Let's talk about tailbone pain, which is quite literally a pain in a lot of people's butts. The tailbone, or coccyx, is a small triangular bone that can be tricky to deal with and is often a source of frustration for both patients and medical providers trying to manage patient pain. Why? Let's dig into this pelvic floor topic and learn more.

Anatomy of Your Coccyx:

The tailbone sits at the very base of the spine where it attaches to the sacrum. It bends and stretches in a way that's similar to the lower part of your back. It's a place where different parts, like ligaments, tendons, and muscles from your lower back and bottom area, attach.

In addition to being an attachment site, the tailbone's role is to act as one leg of a tripod (the other two legs being your sit bones) to provide weight-bearing support when you sit and help support the position of the anus. The coccyx also plays a crucial role in maintaining balance and stability while sitting, as well as assisting in the functions of the pelvic floor muscles.

The Major Causes of Tailbone Pain:

There are many different reasons why the tailbone can become painful, including external trauma, internal trauma, and non-traumatic causes to your coccyx.

-External trauma: A direct fall onto the tailbone leading to bruising, dislocation, or even breaking. Additionally, repetitive or prolonged sitting on hard, narrow, or uncomfortable surfaces.

-Internal trauma: Childbirth, especially during a difficult delivery or if an instrument like forceps was used. As well as surgical injuries to your tailbone area.

-Non-trauma: Pregnancy, due to hormonal changes and added pressure on the spine from the growing baby. Degenerative joint or disc disease, joint hyper-mobility (too much mobility) or hypo-mobility (stiffness), rapid weight loss resulting in loss of cushioning, or the pain might actually come from a different area, like a muscle spasm in your pelvic floor. In some cases, underlying conditions such as pilonidal cysts or infections can also cause tailbone pain.

In most cases, pain will usually worsen with sitting for an extended period, leaning back while sitting, standing for a long time, walking, driving, or standing up from a seated position. Some people also experience pain with intercourse or when pooping.

When should I see a doctor for tailbone pain?

You should consult a doctor if the pain is severe, persists for more than a few weeks, interferes with your daily activities, or is accompanied by unexplained weight loss or fever. It's also advisable to seek medical attention if the pain radiates down your legs or is accompanied by numbness or tingling sensations.

Treatments for Coccyx/Tailbone Pain:

Finding an effective treatment for tailbone pain can be challenging. The most common approach is to change the surface on which you are sitting or use a wedge-shaped or donut cushion. This can help alleviate some of the pain but might not address the underlying cause unless there was a direct injury to the tailbone.

Traditional medical management usually consists of pain-relieving medications, injections, or nerve blocks in and around your tailbone area. Removal of the tailbone is considered a very last resort if all other therapies fail, which sounds absolutely horrifying to us! In addition to these treatments, some patients also find relief through alternative therapies such as chiropractic care, acupuncture, and osteopathic manipulative treatment (OMT). However, one of the most effective and comprehensive approaches to managing tailbone pain is Pelvic Floor Physical Therapy (PFPT).

Pelvic Floor PT Treatments for Coccyx/Tailbone Pain

Of course, since you're reading a Pelvic Floor Physical Therapy blog, we have to highlight this option. Pelvic Floor Physical Therapy is a safe and conservative way to treat tailbone pain in patients of any age and gender. This therapy focuses on improving the function of the pelvic floor muscles and alleviating pain through a variety of targeted techniques and exercises.

Pelvic Floor PT not only addresses the immediate pain, but also aims to correct any underlying dysfunction that may be contributing to the pain. This holistic approach ensures that patients receive comprehensive care that targets both symptoms and root causes.

What does a Pelvic Floor Examination look like for tailbone pain?

First, we investigate the underlying causes of your pain, including examining your posture and movement patterns that might be affecting your tailbone. Then, we check your tailbone directly. This can be done externally, but the most accurate way to assess the mobility of your tailbone and your pelvic floor muscles contributing to your pain is through a rectal exam. We understand this may be uncomfortable, but it provides us with the best information on how to treat your pain effectively. The information we gather through the exam helps us tailor treatments to address the root causes of your pain. Below is an example of what that exam looks like, and it would be conducted on your side while completely covered with a comfortable sheet in a private room.

During the examination, the physical therapist may also assess the surrounding muscles and tissues, such as the gluteal muscles and the sacroiliac joint, to identify any additional sources of discomfort or tension. This type of evaluation ensures that all potential contributors to your pain are addressed.

Effective Pelvic Floor PT Techniques for Tailbone Pain

1. Manual Therapy: Pelvic floor physical therapists use hands-on techniques to manipulate and mobilize the tissues around the tailbone. This can include gentle stretching, massage, and pressure application to relieve tension and improve mobility.

2. Trigger Point Release: Identifying and releasing trigger points in the pelvic floor muscles can significantly reduce pain. These are hyper-irritable spots in the muscle that can refer pain to other areas, including the tailbone.

3. Biofeedback: This technique helps patients learn how to control their pelvic floor muscles. By using visual, auditory, or tactile feedback, patients can see how their muscles are functioning and learn to relax or strengthen them as needed.

4. Postural Education: Poor posture can exacerbate tailbone pain. Pelvic floor physical therapists teach patients how to maintain proper posture to reduce strain on the coccyx and surrounding muscles.

5. Exercise Programs: Exercises might focus on improving flexibility or relaxation of the pelvic muscles that attach to the tailbone to help reduce pain. Other exercises can focus more on postural stability or core stabilization in order to help reduce strain on the tailbone.

6. Pelvic Floor Muscle Training: Specified exercises can strengthen the surrounded areas that support the pelvic floor muscles which reduces the load on the pelvic floor muscles. Other pelvic floor training can help to teach patients how to actively relax the pelvic floor for pain releif.

7. Pain Management Techniques: Education on how to manage pain through techniques such as relaxation exercises, mindful movements, or other techniques like dry needling or cupping can be invaluable for patients dealing with chronic tailbone pain.

Why Choose Pelvic Floor PT for Tailbone Pain over other options?

Holistic Healing for Lasting Relief: Pelvic Floor PT provides a holistic approach to managing tailbone pain by addressing the body as a whole rather than just focusing on the painful area. When tailbone pain is addressed by connecting what is happening at the pelvic floor level to the rest of the body, this allows you to find the root causes which will lead to a more effective long term solution.

Customized Care for Effective Recovery: Because pelvic floor PTs have analyzed what is what is happening at the pelvic floor muscles, they are the best equipped to know what type of strengthening, stretching, or retraining your body actually needs. By doing this, you can ensure that you are working on what your body actually needs versus doing generalized strengthening or stretching program around the pelvis. This is where many programs can fall short, leading to only short term fixes.

Empowered Recovery Through Education: Because you are educated about what is happening at the pelvic floor level, how it relates to their body, and possible root causes it allows you to have better understanding of how to effectively manage and improve tailbone pain. This combined with specified stabilization, strengthening, or stretching allows you to be independent in your care versus dependent on other techniques or interventions.

Experiencing tailbone pain and not sure if Pelvic Floor PT is the right thing to do?

Give us a call or send a contact form in, and we’d be happy to chat!

Written by Chicago Pelvic very own, 

Dr. Rebekah Wolinetz, PT, DPT, WCS, PRPC, PCES, Cert. DN