Calcium Crystal Deposition." Spine 33 17 (2008): E620-623. PubMed. <PMID: 18670332>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.