What is coccydynia?
The coccyx is a small chain of bones at the base of the spine that acts as an anchor for the pelvic floor and gluteal muscles. When it is bruised by a fall, pushed backward during childbirth, or irritated by long hours on hard seats, the muscles attached to it tighten to protect it. That protective tension becomes its own source of pain, keeps the joint from moving normally, and explains why tailbone pain so often persists long after the bone has healed.
Treatment has traditionally meant cushions, anti-inflammatories and, if those failed, injections or surgery. Manual therapy of the coccyx and the levator ani muscles is a well-described middle step, and a pelvic floor physiotherapist is trained to deliver it.
Common signs and symptoms
- A sharp or aching pain at the tailbone when sitting, especially on hard surfaces
- A stab of pain when standing up from a chair
- Pain with bowel movements or with sex
- Tenderness when the tailbone is pressed
- Relief when leaning forward or sitting on one buttock
- Low back, buttock or pelvic floor pain alongside the tailbone pain
What causes it?
- A fall onto the buttocks, or repeated minor trauma from cycling or rowing
- Childbirth, particularly a difficult or instrument-assisted delivery
- Prolonged sitting with poor posture, or rapid weight change
- Overactive pelvic floor muscles pulling on the coccyx
- Hypermobility or reduced mobility of the coccyx joints
- Rarely, infection or tumour, which is why persistent pain should be checked
How pelvic floor physiotherapy helps
Pelvic floor physiotherapy for coccydynia treats the muscles that attach to the tailbone as well as the joint itself. Releasing the levator ani and gluteal muscles, restoring normal coccyx movement and correcting the way you sit and rise usually settles pain that cushions alone never touched.
A treatment plan typically includes:
- An assessment of coccyx position and mobility, and of pelvic floor, gluteal and hip muscle tension
- Manual therapy for the levator ani and coccygeus muscles, externally and, with your consent, internally
- Gentle mobilisation of the coccyx and sacrococcygeal joint
- Down-training and stretching for the pelvic floor, hips and buttocks
- Sitting posture, cushion choice and sit-to-stand technique
- Bowel strategies when bowel movements aggravate the pain
What the research says
The studies below are peer-reviewed and linked to their permanent records so you can read them yourself.
This study of manual treatments for coccydynia, including massage of the levator ani muscles, mobilisation and stretching, reported improvement in a proportion of patients, with better results in those with shorter symptom duration and a stable coccyx.
Maigne JY, Chatellier G. Comparison of three manual coccydynia treatments: a pilot study. Spine, 2001. View study
Patients with chronic coccydynia, including some who still had pain after their coccyx had been surgically removed, reported significant pain reduction after a course of pelvic floor physical therapy.
Scott KM, Fisher LW, Bernstein IH, Bradley MH. The treatment of chronic coccydynia and postcoccygectomy pain with pelvic floor physical therapy. PM&R, 2017. View study
Treatment at Corelife Wellness in Oakville
Corelife Wellness is a dedicated pelvic health clinic at 3075 Hospital Gate, Unit 312, Oakville, next to Oakville Trafalgar Memorial Hospital. Care starts with a free 15-minute consultation by phone, video or in person, followed by a full assessment with our Registered Physiotherapist. Every pelvis is unique, so your plan is built from that exam rather than a template. No referral is needed, and physiotherapy is often eligible under extended health benefits.
How assessment and treatment work, and how to book, are on our main page: Pelvic floor physiotherapy in Oakville.
Helpful reading from our team
When to see a doctor first
Pelvic floor physiotherapy is safe and you do not need a referral, but some symptoms need a medical assessment before or alongside treatment:
- Tailbone pain with fever, night sweats or unexplained weight loss
- Pain that wakes you at night and is not related to position
- Numbness in the saddle area, or new bladder or bowel control problems
- A history of cancer, or a lump or swelling at the tailbone
