1. Introduction Delivery related Coccydynia are thought to occur in around 1 to 4 % (Maigne&Tamalet, 1996 ), however other studies have shown it to be as high as 14%(Ryder I 2000 cited Wray et al 1991). This is a case study of a 34 year old woman who suffered coccyx trauma during her first vaginal Delivery related Coccydynia are thought to occur in around 1 to 4 % (Maigne&Tamalet, 1996 ), however other studies have shown it to be as high as 14%(Ryder I 2000 cited Wray et al 1991). This is a case study of a 34 year old woman who suffered coccyx trauma during her first vaginal birth 4 years previously. Treatment at that time consisted of manual physiotherapy, osteopathy and local anesthetic block at the pain clinic with minimal result. MRI scan at that time showed bony bruising but no fracture or obvious dislocation. No manual therapy of the Pelvic Floor Muscles was carried out postnatally. This case study highlights the effectiveness of Pelvic Floor Rehabilitation in the treatment of chronic coccyx pain. A Woman’s Tail and her Pelvic Floor Case Study of the Involvement of Pelvic floor Muscles in Chronic Coccydynia Shalini Wiseman (MISCP,POGP) & Jean Dennehy (MISCP,POGP) Clinical Presentation Patient was referred with coccyx/pelvic girdle pain post second delivery via caesarean section with a 4 year history of coccyx pain. Her symptoms was graded on the Visual Analogue Scale (VAS) and Patient Specific Functional Scale (PSFS).See Table 1. Other symptoms included pain on opening her bowels and increased pain on sexual arousal.Patient was examined spinally as per European Guidelines for Pelvic Girdle Pain at 6 weeks postpartum. Right up slip of the iliac crest with a right anterior pubic symphysis and right side bent sacrum in extension was corrected using Muscle Energy Technique and myofascial trigger points was released. The Patient required 4 sessions of 30 -45 minutes. Advice with regard coccyx pain management and exercise was given. With manual therapy treatment, pain reduced considerably in sit to stand,however the symptoms graded on PSFS persisted. Ryder I 2000 cites Peyton’s (1998) retrospective study of 180 obstetric related Coccydynia showed: References Laycock J(1994)Clinical evaluation of the pelvic floor.In: Schussler B, Laycock J,eds. Pelvic floor re- education. Vol 14.London:Springer –Verlag 1994:Pages 42 -8 Maigne j et al (1996) Standardized Radiological protocol for the study of common Coccydynia and characteristics of lesions observed in sitting position, Spine 21(22): Pages2588 -259 Ryder I, Alexander J (2000) Coccydynia: A woman's tail, Midwifery Vol. 16 Issue 2, Pages 155-160 Rosenbaum T.Y. 2009 Physical Therapy treatment of persistent genital arousal disorder during pregnancy: A case report, Journal of Sexual Medicine 2009,10(1111),Pages j 1743 -6109 Contact Details Shalini Wiseman Senior. Physiotherapist in Women’s Health and Continence Cork University Maternity Hospital Email:shalini.wiseman@hse.ie : Pelvic floor muscle dysfunction and Rehabilitation Pelvic floor muscle (PFM) assessment was done at 12 weeks post partum as per the Modified oxford grading system (MOGS), (Laycock.J 1994) and along the Vertical and Horizontal Clock (Haslem et al 2007) to assess strength and muscle tone. Physiotherapy for coccydynia involves manually working on tight, painful muscular structures such as the Coccygeus, Puborectalis, Illiococcyx, Ischiococcyx,Obturator internus, Piriformis and Gluteus medius muscles. Puborectalis was reviewed vaginally and ano- rectally which resolved her bowel symptoms completely. Persistent dyspareunia with pain on sexual arousal was assessed for pudendal nerve (PN) involvement. The PN was palpated at the ischial spine and alcock’s canal. Nerve palpation revealed hyper tonicity of the obturator internus muscles that may have restricted the space in the alcock’s cannal. Soft tissue mobilization to decrease obturator interni tightness bilaterally was done for 10 – 15 minutes for 4 sessions. Connective tissue work was also performed along the two branches of the Pudendal nerve i.e. Posterior rectal nerve and Perineal nerve. It is possible that the trigger points resulted from those muscles contracting in an attempt to stabilize the traumatised pelvis/coccyx in absence of strong core muscles. This lead to restricted availability of space in the alcock’s cannal,impinging or entrapping the Pudendal nerve over the years leading to pain along the nerve distribution of the perineum, external anal sphincter and the general myotome area (Rosenbaum 2009 cited Filler et al 2009 & Ramsden et al 2003). Coccygeus muscle was released to gain normal coccyxgeal mobility. The treatment lasted over an hour each, for a period of 5 months and involved 2 physiotherapist. Table 1 Outcome measures Pre treatmentPost manual therapy Post manual therapy and Pelvic floor rehabilitation VAS 4/10 to 7/10 depending on activities 4/100/10 PSFS 1.Pain on sitting for longer than ½ hr 8/104/100/10 2.Intolerant to tight cloths 10/10 0/10 3. Pain during intercourse 8/10 0/10 Other symptoms 8/10 0/10 Conclusion Pre existing coccyx injury affects its ability to flex and extend during birth. Along with this, spasm of the muscles around the coccyx can lead to pelvic floor dysfunction and pudendal nerve symptoms.Pelvic floor assessment should be a vital part in the treatment of Chronic Coccydynia with normal coccyxgeal mobility to rule out any associated anomalies of mid pelvic floor muscles and pudendal nerve. 36% (n = 64) Experience low back pain 20% (n= 36) Pelvic pressure 11% (n=20) Painful bowel movements or rectal spasm 7% (n=13) Dyspareunia or painful intercourse