- The tailbone is located at the base of the spine. It is common to only become aware of existence of the tailbone when it hurts.
- Tailbone pain usually aggravated by sitting.
- Tailbone pain rarely interferes with movement.
Location and structure of the coccyx
The coccyx is located at the base of the spine, where the lowest vertebrae in adults have fused into a single structure. The coccyx does not have a specific role in movement, but it functions as part of the weight-bearing structure in a sitting position. Another of its main functions is to act as an attachment point for the muscles and connective tissue of the buttocks and pelvic floor.
Coccyx pain
Coccyx pain can start for no clear reason or after different accidents where the coccyx gets hit. A classic coccyx injury in adults is sledding, where the coccyx hits something like a rock during the descent. Perhaps the most common cause of symptoms today is sports that are performed in a sitting position, such as rowing and cycling. Tailbone pain is five times more common in women than in men, due to differences in the structure of the area and factors related to childbirth. Symptoms in the tailbone area may also be caused entirely or partially by other dysfunctions of the pelvic floor muscles or pelvic area, such as SI joint and gluteal muscle dysfunction. It is quite common for people to confuse the sacrum and coccyx areas, as the coccyx is a small and somewhat hidden structure at the end of the sacrum.
Symptoms of coccyx pain
The most common symptom is local pain and soreness when sitting in the gluteal cleft. Leaning back in a sitting position usually increases the symptoms, as more pressure is applied directly to the coccyx from the sitting bones of the pelvis. The muscles and connective tissues are also less able to support the position when leaning back, which further increases the direct pressure on the coccyx. The pain can be relieved by using various coccyx cushions with an opening at the coccyx, which reduce the direct pressure on the coccyx when sitting.
In studies, the most common misalignment of the coccyx is a twist to either side and/or excessive inward placement. Very rarely have I encountered patients suffering from tailbone pain whose tailbone is tilted more backward. Palpation usually reveals tenderness in the connective tissues and muscles attached to the tailbone. Some patients have various clear functional disorders of the pelvis, the treatment of which alone helps with coccyx pain.
Causes of long-term symptoms
Prolonged symptoms are usually caused by a combination of several factors rather than just one of the factors listed below.
- Excessive physiological strain due to previous injuries, excessive sitting, difficult vaginal deliveries, or functional disorders in the pelvic floor and/or gluteal muscles.
- Excessive or insufficient mobility of the tailbone and abnormal congenital structure.
- Psychological factors, such as anxiety, depression, and/or excessive mental strain.
- Lifestyle factors, such as being overweight, too little or unbalanced exercise, or insufficient or poor-quality sleep.
- Central sensitization of the nervous system.
Treatment and rehabilitation of tailbone pain
Treatment and rehabilitation are tailored to the individual. The tailbone is one of the simplest structures to examine in a clinic, as its movement and positional abnormalities are usually minor. It is common for symptoms in the tailbone area to be related to the deep gluteal muscles and pelvic function, such as SI joint dysfunction. At best, pain concentrated in the tailbone can be treated by treating only the pelvis, which eliminates the pain.
Read more about related pain syndromes
Low back intervertebral disc problems
Hip flexor pain (Psoas syndrome)
Viimeksi päivitetty 13.10.2025
