The tailbone, or coccyx, is a small triangular bone at the very end of your spine. It attaches to the bottom of the sacrum, the large bone in your lower back that connects the sides of the pelvis, through the sacrococcygeal joint.

More common in women versus men, tailbone pain, or coccydynia, occurs as a result of excessive force from a fall or repetitive falling and/or sports that involve constant pressure on the area (i.e. cycling, horseback riding, rowing). It is also caused by excessive pressure from childbirth (primarily vaginal deliveries) and/or chronic straining to have a bowel movement.

Most people with tailbone pain report pain with sitting, getting up from sitting, bending, having sex, going to the bathroom, any type of touch or pressure, or simply throughout the day. Pain can be felt right at the tailbone, and/or refer upward or downward. Someone’s experience of tailbone pain can range from somewhat bothersome to extremely debilitating depending on the nature of the injury.

Like the top of a tent is to the fabric around it, the tailbone is the connection point for a number of pelvic floor muscles – a group of muscles that control pee and poo, support your organs, work with your core to give you control and stability as you move, play a role in sexual function, and help with circulation.

When the pelvic floor contracts, as they should when you stand up for instance, the tailbone curls up, or flexes, and it returns to its resting position when the pelvic floor muscles relax. When the pelvic floor muscles lengthen, as they should with a bowel movement for example, the tailbone uncurls or extends, and it returns to its resting position when the pelvic floor muscles relax. These are minimal but important movements for daily functioning.

Once a tailbone injury occurs, the sacrococcygeal joint and/or the surrounding muscles and nerves can become extra sensitive to movement and/or pressure. This can occur whether the tailbone does not move enough or whether it moves too much. It is also important to note that tailbone pain is not always local in nature – it can also be referred from other nearby anatomy, such as nerves in your spine or other pelvic joints or muscles.

If you have tailbone pain, depending on the nature of your injury, there are a few self-management strategies that can help alleviate discomfort:

  • Posture: Sitting upright on your “sitz bones,” the bony bumps under each butt check where your legs and pelvis meet, allows the tailbone to rest freely. People often slouch when they sit, which puts more direct pressure on the tailbone, pushing it into flexion. If changing your posture and the type of seating (hard vs soft) are not enough, using a donut cushion or a sitting wedge with a central hole can allow you sit longer with less pain.
  • Pain management: Applying ice or heat to the area can temporarily help with pain, as ice typically helps alleviate any inflammation or swelling, and heat (a hot pad or hot bath) typically helps relax muscles. Both temperature changes temporarily quiet brain signaling that is perceived as pain.
  • Exercise: Certain exercises can help lengthen the pelvic floor (which extends the tailbone) and strengthen pelvic floor (which flexes the tailbone) depending on what is needed. Stretching exercises like cat/cow, deep squats, pelvic floor lengthening (“reverse kegels”) and deep breathing, as well as conditioning exercises that focus on glutes and hamstrings can all help mobilize the tailbone into extension. Conversely, pelvic floor contractions (“kegels”) and most core work can help mobilize the tailbone into flexion.

While other medical options include pain medication, injections, imaging, modalities (like electrical stimulation) and more rarely, surgery, pelvic health physiotherapy can be effective conservative management for reducing and resolving tailbone pain, as it:

  • Addresses joint or muscle dysfunction related to the tailbone through manual techniques
  • Provides specific exercises for helping the tailbone move more optimally and optimizing pelvic floor muscle function
  • Assesses for any surrounding anatomy that could be the culprit regarding the pain
  • Helps desensitize body tissues that have experienced persistent pain
  • Uses tools such as taping techniques for more immediate pain relief

We at The Mama’s Physio hope this information is empowering and reassuring. If you are experiencing tailbone discomfort or pain, are at higher risk due to chronic constipation or pregnancy, and/or experience frequent falls with activities you participate in, we would love to employ our skills and expertise to help you in your healing journey.

Sources:

Dufour, Sinead. “Pelvic Health Solutions: Pregnancy, Pelvic Girdle Pain, & The Pelvic Floor.” Abbotsford, BC, January 2019.

Foye, Patrick M. “Coccydynia: Tailbone Pain.” Physical Medicine and Rehabilitation Clinics of North America 28, no. 3 (2017): 539–49.

Howard, Paul D., Andrea N. Dolan, Anthony N. Falco, Brett M. Holland, Caitlin F. Wilkinson, and Anna M. Zink. “A Comparison of Conservative Interventions and Their Effectiveness for Coccydynia: A Systematic Review.” Journal of Manual and Manipulative Therapy 21, no. 4 (2013): 213–19.

Marinko, Lee N., and Matthew Pecci. “Clinical Decision Making for the Evaluation and Management of Coccydynia: 2 Case Reports.” Journal of Orthopaedic & Sports Physical Therapy 44, no. 8 (2014): 615–21.