Anatomy and Physiology of the Coccyx

The coccyx, often referred to as the “tailbone,” sits at the very base of the spine beneath the sacrum. It is made up of three to five fused vertebrae and serves as an attachment point for a number of important muscles, tendons, and ligaments. These include parts of the pelvic floor muscles, which play an important role in continence and support, as well as gluteal and deep spinal muscles that contribute to posture and movement

Despite its small size, the coccyx has a significant function in weight distribution when sitting and provides stability for the pelvic region. Any disruption to its normal alignment, mobility, or surrounding tissue health can lead to pain.

Causes of Coccyx Pain

Coccyx pain can develop for a variety of reasons. The most common causes include:

• Direct trauma – such as a fall onto the buttocks or injury during sport.
• Childbirth – pressure on the coccyx during delivery may cause bruising, or lasting strain on the supporting tissues.
• Prolonged sitting – especially on hard surfaces or poor seating, which can compress the coccyx.
• Repetitive strain – activities such as cycling, rowing, or horse riding.
• Pelvic floor dysfunction – tightness or imbalance in the pelvic floor muscles can pull on the coccyx.
• Postural changes – particularly after pregnancy or spinal injury.

In some cases, no clear cause is identified, which can be frustrating for patients.

Who is More Susceptible?

Coccyx pain is more common in women than men, which is thought to be related to differences in pelvic anatomy and the significant effects of childbirth on the pelvis.

It can also affect individuals who sit for long hours at work, athletes in sports that involve repeated pelvic pressure, and people with poor sitting posture.

People with hypermobility or a history of pelvic or lower back problems may also be more prone to developing coccydynia.

Onset and Presentation

Coccyx pain usually develops gradually, but it can also occur suddenly after trauma.

The main symptom is pain when sitting, especially when leaning back or sitting on a hard surface.

Pain can also be increased when standing up from sitting or during prolonged standing.

Some people also experience pain during bowel movements or sexual intercourse due to the connection of the coccyx with the pelvic floor muscles.

Symptoms

• Localised pain at the tailbone
• Increased pain when sitting or rising from a seated position
• Pain when leaning backwards while sitting
• Discomfort during bowel movements or intercourse
• Referred pain into the buttocks or lower back

Assessment and Diagnosis by a Physiotherapist

At Complete Physio, assessment begins with a detailed history and physical examination. Your physiotherapist will explore when the pain started, what aggravates or relieves it, and any relevant medical or pelvic health history. They will also assess posture, sitting tolerance, pelvic floor function, spinal mobility, and surrounding muscle balance.

In some cases, internal assessment of the pelvic floor may be suggested, particularly if there are signs of muscle spasm or dysfunction contributing to the pain. This is always discussed openly and carried out with consent.

Our pelvic specialist will carry out these internal assessments – please make sure you request an appointment with her at the time of booking. 

Imaging

Although coccyx pain is often diagnosed clinically, imaging may be recommended if symptoms persist or if there is suspicion of fracture, tumour, or unusual anatomy.

Options include:

• X-rays – these are used to rule out fractures. They are sometimes taken in both sitting and standing positions to assess mobility of the coccyx.
• MRI scans – these are useful for ruling out other causes of pelvic or lower back pain, such as disc problems or sciatica.

Physiotherapy Treatment

Physiotherapy is the primary treatment for coccyx pain. At Complete Physio we have a specialist pelvic health service, and we offer a range of tailored approaches:

• Manual therapy – including mobilisation of the coccyx and sacrum, soft tissue release to the gluteal and pelvic floor muscles, and joint mobilisation for the spine and pelvis.
• Pelvic floor rehabilitation – many people are unaware that tightness, weakness, or poor coordination of the pelvic floor muscles can contribute to coccyx pain. Our physiotherapists, trained in pelvic health, can provide specific exercises and relaxation techniques.
• Posture and ergonomic advice – strategies to reduce coccyx strain during sitting, such as cushions, sitting posture modifications, and activity adjustments.
• Exercise prescription – focused on improving pelvic and core stability, hip strength, and spinal mobility.
• Breathing and relaxation techniques – to reduce pelvic floor tension and pain sensitivity.

Pilates 

Pilates can be an excellent adjunct to physiotherapy for managing coccyx pain.

By focusing on controlled movement, core stability, and posture, Pilates helps reduce the strain placed on the coccyx during daily activities. Specific exercises can improve pelvic floor coordination, strengthen the deep abdominal and gluteal muscles, and encourage better spinal alignment. Importantly, Pilates also emphasises breathing and relaxation, which can help release tension in the pelvic floor muscles that may otherwise pull on the coccyx and perpetuate pain.

Our holistic model means that physiotherapists at Complete Physio do not just treat the coccyx in isolation. We consider the entire musculoskeletal and pelvic health system, often working alongside colleagues in women’s and men’s health physiotherapy.

Injections

For persistent pain that does not improve with physiotherapy alone, guided injections may be considered.

At Complete Physio, our team, led by Sports Medicine specialist, Dr Matteo Bernardotto, offers expert diagnosis and advanced injection treatments for chronic coccyx pain – please link to the coccyx injections service page when live that will target the source of your pain and inflammation around the coccyx.

These injections can be highly effective, especially when combined with ongoing physiotherapy to address underlying muscle or postural dysfunction. Injections are never given as a stand-alone treatment but part of a wider management plan.

Q&A

Is coccyx pain serious?

Most cases are not serious and respond well to physiotherapy. However, persistent or worsening pain should be assessed to rule out other causes.

Do I always need an injection?

No. Many people improve significantly with physiotherapy alone. Injections are considered only when pain persists despite conservative treatment.

How long does it take to get better?

Recovery varies, but with tailored physiotherapy, many people notice improvement within 6–12 weeks. Chronic cases may take longer.

Can coccyx pain come back?

Yes, particularly if the underlying cause such as poor posture, pelvic floor dysfunction, or prolonged sitting is not addressed. Ongoing management strategies are often helpful.

References

• Foye, P.M. (2007) ‘Coccydynia: Tailbone pain’, Physical Medicine and Rehabilitation Clinics of North America, 18(1), pp. 247–272.
• Lirette, L.S., Chaiban, G., Tolba, R. and Eissa, H. (2014) ‘Coccydynia: An overview of the anatomy, etiology, and treatment of coccyx pain’, Ochsner Journal, 14(1), pp. 84–87.
• Postacchini, F. and Massobrio, M. (1983) ‘Idiopathic coccygodynia: Analysis of fifty-one operative cases and a radiographic study of the normal coccyx’, Journal of Bone and Joint Surgery – Series A, 65(8), pp. 1116–1124.