Sitting through work, driving or feeding your baby can become uncomfortable when your tailbone hurts. Tailbone pain, also called coccydynia, often improves with pressure relief and a carefully chosen rehabilitation plan. Physiotherapy can address movement and muscle-related contributors, while chiropractic care may help selected associated back or pelvic symptoms. The starting point is understanding why you hurt, rather than assuming the tailbone needs an adjustment.
This guide from Townline Physiotherapy & Wellness in Abbotsford explains treatment options, pregnancy and pelvic floor considerations, cushion choices and symptoms that need medical attention.
What tailbone pain can feel like
The coccyx is the small bone at the bottom of your spine. Pain is usually felt centrally near the top of the buttock crease. Sitting, getting up from a chair or passing a bowel movement may aggravate it.
Pain in this area can also come from nearby muscles, joints or other conditions. An assessment helps distinguish local coccyx pain from referred back painand problems that need medical investigation.
What causes tailbone pain?
Tailbone pain can start after one injury or develop gradually. Understanding the trigger helps guide care.
Falls onto the buttocks or a direct blow: Slipping on ice, falling down stairs or landing heavily during sport can injure the coccyx and surrounding tissues. Bruising is more common than a fracture. Some injuries can involve a fracture, dislocation or ligament injury, but pain after a fall does not automatically mean the tailbone is broken or “out of place.” Significant or worsening pain needs assessment.
Pregnancy and childbirth: Changes in loading during pregnancy may aggravate the area. Pressure during vaginal birth can sometimes injure the coccyx or nearby tissues.
Repeated pressure or strain: Cycling, prolonged driving and sitting for long periods, especially on a hard surface, can irritate the area even without a memorable injury.
Pelvic floor muscle tension: Muscles attached around the coccyx may become tense or tender and contribute to pain. This is one reason pelvic floor assessment may be relevant.
Joint movement and referred pain: Too much or too little movement at the coccyx joints can contribute. Pain felt near the tailbone may also come from nearby back or pelvic structures rather than the coccyx itself.
No clear cause: Some people develop pain without an identifiable injury. Less commonly, infection or another medical condition is responsible, which is why the warning signs below matter.
Red flags and when to seek medical care
Most tailbone pain is not an emergency. However, do not assume every new symptom is a muscle or joint problem.
Go to an emergency department immediately for new difficulty starting or passing urine, loss of bladder or bowel control, numbness around the genitals or anus, or rapidly worsening leg weakness, particularly with back or leg pain. These can signal serious nerve compression, including cauda equina syndrome. Do not wait for a physiotherapy or chiropractic appointment.
Seek urgent medical assessment for fever or feeling unwell with worsening pain; a red, hot, swollen area or drainage near the buttock crease; or significant pain after a major fall or accident. Infection and traumatic injury require assessment before routine manual treatment.
Arrange a prompt medical review for unexplained weight loss, a history of cancer with new persistent pain, a new lump, or progressive pain that is not eased by changing position. Persistent night pain also deserves review. These findings do not establish a diagnosis, but they change how the problem should be investigated.
During pregnancy, contact your maternity provider urgently for vaginal bleeding, leaking fluid, regular painful contractions, severe abdominal pain or reduced fetal movement when movement is normally expected. Do not attribute these symptoms to the tailbone.
How physiotherapy can help tailbone pain
A physiotherapist can review the onset of symptoms, sitting tolerance, daily activities, previous injuries and relevant pregnancy or pelvic symptoms. Assessment may include how your back, hips and pelvis move, muscle function and the positions that reproduce or ease discomfort.
Treatment is tailored to the findings and may include:
Adjusting sitting, driving and work arrangements to reduce sustained pressure.
Gradually rebuilding tolerance for walking, exercise and everyday tasks.
Gentle mobility and strength exercises selected for your symptoms.
Hands-on treatment of relevant muscles or joints when appropriate.
Referral for pelvic floor assessment or medical review when indicated.
Research supports possible improvement with several physical therapy approaches, but studies vary and long-term evidence remains limited. No single technique works for everyone. Progress should be judged through practical goals such as sitting longer, rising more comfortably and returning to valued activities.
Can a chiropractor help with tailbone pain?
A chiropractor can assess musculoskeletal contributors and screen for reasons to refer for medical care. Depending on the findings, care may include activity advice, exercise and selected manual techniques for associated back or pelvic symptoms.
Evidence specific to chiropractic adjustments for coccydynia is limited. Studies of coccyx manipulation do not prove that every painful tailbone is displaced or that an adjustment will correct it. A randomized trial of internal manipulation found only mild effectiveness for chronic coccydynia.
Direct coccyx treatment is not routine for everyone. Suspected fracture, infection or other concerning findings need evaluation first. Any proposed intimate technique requires a clear explanation, appropriate training and specific consent. You can decline it. Choose care based on assessment and measurable benefit, not a promise to “put the tailbone back in place.”
Tailbone pain during pregnancy and after birth
Pregnancy changes how weight is carried through the trunk and pelvis. A previous coccyx injury may become more sensitive, and childbirth can sometimes injure the area. Persistent pain deserves attention rather than being dismissed as something you must tolerate. [7]
Helpful adjustments may include supported sitting, a coccyx cushion, frequent changes of position and side-lying rest with pillows. A physiotherapist can adapt activity and exercise to your stage of pregnancy and symptoms. Discuss comfortable labour positions with your maternity team. After birth, feeding arrangements and how you lift or carry your baby may also need adjustment.
Tell your provider about your pregnancy, delivery, healing and any medical restrictions. Check medication choices with your maternity provider or pharmacist; do not assume a pain medicine suitable before pregnancy is suitable now.
Pelvic floor therapy for tailbone pain
Pelvic floor muscles attach around the coccyx and may contribute to pain when they are tense, tender or poorly coordinated. Symptoms such as painful bowel movements, pelvic discomfort or pain during intercourse can make a pelvic floor assessment useful, after medical causes are considered.
Pelvic floor therapy is not simply doing more Kegels. Some people need to learn relaxation and coordination before strengthening. A retrospective study found improvement with pelvic floor physical therapy focused on relaxation, although its design cannot establish how well everyone will respond.
Assessment and treatment can begin externally. If an internal examination is suggested, the clinician should explain its purpose and alternatives and obtain your consent. You may decline, pause or stop. Townline’s women’s pelvic floor service can help assess whether this approach suits your symptoms.
Should you use a donut pillow for tailbone pain?
A donut pillow is not automatically the best choice. Its back ring can press against the coccyx or lower sacrum and aggravate pain. A coccyx cushion with a rear cutout, often U-shaped or wedge-shaped, may unload the painful area more effectively. Individual comfort matters.
Place the cutout behind you beneath the tailbone and follow the cushion’s instructions. Use a stable chair, support your feet and check whether sitting actually feels easier. A donut cushion may suit some people, but stop using it if pressure, pain or numbness increases. Do not use any cushion to push through hours of painful sitting. Change position regularly and ask your clinician to check the fit if you are unsure.
Simple steps while you arrange an assessment
Break up prolonged sitting and temporarily reduce activities that clearly aggravate symptoms. Gentle walking may be easier than cycling or seated exercise. A wrapped cold or warm pack may provide short-term comfort; protect the skin and avoid excessive heat. If constipation or straining increases pain, ask a pharmacist or medical provider about appropriate management.
Avoid forceful stretching, self-manipulation or repeatedly pressing on the tailbone to test it. If symptoms worsen or daily activities remain difficult, seek assessment rather than continuing an unsuitable exercise routine.
Frequently asked questions
How long does tailbone pain take to settle?
Some cases improve over a few weeks, while persistent pain can last longer. The cause, irritation level and daily demands influence recovery. Seek assessment if it is not improving or is affecting normal activities.
Do I need an X-ray or MRI?
Not everyone does. A medical clinician may recommend imaging after significant trauma, concerning examination findings or persistent unexplained symptoms. Imaging should answer a clinical question rather than be routine for every painful tailbone. [3]
Should I start Kegel exercises?
Not automatically. If your pelvic floor is already overactive, more squeezing may be uncomfortable. Assessment helps determine whether relaxation, coordination or strengthening is appropriate.
Is an internal examination required?
No. Discuss what can be assessed externally first. An internal examination is considered only when relevant and with informed consent; declining it should lead to a discussion of alternatives.
Should I see a physiotherapist or chiropractor first?
Either can assess musculoskeletal symptoms within their scope and refer when necessary. Physiotherapy is a useful starting point for activity and exercise rehabilitation, while pelvic floor symptoms may warrant a clinician with pelvic health training. Red flags require medical care first.
Can I continue exercising?
Usually the aim is to stay active within tolerable limits, adjusting activities that provoke symptoms. Avoid forcing painful positions. Pregnancy, recent childbirth and suspected injury require individualized advice.
Tailbone pain assessment at Townline Physiotherapy
If tailbone pain is interfering with sitting, work or daily life, contact Townline Physiotherapy & Wellness in Abbotsford to discuss the appropriate assessment and clinician. Tell the booking team if you are pregnant, recently postpartum or experiencing pelvic floor symptoms.
This article provides general education and does not replace an individual assessment.
