Tailbone pain–what a pain in the you know what! 

Tailbone pain, otherwise known as coccyx pain or coccydynia, can vary from a constant annoyance to pain severe enough to limit your activities day to day. With a fairly low incidence rate, your Doctor might not know what to recommend if you report tailbone pain. As a Physical Therapist specializing in Pelvic Health, I’m here to tell you that tailbone pain is highly treatable and something you do not need to live with! Let’s explore more about what causes tailbone pain and how Physical Therapy can be of great help.

Anatomy

The tailbone is the bone at the very tip of your spine. It may seem like an unimportant body part but it actually serves as an attachment point to some of your pelvic floor muscles and your Gluteus Maximus.  It also helps to anchor your spinal cord, provide weight bearing support in sitting, helps with sexual function, and helps with defecation and continence. As you can see, despite its size, this structure is exceptionally important! 

Pain/Dysfunction

Tailbone pain is clinically defined by the following:

  • Localized pain to the tailbone/coccyx
  • Pain is felt in sitting, leaning back while sitting, and standing from sitting
  • Pain can also be felt with sexual activity and/or with bowel movements

Tailbone pain is not always associated with a traumatic event like falling, but over time smaller traumas such as prolonged sitting with poor posture or repetitive loading with poor body mechanics (like weightlifting, jumping, or running) can lead to tailbone pain. In fact, about ⅓ of tailbone pain cases have no known pathology. 

Clinically, the 3 most common reasons for tailbone pain that I see in my office are the following:

  • Pelvic Floor Muscle Spasm

Some of your pelvic floor muscles attach directly to the tailbone. If these muscles are tight, in spasm, or are being overused, they can pull on the tailbone causing it to sprain. This happens with people that habitually clench their bottoms while standing or bending over, people who tuck their pelvises into a slumped posture in sitting, and people who have weak glutes and cores. Pelvic floor muscle tension can also be associated with high stress or anxiety.

  • Pregnancy and Childbirth

The pelvic floor muscles are doing a lot of work during pregnancy reacting to the growing pressure in the abdomen and pelvis paired with your changing posture. This can place a lot of strain on the tailbone. During a vaginal childbirth, the tailbone needs to extend to get out of the way of the baby descending into and out of the birth canal during delivery. When the sacrum and tailbone are fixed against the bed in the classic dorsal lithotomy birthing position, this can place extra strain on the tailbone. This is one of the reasons I counsel all my pregnant patients on alternative birthing positions! 

  • Trauma

A fall down the stairs, a slip on the ice, or repetitive trauma from cycling or horseback riding — the tailbone pain can be broken, bruised, or dislocated just like any other bone in the body.  Along with pain management strategies following an acute injury, we want to make sure a tailbone heals in the correct alignment and without compensation from surrounding joints and muscles.

Treatment

A trained Physical Therapist will not only directly assess your tailbone, but they will also look at your surrounding joints and all the contributing factors that could be causing your pain. 

Together at Physical Therapy, we work on the following to treat your tailbone pain:

  • Posture and ergonomic adjustments in sitting and standing to avoid undue stress on the tailbone including cushion recommendations
  • Glute and core strengthening to offload your tailbone and pelvic floor
  • Techniques for lifting, sit to stand, and bending to reduce strain on the tailbone
  • Pelvic floor muscle assessment and treatment
  • Manual therapy techniques to help with muscle spasm and joint motion
  • Pain management strategies including taping techniques, hot/cold therapy, and electrotherapy

Physical Therapy is incredibly effective for tailbone pain (conservative treatment is effective in 90% of cases) and we work with you to restore your functional status and to reduce or eliminate your pain. 

You don’t have to resign yourself to a life of sitting on a donut cushion and avoiding hard benches! See a qualified Physical Therapist today to heal your tailbone pain.

If you are in the Portland area, give us a call at 503-295-2585 to schedule an appointment to help you with your tailbone pain.

If you live outside Portland, Oregon, we do offer Telehealth visits which are a great way to get the benefits of seeing a PT from the comfort of your own home! You can also read our blog about “How to Find a Good PT” or visit Pelvicrehab.com to find an experienced pelvic rehab practitioner in your area.

Resources:

Aggarwal A, Kumar S, and Kumar D. Factors influencing the evaluation and management outcomes of coccygodynia: A literature review. J Back Musculoskelet. 2013;(1):105 –115.


Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84-87.