What is coccyx (tailbone) pain?
A comprehensive review of what coccyx pain is, where the coccyx is, how it is diagnosed and how you can treat it.
The coccyx (tailbone) on anatomical model of the pelvis
What is coccyx (tailbone) pain?
Coccyx pain, also known as coccygodynia or coccydynia, refers to any pain located in or around the coccyx.
The coccyx is a small triangular bone situated at the end of your spine, reminiscent of where a tail would start in other animals. Muscles used in activities such as walking, sitting, and maintaining posture attach to the coccyx. Pain in this area can be caused by a variety of factors, including injuries or strains to surrounding ligaments or muscles.
Read on to learn more about coccyx pain and what you can do about it.
What does coccyx (tailbone) pain feel like?
Pain in the coccyx is commonly a dull or achy sensation, although it can occasionally be sharp. This pain is often worse when sitting.
What causes coccyx (tailbone) pain?
Coccyx pain is frequently caused by a strain of one of the coccyx joints, joint stiffness, or a spasm of the muscles attached to the coccyx.
Common causes of tailbone pain include:
Direct Hit or Fall: Impacting the coccyx during activities such as a snowboarding accident or a fall down the stairs can lead to tailbone pain.
Prolonged Labor: The tailbone is positioned behind the uterus and birth canal, and excessive pressure can be applied to it during childbirth, especially if the birth occurs with the mother lying on her back. This can lead to alignment issues after birth, which the body may not be able to correct.
Pregnancy: During pregnancy, the ligaments in the pelvis relax and lengthen to accommodate the growing baby. This ligament relaxation can result in more movement at the coccyx with everyday movements such as walking or moving from sitting to standing, leading to pain.
Pelvic Floor Tension: Many pelvic floor muscles attach to the tailbone. Increased tension in these muscles can place strain on the coccyx, causing tenderness and pain in the coccyx area.
Prolonged Sitting with Poor Posture: Sitting for extended periods, especially with poor posture that curves the back, can exert extra pressure on the tailbone, leading to pain.
Postural Imbalances: Injuries or poor movement patterns elsewhere in the pelvis or body can transfer stress to the tailbone, sacrococcygeal joint, and attached soft tissues, resulting in pain.
Gradual Onset: Sometimes, tailbone pain develops so gradually and subtly that it becomes difficult to identify a specific cause. This slow onset can make diagnosis and treatment challenging.
Where is the Coccyx (Tailbone) and What does it do? A brief anatomy lesson.
The coccyx, or tailbone, sits at the very end of your spine within the pelvis. It typically consists of 3-5 vertebrae that may or may not be fused together, and no two coccyx bones are identical.
The coccyx forms a joint with the sacrum, known as the sacrococcygeal joint, which is designed to have a certain amount of movement. Clinically, one of the possible causes of coccyx pain is too little movement (hypomobility) or too much movement (hypermobility) at the sacrococcygeal joint.
What does the coccyx do?
Despite its small size, the coccyx has three very important functions:
Provides an insertion for many muscles and ligaments. These muscles include your glutes and pelvic floor muscles.
Provides weight bearing support for your pelvis while in the seated position.
Provides support to the anus.
When does Coccyx Pain Hurt?
Coccyx pain may be felt in the same place for everyone, but when and why you feel your coccyx pain can vary greatly from person to person. Below are some of the common times people will feel their coccyx pain:
Pain with sitting, particularly when sitting on hard surfaces or when leaning backwards/slouching.
Moving from sitting to standing or vice versa
Pain with bowel movements, sex, coughing or sneezing
Pressing on the area
Pelvic floor issues may also affect your coccyx pain
What are the Risk Factors?
There are a variety of different factors that contribute to whether or not you will develop tailbone pain. Below are some of the common risk factors:
Female - Females are five times more likely to suffer from coccyx pain due to anatomical differences and factors such as childbirth which directly impact the coccyx.
Hypermobile coccyx - a coccyx that moves more than average may increase your experience of pain.
A short perineum combined with a difficult labour - the perineum is the space between the vulva and anus. If it is shorter than average, there is less space between the birth canal and the coccyx. This short length may place more pressure on the coccyx during birth, resulting in injury for some people.
Rapid weight loss - Pain can occur due to the loss of the cushioning effect of fat (adipose) tissue in the buttock region
Obesity - Body mass index may influence how a person sits, changing the way weight is placed upon the coccyx.
Morphological positions (shapes) of the coccyx - Certain coccyx shapes are more likely to cause pain. If you have a straight coccyx bone or one that is flexed (curved forward), you are more likely to experience pain with a coccyx injury.
Age - people aged between 30 and 50 are more likely to experience coccyx pain
Presence of a bony spicule - A bony spicule is a pointy bit of bone at the end of the coccyx bone. A spicule is often something you are born with and may cause irritation to the overlying bursae and ligaments.
How is coccyx pain diagnosed?
Diagnosis of coccyx pain typically involves taking a medical history and having a physical examination. The reason you have coccyx pain is unique to you, which means that your ‘story’ is important.
You may also require imaging studies (X-rays, MRI, or CT scan), which can help identify the position of the coccyx and rule out other conditions
How do you treat coccyx pain?
There is no ‘standard treatment’ as the cause of coccyx pain is different for everyone Treatment options for coccyx pain include:
Using cushions or donut pillows
Applying ice or heat
Pain medications (e.g., NSAIDs)
Lifestyle modifications
Exercises
Hands-on manual therapy such as Osteopathy or Physiotherapy
Injections (e.g., local anesthetics or corticosteroids)
Surgery (in rare, severe cases)
How long does coccyx pain take to heal?
Most cases of coccyx pain resolve within weeks to months, but for some people the pain can become chronic. If you have pain that is not improving, it may be helpful to explore your treatment options.
If you’d like to try some hands-on manual therapy, book to see one our Osteopaths. Coccyx pain is one of our passions.
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