Coccydynia (Tailbone Pain)

What Is Coccydynia?

Coccydynia refers to pain in the coccyx, or tailbone, which is the small bony structure at the very bottom of the spine. Tailbone pain is often aggravated by sitting, especially on firm surfaces, leaning back in a chair, cycling, driving, or transitioning from sitting to standing.

Coccydynia may occur after a direct fall onto the tailbone, prolonged seated pressure, childbirth, repetitive strain, or pelvic-related changes. In some cases, symptoms develop gradually without a clear injury. The pain may feel sharp, aching, bruised, tender, or pressure-like around the base of the spine.

Because the tailbone connects with muscles, ligaments, fascia, and pelvic floor structures, pain in this region may be influenced by more than the coccyx alone. Pelvic mechanics, sacroiliac joint movement, hip mobility, posture, and soft tissue tension may all contribute to how pressure is distributed while sitting and moving.

Persistent or severe tailbone pain should be assessed by a licensed medical professional, especially if it follows significant trauma, is associated with neurological symptoms, unexplained weight loss, fever, bowel or bladder changes, or worsening pain.

Individuals May Experience

• Pain at the base of the spine when sitting

• Tailbone pain that worsens on firm chairs or hard surfaces

• Discomfort when leaning back in a chair

• Pain when transitioning from sitting to standing

• Tenderness around the tailbone

• Increased discomfort during prolonged sitting or driving

• Pain with cycling, rowing, or seated exercise

• A bruised or pressure-like feeling near the coccyx

• Discomfort after a fall or direct impact

• Pelvic, gluteal, or lower back tension

• Difficulty finding a comfortable seated position

• Increased sensitivity around the lower spine or pelvis

What Contributes to Coccydynia?

Several factors may contribute to coccydynia or ongoing tailbone pain, including:

• Direct trauma to the tailbone, such as a fall

• Prolonged seated pressure

• Sitting on firm or poorly supportive surfaces

• Postural strain while sitting

• Pregnancy or postpartum changes

• Childbirth-related pressure or trauma

• Pelvic floor tension or coordination issues

• Sacroiliac joint restriction

• Reduced hip or pelvic mobility

• Fascial tension in the pelvic, gluteal, or lower back region

• Repetitive seated activities such as driving, cycling, or desk work

• Previous lower back, pelvic, or hip injury

Tailbone pain often involves how pressure is distributed through the pelvis. If the pelvis is tilted, restricted, or poorly supported, more pressure may be placed through the coccyx when sitting. Surrounding muscles and connective tissues may also tighten protectively, which can increase discomfort and reduce mobility.

How Manual Therapy May Help

Manual therapy and rehabilitation may help identify mechanical contributors to tailbone pain, including pelvic mobility, sacroiliac mechanics, posture, hip movement, and surrounding soft tissue tension. The goal is to reduce unnecessary pressure through the tailbone and improve how the pelvis supports sitting, standing, and movement.

Care should be individualized based on symptom severity, history of trauma, pregnancy or postpartum status, sitting tolerance, pelvic mechanics, and functional limitations.

Osteopathic Manual Therapy

Osteopathic Manual Therapy may focus on how the coccyx region relates to the pelvis, sacrum, hips, lower back, and surrounding fascial structures. Rather than only focusing on the painful point, treatment may assess how the entire pelvic region is moving and loading.

Treatment may involve:

• Assessing pelvic alignment and mobility

• Improving sacroiliac joint mobility

• Addressing sacral and pelvic mechanics

• Reducing fascial tension in the pelvic region

• Addressing gluteal, hip, and lower back tension

• Improving mobility through the lumbar spine and pelvis

• Supporting more balanced pressure distribution while sitting

• Reducing compensation patterns around the hips and lower back

The goal is to improve pelvic mechanics, reduce surrounding tension, and help decrease mechanical pressure on the tailbone during sitting and movement.

Physiotherapy

Physiotherapy may help improve support around the pelvis and reduce mechanical strain on the tailbone. This may be especially helpful when tailbone pain is related to posture, pelvic weakness, prolonged sitting, postpartum changes, or difficulty transitioning between sitting and standing.

Physiotherapy may include:

• Pelvic stability training

• Core strengthening

• Hip and glute strengthening

• Movement retraining strategies

• Postural education for sitting and work positions

• Guidance on cushions, seating modifications, and pressure relief

• Gentle mobility exercises for the hips, pelvis, and lower back

• Gradual return to sitting, exercise, or daily activities

• Breathing and relaxation strategies when guarding is present

• Referral guidance when pelvic floor-specific care is needed

Rehabilitation helps improve support around the pelvis, reduce compensatory strain, and build tolerance for sitting and daily movement.

Book an Assessment

If sitting causes persistent tailbone pain, or if discomfort at the base of the spine is affecting driving, work, exercise, or daily comfort, our team can assess pelvic mechanics and guide appropriate care.

A comprehensive assessment can help identify whether your symptoms may be influenced by sacroiliac mobility, posture, pelvic stability, hip mechanics, soft tissue tension, or pressure distribution through the tailbone.