Tailbone Pain (Coccydynia): Causes, Cushions, Treatment and Exercise

5 timesMore common in women than in men; the average age at onset is 40

Up to 70%Proportion of patients whose X-rays taken sitting and standing show abnormal tailbone movement

~90%Proportion of patients who, according to the literature, improve with non-surgical treatment

16 trialsTedavileri inceleyen 2025 tarihli sistematik derleme; 858 hasta

Symptoms

Pain and tenderness at the very bottom of the spine, above the buttocks
Usually a dull ache, with occasional sharp pain
Worse when sitting and when getting up from sitting
Worse when bending forward or on the toilet
Can make sleep and daily activities difficult
Relief when sitting on one buttock or on the legs

What causes it?

A fall onto the tailbone
Pregnancy and childbirth
Long periods of sitting, such as in a car or on a bike
Poor sitting habits
Being overweight or very underweight (excess weight is 3 times more common in people with tailbone pain)
Very flexible joints, or a stiff tailbone joint
Sometimes no clear cause is found

What can you do yourself?

Adjust how you sit

You can sit upright with your lower back supported and avoid sitting for long periods.

A special cushion

A cushion designed for the tailbone can reduce pressure when you sit. Lying on your side also brings relief.

Heat or cold

You can apply an ice pack wrapped in a towel for 20–30 minutes, or use heat for longer.

Prevent constipation

If the pain is worse on the toilet, measures that soften the stool help; you can ask your pharmacist. Painkillers can also give short-term relief.

How is it diagnosed?

The diagnosis is made by examination, and other problems in the area, such as a pilonidal cyst, are ruled out. An X-ray taken in a single position is usually not helpful. X-rays taken sitting and standing (dynamic X-rays) show in up to 70% of patients that the tailbone is overly mobile, has slipped or does not move; normally the tailbone moves between 5 and 25 degrees when sitting. An MRI may be done if needed.

Treatment options

A systematic review published in 2025 examined 858 patients in 16 studies. The recommended approach is to try non-surgical methods first and move forward step by step if needed. For recent pain (lasting less than 2 months), the first step is at least 8 weeks of protecting the tailbone from load, adjusting how you sit, preventing constipation and using painkillers; for pain lasting longer than 2 months, a detailed assessment with dynamic X-rays and MRI can be done.

PhysiotherapyHands-on treatment of the muscles around the tailbone, pelvic floor work and exercise. The effect of hands-on treatment was mild in studies; in one study combining taping with exercise, pain and function improved within 1 month.
Shockwave therapy (ESWT)It reduced pain in several small randomised trials; in one, its effect lasted longer than a steroid injection. Promising, but larger studies are needed.
InjectionsA steroid injection, or a block of the nerve cluster in front of the tailbone (ganglion impar), is among the options for pain that does not settle. In an older study, injection alone was successful in 59% of patients, and 85% when combined with hands-on treatment of the tailbone.
RadiofrequencyNumbing the nerves with heat; so far there are few, low-quality studies.
SurgeryWhen other methods have not worked, part or all of the tailbone can be removed. Published success rates range from 60% to 91%; the best results are seen in people whose tailbone is overly mobile or has slipped. The most common problem is wound infection (in up to 22%).

In a study following patients with long-standing pain, more than half still had marked symptoms 3 years later. If pain has not improved within a few weeks, seeing a doctor or physiotherapist can help you start the right treatment early.

Exercises at home

Six movements to ease the tailbone

Movements that work the pelvic floor muscles and relax the hips and lower back. Do them slowly and within a pain-free range; you can skip any movement that clearly makes your pain worse.

Pelvic floor squeeze lying down

Pelvic floor exercise lying down

Lie on your back with your knees bent. Gently draw your pelvic floor muscles in and up as if holding in urine, hold for 5 seconds, then relax completely. Try not to squeeze your buttocks or stomach.

10 reps, 2–3 times a day

Pelvic floor squeeze sitting

Pelvic floor exercise sitting

Sit upright on a cushion that feels comfortable, or towards the front of a chair. Do the same contraction sitting down, then relax completely.

10 reps, twice a day

Pelvic tilt

Lie on your back with your knees bent. Gently press your lower back towards the floor and release; keep the movement small and pain-free.

10 reps

Knee to chest

Knee-to-chest stretch

Lie on your back. Use both hands to draw one knee slowly towards your chest and hold for 20 seconds; then do the other leg. Feel your hips and lower back relax.

20 seconds on each leg, 3 repetitions

Cat–camel

Get on your hands and knees. As you breathe out, round your back upwards; as you breathe in, let your lower back sink gently. Move within a comfortable range.

8–10 reps

Brisk walking

Short walking breaks

Because sitting for a long time can make the pain worse, you can get up every 30–45 minutes and walk for a few minutes.

Often through the day

Frequently asked questions

How long does tailbone pain last?

The pain often eases within a few weeks, but it can sometimes last longer. In a study following patients with long-standing pain, more than half still had marked symptoms after 3 years. So an early assessment can be helpful if the pain does not go away.

What kind of cushion should I use?

Cushions designed specially for the tailbone can reduce pressure when you sit. They come in different shapes that leave the tailbone free; you can choose by trying which feels most comfortable for you.

Should I have a cortisone injection?

For pain that persists despite home measures and physiotherapy, injections into the tailbone joint or the nerve cluster around it (ganglion impar) are among the options, and studies have shown that they reduce pain. You can make this decision with your doctor, taking into account how long and how severe your pain has been.

Will I need surgery?

Rarely. Surgery (removing part or all of the tailbone) is considered when other treatments have not worked. In one study, about 70% of those who had surgery improved meaningfully at 2 years; wound problems are among the known risks of the operation.

When should you see a doctor?

If the pain has not improved after a few weeks of home measures
If the pain is stopping you doing daily activities
If you have a fever along with tailbone pain, and pain in your stomach or lower back too

Sources

NHS. Tailbone (coccyx) pain. Page last reviewed 20 November 2025.
Patel R, Appannagari A, Whang PG. Coccydynia. Curr Rev Musculoskelet Med. 2008;1(3–4):223–226.
Mazzoleni MG, Maffulli N, Bardazzi T, Memminger M, Bertini FA, Migliorini F. Management of coccygodynia: talking points from a systematic review of recent clinical trials. Ann Joint. 2025;10:9.