Getting to the Bottom of Tailbone Pain (Coccydynia)

Tailbone pain, clinically called coccydynia, describes pain and discomfort surrounding your coccyx – the small triangular bone at the base of your spinal column. Acute pain can arise after a fall on your bottom, often involving a coccyx bruise or fracture, or it can develop gradually from certain conditions and activities.

We answer your questions about the coccyx, the various causes of pain, and new advanced treatment strategies that reduce coccyx pain and inflammation and accelerate healing.

The coccyx (aka tailbone) serves as a critical attachment point for your pelvic floor muscles and ligaments, providing an anchor that supports the anus, anal sphincter, and pelvic organs. Its connections to the gluteus maximus and levator ani muscles make the coccyx a key structure for balance and pelvic stability. It also works together with the sit bones, acting as a weight-bearing tripod that supports the body when sitting. A fibrous band called the filum terminale attaches the spinal cord to the coccyx.

Coccyx pain typically arises from either trauma, pressure or overuse, although in rare cases it can arise from a tumor or infection.

Common causes of coccyx pain include:

• Trauma from a fall, sometimes resulting in a bruise or stress fracture
• Fascial dysfunction that fails to support the pelvic structures
• Pregnancy and childbirth
• Prolonged sitting on hard surfaces
• Driving for extended periods
• Repetitive stress from sports like rowing or cycling
• Chronic poor posture
• Overweight and obesity
• Underweight, with reduced cushioning when sitting
• Joint hypermobility
• Degenerative joint disease

Coccygodynia is relatively rare, estimated to comprise only 1–3% of all back pain disorders. The condition most frequently occurs in adult females and obese individuals

Fascia is a body-wide web of thin, elastic connective tissue that envelops and connects muscles, bones, ligaments, nerves, blood vessels, and organs throughout the body. It is made up of collagen, embedded with sensory nerves, and infused with hyaluronic acid, making it slippery, and enabling the body’s structures to glide without friction.

Fascia provides structural support to the pelvic floor by maintaining balanced elastic tension – a phenomenon known as biotensegrity – that holds structures in place as you move. Fascia surrounds the coccyx segments, and the coccyx is linked to broader fascial networks, creating a chain of tension from the lower back, hips, abdomen and even lower extremities.

Fascial connections establish the coccyx as an anchor for the pelvic floor and posterior pelvic structures. When fascial planes become dysfunctional, pelvic tension is disrupted, and the coccyx may be subjected to excessive loads, causing pain. Nerve may also be entrapped in densified fascia, generating pain.

• Localized pain at the tailbone
• Pain that worsens when sitting
• Pain when transitioning from sitting to standing
• Pain during bowel movements
• Pain during sexual intercourse
• Pain or tenderness when pressured

While tailbone pain often self-resolves, severe pain that does not get better after a few weeks may indicate more serious issues that require medical attention.

To accurately diagnose and treat coccydynia, the exact underlying cause of pain must be identified. Coccydynia diagnosis relies heavily on health history (to determine onset and review symptoms), and a physical exam, to inspect the area for swelling or bruising, reproduce the pain by applying pressure, assess coccyx mobility, and evaluate pelvic floor function. Posture, hip and spine range of motion, and abnormal movements are taken into account.

Imaging with xray or MRI often comes back normal, despite pain symptoms, and is typically reserved for severe cases, or when there is a history of significant trauma.

Treatment typically begins with conservative care. Applying ice can help to numb pain and reduce inflammation, and use of a cushion when sitting can help to reduce pain. Avoid excessive sitting, and substitute activities like rowing or cycling with alternatives like walking or swimming.

Modification of lifestyle factors like poor posture and excess body weight can help relieve symptoms over time. Dietary changes can help reduce straining during bowel movements. Eliminate sugary foods and beverages and limit foods like pasta and rice. Steer clear of fast and ultra-processed foods. Eat mostly fresh fruits and vegetables, pastured meats, wild caught fish, and fermented foods like sauerkrauts, kimchi, kombucha, and cultured dairy.

Conservative treatment interventions include:

• Physical therapy, to strengthen and stabilize pelvic stuctures and improve posture.
• Pelvic floor therapy, to restore integrity of the pelvic floor muscles and fascia.
• Ultrasound-guided dry needling, to target trigger points in pelvic tissues.
• Extracorporeal shockwave therapy, to reduce pain and inflammation and promote tissue healing.
• Stecco fascial manipulation, to release fascial restrictions around the coccyx, pelvic floor, glutes, and lower back.
• Corticosteroid injections, to relieve pain and reduce inflammation.
• Pulsed radiofrequency ablation, to reset pain-transmitting nerves.
• Ultrasound guided nerve hydrodissection, to separate entrapped nerves from surrounding tissue.

In severe, persistent cases, a coccygectomy – a surgical procedure that completely removes the coccyx – may be recommended. However, success rates can vary, and removing the coccyx can dramatically affect functional mechanics of the lumbopelvic region.

You can significantly reduce your risk of coccydynia by taking common-sense steps that improve your overall health.

Conservative treatment interventions include:

• Avoid excessive sitting, especially on hard surfaces, and take frequent breaks to move and stretch.
• Select an ergonomically designed chair with good lumbar support.
• Be aware of posture when sitting. Maintain an erect spine, with shoulders back and feet flat on the floor. Avoid slouching with the shoulders rounded and head forward. Tilt your pelvis slightly forward to shift weight onto your sit bones and off of your tailbone.
• Stay physically active. Regular walking helps the body to restore healthy joint alignment and tones the pelvic floor muscles and fascia. Add pelvic floor and core exercises to your routine to optimize myofascial pelvic tone.
• Reduce excess body weight to relieve stress on the coccyx.
• Take precautions in the early stages of pregnancy to optimize pelvic health and posture, to avoid tailbone pain in the later stages.

Tailbone pain can range from uncomfortable to debilitating, but you don’t have to deal with it on your own. At NYDNRehab, we leverage the most advanced holistic treatment approaches to eliminate coccydynia pain and accelerate recovery. We use the highest-resolution ultrasound to guide our energy therapies and injection procedures, ensuring precise and effective treatment.

Our personalized one-on-one physical therapy sessions are focused on treating the whole patient, not just your symptoms, providing effective and lasting relief, without drugs or surgery. Contact NYDNRehab today, and get rid of tailbone pain so you can get back to doing the things you love!