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The Coccygeus is a muscle of the pelvic region.

Anatomical Attachments:

  • Origin: Attaches from the spine of the ischium and the sacrospinous ligament.
  • Insertion: Attaches to the coccyx and into the last segment of the sacrum.

Action: Collectively works with the levator ani muscle in supporting the pelvic viscera and pulls forward and supports the coccyx.

Nerve Supply: Pudendal plexus nerves (S4, S5).

Nerve Entrapment: Dysesthesia associated with the pelvic floor are usually the direct result of trauma. While heavily innovated by nerve, the primary area of study has been devoted to coccygeal pain, referenced as Coccydynia. However, some authors choose to differentiate between Coccydynia (which is a compressive force caused by an anterior and laterally deviated coccyx exerting pressure on the nerve), and coccyalgia which is nerve pain experienced without osseous encroachment. Due to the numerous muscles that attach to the coccyx and the course that the nerve travels, it is possible that what some describe as coccyalgia, is the result of entrapments. The reader should also note that trigger point referral of the Sphincter ani, Levator ani, Obturator internus, and the Superficial Transverse Perinei also have similar but distinct referral patterns to the coccygeus and nerve entrapment syndromes associated with the pelvic floor.

Vascular supply: Internal pudendal and inferior gluteal arteries.

Travell and Simons Trigger Point Pain Referral:  

Click on a small image to view an enlarged image


Trigger Point Signs and Symptoms: Difficulty in sitting for prolonged periods of time, pain is experienced around the anus, sacrum, coccyx, vagina, hip, and/or low back. According to Travell and Simons, triggers within this muscle contribute to the low back pain of women during their last months of pregnancy. When the coccygeus is hypertonic, it can anteriorly or laterally deviate the coccyx, thus making for a more difficult delivery.

Trigger Point Activating and Perpetuating Factors: Persistent emotional stress, sitting with slumped posture, direct trauma or surgery to the buttock or pelvic region.

Differential Diagnosis: (Segmental, Subluxation, Somatic dysfunction) S1 S2 S3 S4 or S5 radiculopathy, Coccygodynia (coccygeal nerve compression), Coccyalgia, Coccygeal spasm, Coccygeal fracture, Levator syndrome, Tension myalgia of pelvic floor, Pregnancy, Spontaneous Abortion (Miscarriage), Proctalgia fugax, Hemorrhoids, polyps, Anal fissure, Colorectal cancer, Crohn’s Disease, Diverticular disease, Fecal impaction or Constipation, Proctitis, Prostatitis, Prostate cancer, Vaginismus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.


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