Coccyx & Tailbone Pain

Coccyx pain, commonly referred to as “tailbone pain,” can be caused by a variety of factors ranging from a fall to pregnancy. The coccyx is the small triangular bone that is made up of 3 to 5 bones. It is found at the end of the spine, true to its common name as a “tailbone.” The coccyx can easily shift and cause a host of new symptoms after the initial injury, requiring attention and skilled therapy to correct. In some cases, even after coccyx has healed from a fracture or dislocation, the pelvic floor muscles surrounding the coccyx may still be in spasm for some time and cause further pain, necessitating pelvic floor physical therapy.


– Pain in “tailbone”, or coccyx
– Feeling of tightness in coccyx
– Difficulty and pain with sitting
– Pain with prolonged standing
– Pain with performing sit to stand
– Difficulty/pain with bowel movements
– Pain with sex
– Painful menstruation


Trauma (i.e. falling onto the tailbone), childbirth, constipation/straining of bowels, and pelvic floor spasms are some of the possible causes of coccyx pain. Other causes could be imbalance of strength/length of surrounding musculature. This means that if musculature on one side of the coccyx is especially spasmed for an unknown reason, it may actually pull the coccyx to that side causing pain and dysfunction. Dysfunction of the coccyx could create problems with bowel movements and sitting.

Constipation/straining of bowels is an important cause to note. The straining to have a bowel movement can in fact cause severe pelvic floor muscle spasms. Some of the larger pelvic floor muscles attach to the coccyx. Therefore if they become spasmed, the pelvic floor muscles can place stress on the coccyx.


Your physical therapist will perform a thorough evaluation to assess your symptoms and identify the cause of the problem. Being the evaluation will be internal and external, you and your therapist will work together to ensure your comfort throughout the entire process. The internal assessment will evaluate the muscles of the pelvic floor, which attach to the coccyx. Your therapist will assess the length of the muscles, pain of the muscles upon palpation, and eventually check for strength balance once any spasms have been released. If your therapist feels you may need further examination or testing, she will refer you to an MD.


Treatment for coccyx or tailbone pain will depend on your presentation. Your therapist is also an orthopedic trained physical therapist who will be able to target treatment to the overlap of orthopedic and pelvic floor symptoms, with a focus on the actual cause. She will address both the pelvic floor and musculoskeletal pain through manual and therapeutic exercise, as needed. Manual therapy may include release of the pelvic floor muscles through manual pressure to the targeted tight muscles. Your therapist and you will also discuss home exercises and strategies to reduce your symptoms, toileting techniques to reduce pain with bowel movements, and modifications for more comfortable sitting.

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