Tailbone Pain: Coccydynia

The tailbone is the very last bone in the spine, and it may be lower than you think. Often patients gesture to their sacrum when talking about their tailbone, but as the illustration below shows, they’re not the same thing.

The tailbone and associated anatomy

Tailbone Anatomy

As the name suggests, the tailbone (or coccyx) is a residual nod to the tails we used to have about 25 million years ago. The bone is made of a few small vertebrae fused together, and its only joint is with the sacrum above it. This joint is supported by ligaments, but due to a lack of support on the lower end, it can be susceptible to displacement injury.

Associated Muscles

A few muscles attach to the coccyx, which can help to support it when they’re working well, or potentially lead to injury if they’re not. The strong gluteus major attaches along the side of the bone, and two muscles of the pelvic floor attach to the front.

Injuries to the Tailbone

Typical symptoms include a dull ache that may be constant, with sharper pains on movements that directly affect the joint, or indirectly via the muscles that act on it. These include:

  • moving from sitting to standing or vice versa
  • opening your bowels
  • walking
  • sitting for long periods, or in a slouched position
  • bending forwards
  • having sex

Coccyx injuries often occur in childbirth or as the result of a fall. An injury could involve a fracture, displacement, or both.


As the baby descends through the birth canal, their position may push against the tailbone, causing it to tilt backwards. This kind of injury may correct itself as the body heals from birth and the pelvic floor muscles head towards their pre-birth state. Alternatively, symptoms may persist and it may be time to seek treatment.

One factor in the tailbone’s mobility is birthing position. Some positions allow the sacrum and coccyx to move more, giving the joint between the two bones 16° of range. Positions that restrict the bones can limit their movement to only 4°. If birth requires more movement than this, it will take it from somewhere else- potentially leading to injury.


Falling directly into a sitting position and landing on the coccyx can cause the opposite injury to those described above. Here, the tailbone can be pushed forwards.

Osteopathy and Coccydynia

Your osteopath can use techniques to mobilise the tailbone and encourage it to return to its correct position. We will look at the whole case to understand the original cause and the maintaining factors. With this in mind, we can work out which muscles might need relaxing or strengthening. With this in mind, we can devise a treatment plan comprised of techniques done in clinic and exercises for you to do at home. These exercises might include:

  • pelvic floor exercises
  • advice about sitting, such as using a donut-shaped cushion
  • stretches or strengthening exercises
  • using heat or ice

We understand that problems in this intimate area can be embarrassing and make you feel vulnerable. You are welcome to bring a friend or family member along as a chaperone if you like, and in any case, you can be sure that nothing will happen without your explicit consent.

Click here to make an appointment in Alsager for your tailbone pain.