Tailbone Pain (Coccydynia): Treatment Through Pelvic Floor Physical Therapy

Overview

Tailbone pain, medically known as coccydynia, is persistent discomfort or sharp pain in the coccyx, the small triangular bone at the base of your spine. This condition can transform simple daily activities like sitting at your desk, standing up from a chair, or even sleeping into painful challenges that significantly impact your quality of life.

Coccydynia affects approximately 1 in 100 adults at some point in their lives, with women experiencing this condition five times more frequently than men. This higher prevalence in women often relates to anatomical differences, pregnancy-related changes, and childbirth trauma. However, tailbone pain doesn't discriminate by age or gender, affecting people across all demographics including pregnant individuals, new parents, office workers, athletes, elderly adults, and anyone who has experienced trauma to the area.

The condition is particularly common during pregnancy and the postpartum period due to hormonal changes that soften ligaments and the physical demands of childbirth. Additionally, individuals who spend long hours sitting, cyclists, rowers, and those in sedentary occupations frequently develop coccydynia. The good news is that most people don't have to live with chronic tailbone pain.

Pelvic floor physical therapy plays a crucial role in treating coccydynia because the pelvic floor muscles attach directly to the coccyx and surrounding structures. When these muscles become tight, weak, or dysfunctional, they can contribute to and perpetuate tailbone pain. Through specialized pelvic health treatment, most individuals experience significant improvement in their symptoms and can return to comfortable, pain-free daily activities.

Symptoms

Recognizing the symptoms of tailbone pain helps you understand whether your discomfort might be coccydynia. The pain typically centers around the tailbone area but can radiate to surrounding regions, creating a constellation of symptoms that affect multiple aspects of daily life.

Direct Tailbone Symptoms:

• Sharp, stabbing pain when sitting, especially on hard surfaces
• Aching or throbbing pain that worsens with prolonged sitting
• Intense pain when transitioning from sitting to standing
• Tenderness when touching the tailbone area directly
• Pain that shoots up into the lower back or down into the legs

Functional Impact Symptoms:

• Difficulty finding comfortable positions while sleeping
• Pain during bowel movements or straining
• Discomfort during sexual activity or pelvic exams
• Increased pain after long car rides or desk work
• Avoiding certain chairs or seating arrangements
• Compensatory postures that lead to neck, shoulder, or hip pain

Associated Pelvic Floor Symptoms:

• Pelvic floor muscle tension and spasms
• Referred pain into the pelvic region
• Changes in bowel or bladder function
• Increased urgency or frequency of urination
• Difficulty with pelvic floor muscle relaxation

Many people with tailbone pain develop protective movement patterns, unconsciously shifting their weight or avoiding certain positions. While these strategies might provide temporary relief, they often create secondary problems in other areas of the body, making comprehensive pelvic health treatment essential for full recovery.

Causes

Understanding what causes tailbone pain helps in developing an effective treatment plan. Coccydynia can develop from various factors, often involving a combination of mechanical stress, trauma, and muscular dysfunction.

Trauma and Injury Causes: Direct trauma is one of the most common causes of tailbone pain. Falls onto the tailbone, particularly backward falls on hard surfaces, can bruise, fracture, or dislocate the coccyx. Childbirth represents another significant cause, as the baby's passage through the birth canal can stretch or injure the coccyx and surrounding ligaments. Sports injuries from activities like cycling, rowing, or contact sports can also damage the tailbone area.

Postural and Mechanical Causes: Poor sitting posture and prolonged sitting on inappropriate surfaces contribute significantly to coccydynia development. Office workers, drivers, and students often develop tailbone pain from sitting on hard chairs for extended periods. Improper body mechanics during lifting, bending, or other daily activities can place excessive stress on the coccyx and surrounding structures.

Pregnancy and Postpartum Factors: Pregnancy brings unique risk factors for tailbone pain. Hormonal changes during pregnancy soften the ligaments supporting the coccyx, making it more susceptible to injury. The growing baby's weight can also shift the mother's center of gravity, placing additional stress on the tailbone. During delivery, the coccyx must move and flex to allow the baby's passage, sometimes resulting in bruising, fracture, or lingering dysfunction.

Medical and Anatomical Factors: Some individuals have anatomical variations in their coccyx that predispose them to pain. Joint hypermobility conditions can make the tailbone area more vulnerable to injury. Previous spinal surgeries, pelvic surgeries, or radiation treatments can alter the normal mechanics and healing of the tailbone region. Rarely, infections, tumors, or other serious medical conditions can cause tailbone pain, which is why proper evaluation is essential.

Pelvic Floor Dysfunction Connection: The intimate relationship between the coccyx and pelvic floor muscles means that dysfunction in one area often affects the other. Tight, overactive pelvic floor muscles can pull on the coccyx, creating pain and restricted movement. Conversely, tailbone injury can cause protective muscle guarding in the pelvic floor, leading to a cycle of pain and dysfunction that requires specialized treatment to resolve.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor physical therapy offers a comprehensive, non-invasive approach to treating tailbone pain by addressing both the immediate symptoms and underlying contributing factors. This specialized form of physical therapy recognizes the complex relationship between the coccyx, pelvic floor muscles, and surrounding structures.

Targeted Muscle Release and Restoration: Pelvic floor physical therapy focuses on releasing tight, overactive muscles that may be pulling on the coccyx or contributing to pain. Through skilled manual therapy techniques, your therapist can address trigger points, muscle spasms, and fascial restrictions in the pelvic floor and surrounding areas. This muscle work often provides immediate pain relief while restoring normal movement patterns.

Postural Education and Ergonomic Training: Learning proper sitting posture and body mechanics is crucial for both recovery and prevention. Your pelvic health physical therapist will teach you how to sit, stand, and move in ways that reduce stress on your tailbone. This includes recommendations for seating modifications, workplace ergonomics, and daily activity adaptations that support healing.

Pain Management and Nervous System Calming: Chronic tailbone pain can sensitize your nervous system, making you more sensitive to pain signals. Pelvic floor physical therapy incorporates techniques to calm the nervous system and reduce pain sensitivity. This may include breathing exercises, relaxation techniques, and gentle movement strategies that help retrain your body's pain response.

Functional Movement Training: Recovery isn't just about reducing pain; it's about returning to all the activities you love. Your treatment plan will include specific exercises and strategies to help you safely return to work, exercise, intimacy, and other important life activities. This functional approach ensures that improvements made in therapy translate to real-world benefits.

Comprehensive Assessment and Treatment: At Mendwell Pelvic Health, our approach to tailbone pain begins with a thorough evaluation of your symptoms, medical history, and functional limitations. We examine not just the tailbone area, but also assess pelvic floor muscle function, posture, movement patterns, and any contributing factors specific to your situation.

Manual Therapy Techniques: Our skilled therapists use various hands-on techniques to address tailbone pain. External coccyx mobilization can help restore normal movement to stiff or restricted joints. Soft tissue techniques including myofascial release and trigger point therapy target muscle tension and restrictions. When appropriate and with your consent, internal manual therapy techniques may be used to address pelvic floor muscle dysfunction that contributes to tailbone pain.

Education and Self-Management: We believe in empowering you with knowledge and tools for long-term success. Your treatment will include education about your condition, pain science concepts that help you understand your symptoms, and self-management techniques you can use at home. This might include specific stretches, positioning strategies, or pain relief techniques tailored to your lifestyle and preferences.

Progressive Exercise Programming: As your pain improves, we'll introduce targeted exercises to strengthen supporting muscles and improve overall pelvic health. These exercises are carefully progressed based on your tolerance and goals, ensuring you can safely return to all your desired activities while minimizing the risk of symptom recurrence.

Frequently Asked Questions

How long does tailbone pain typically last with pelvic floor physical therapy treatment?

Most patients begin experiencing improvement within 4-6 pelvic floor physical therapy sessions, with significant progress often seen within 8-12 sessions. However, recovery timelines vary based on how long you've had symptoms, the underlying cause, and individual factors. Acute tailbone pain from recent injury often resolves faster than chronic pain that has persisted for months or years.

What should I expect during my first pelvic health appointment for tailbone pain?

Your initial evaluation will include a detailed discussion of your symptoms, medical history, and how tailbone pain affects your daily life. The physical examination focuses on posture, movement patterns, and external assessment of the tailbone and surrounding areas. Internal examination may be recommended but is always optional and performed only with your full consent and comfort.

Can I continue working and exercising while receiving treatment for coccydynia?

Most people can continue their normal activities with modifications during treatment. Your pelvic floor physical therapist will provide specific guidelines for sitting, movement, and exercise based on your symptoms and occupation. We'll work together to find strategies that allow you to maintain your work and fitness routines while supporting your recovery.

Do I need special cushions or equipment for tailbone pain relief?

While cushions and seating modifications can be helpful, they're most effective when used as part of a comprehensive treatment plan. Your therapist may recommend specific cushions, seat modifications, or ergonomic changes based on your individual needs. However, the goal is to reduce your dependence on special equipment over time through improved muscle function and pain resolution.

Is surgery ever necessary for tailbone pain, or can pelvic floor physical therapy resolve most cases?

The vast majority of tailbone pain cases respond well to conservative treatment including pelvic floor physical therapy. Surgery for coccydynia is extremely rare and typically considered only after extensive conservative treatment has failed and in cases of specific structural problems. Most people achieve significant improvement through specialized pelvic health treatment without needing invasive procedures.

Will internal pelvic floor treatment be necessary for my tailbone pain?

Not everyone with tailbone pain requires internal treatment. Many patients achieve excellent results through external techniques alone. Your pelvic floor physical therapist will discuss all treatment options with you and will never perform internal techniques without your explicit consent and comfort. The decision about internal treatment is always yours, and effective treatment can be provided regardless of your choice.