Kegel vs. Reverse Kegel Exercises for Coccydynia

Coccydynia, commonly referred to as tailbone pain, is a painful condition localized to the coccyx that significantly impairs sitting tolerance, transitional movements, and quality of life. The condition is five times more prevalent in females due to anatomical differences and the effects of obstetric trauma. A key yet frequently overlooked contributor to coccydynia is pelvic floor muscle hypertonicity, in which the levator ani, coccygeus, and adjacent muscles exert chronic traction on the coccyx, perpetuating pain and functional disability. Physical therapy, particularly pelvic floor rehabilitation, has emerged as a cornerstone of conservative management. Kegel exercises, which involve concentric contraction of the pubococcygeus and levator ani muscles, strengthen the pelvic floor and improve structural support around the coccyx. Conversely, Reverse Kegel exercises emphasize eccentric lengthening and relaxation of the pelvic floor musculature, addressing the hypertonicity directly implicated in coccydynia. Despite growing evidence for both modalities, no randomized controlled trial to date has directly compared their effects on pain and functional disability in coccydynia patients.

This study will be a randomized clinical trial comparing the effects of Kegel exercises (Group A) versus Reverse Kegel exercises (Group B) on pain and functional disability in patients diagnosed with coccydynia. Pain will be measured using the Numeric Pain Rating Scale (NPRS), functional disability using the Oswestry Disability Index (ODI), and pain-free sitting duration as a timed functional outcome measure. A sample of 30 patients (15 per group), aged 18-50 years, will be recruited using non-probability consecutive sampling and randomly allocated to groups. Both groups will receive their respective pelvic floor exercise protocols for 4 weeks (3 sessions per week, 12 sessions total). Outcome measures will be recorded at baseline, 2nd week, and 4th week. Data will be analyzed using SPSS version 24.

THIS GROUP will receive their respective exercise protocols over 4 weeks (3 sessions per week, 12 sessions total).

Other: KEGEL EXERCISES (Pelvic Floor Strengthening)

THIS group will receive their respective exercise protocols over 4 weeks (3 sessions per week, 12 sessions total).

Other: REVERSE KEGEL EXERCISES (Pelvic Floor Relaxation)

Patients in Group A will perform pelvic floor contraction exercises as follows:

Starting position: Supine lying with knees bent and feet flat, or comfortable sitting on a firm chair. Technique: Patient is instructed to identify pelvic floor muscles by attempting to stop the flow of urine midstream (without performing this during actual urination). The contraction is described as a "squeeze and lift" of the pelvic floor. Protocol: Hold contraction for 5-10 seconds, then fully relax for equal duration. Perform 10 repetitions per set, 3 sets per session, with 60- second rest intervals between sets. Progression: Contraction hold time will be increased from 5 seconds (weeks 1-2) to 10 seconds (weeks 3-4) as muscle endurance improves. Total session duration: approximately 25-30 minutes.

Patients in Group B will perform pelvic floor eccentric relaxation exercises as follows:

Starting position: Supine lying, knees bent; or "happy baby" position (supine, knees drawn toward chest with feet facing ceiling) to facilitate pelvic floor lengthening.

Technique: Patient is guided to differentiate between pelvic floor contraction and relaxation. The Reverse Kegel involves a gentle, controlled "downward bearing out" or "expansion" of the pelvic floor, as though gently pushing the floor downward and outward on inhalation. This is the opposite of Kegel contraction. Protocol: Inhale slowly and allow pelvic floor to fully descend and elongate (2-3 seconds), hold the relaxed position for 5 seconds, then exhale and allow gentle passive recoil (no active contraction). Perform 10 repetitions per set, 3 sets per session, with 60- second rest intervals between sets. Biofeedback cueing will be used (verbal and palpatory) to confirm correct muscle release rather than inadvertent contraction

Time frame: BASELINE AND AFTER 2 AND 4 WEEKS

NPRS 11-point numeric with 0 representing No pain, 1-3 representing Mild Pain (nagging, annoying, interfering little with ADLs), 4-6 representing Moderate Pains (interferes significantly with ADLs), 7-10 representing Sever Pain (disabling, unable to perform

Time frame: BASELINE AND AFTER 2 AND 4 WEEKS

Assesses functional disability related to pain through a questionnaire covering daily activities.

Time frame: BASELINE AND AFTER 2 AND 4 WEEKS

Measures the duration a patient can tolerate sitting before pain requires them to stop or change position.

Comparative Effect of Kegel and Reverse Kegel Exercises on Pain and Functional Disability in Patients With Coccydynia