Coccydynia (Tailbone Pain)

Not all pain felt around the tailbone comes from the tailbone.

True coccydynia stays local. The pain sits over the coccyx itself, and the tailbone is tender when pressed ³. People usually describe a sharp, shooting pain, or sometimes an ache ⁵.

Referred pain reaches the area from somewhere else, such as a nerve root in the lower spine. It usually comes without that tell-tale tenderness over the tailbone ³. If that sounds more like you, start with the Lower Back section of our Injury Finder instead.

An assessment also checks for a pilonidal cyst, an infection in the soft tissue near the coccyx ³. None of this can be reliably sorted out at home.

You usually won't need a scan for this ¹. The diagnosis comes from your history and a physical check. Expect questions about a recent fall or a slow build-up with no obvious trigger, and about what happens when you sit for a while, lean back in a chair or stand up from one ³. Then the tailbone itself is pressed. Tenderness right over the coccyx is the hallmark sign, and pain referred from elsewhere usually doesn't have it ³.

X-rays, CT and MRI are kept for ruling out a fracture, an infection or a tumour ¹. If the joint above the tailbone seems too loose or too stiff, X-rays taken in more than one position can show how it moves ³.

We start by confirming it's the tailbone and not referred pain, and by checking for anything that needs a doctor first. Then we look at what's loading it in your week.

Now the honest part. A 2025 review of nine trials (532 people) concluded that physiotherapy's effectiveness for coccydynia "remains uncertain" ⁴. Several trials carried a moderate-to-high risk of bias, and three were rated low quality ⁴. Manual therapy worked best for recent-onset pain, and its effect faded over time ⁴. In an earlier study it helped only about a quarter of people at six months and at two years ⁷. What's well established is that most tailbone pain settles with conservative care ^1,3. Our job is to help you through that as comfortably as possible, and to spot the minority who need something else.

Tailbone pain shows up when you sit, so The Well Motion Recovery Path™ is measured here in sitting. You move up a phase when you can sit for longer in comfort, not when a date arrives.

• Reset: the first few weeks. A coccyx cushion, supported sitting, lying on your side and ice or heat ², with tape for comfort if you want it ⁴. Expect sitting to stay sore while walking feels fine. If nothing has changed after a few weeks, that is the point for a review ². We move you on once you can sit through a meal without the pain building.
• Rebuild: manual therapy ¹, hip stretches and mid-back mobility ⁸, and pelvic floor exercises where they fit ². Shockwave therapy may be added if progress stalls ⁴. Expect uneven weeks, because the trials behind these treatments are small and their results vary ⁴. We move you on when sitting does what your day asks of it.
• Return: long drives, desk days, and the bike if cycling set it off ². We test the sitting you really do. You leave with a seating set-up and a stretching routine.

How long it usually takes. Tailbone pain usually settles within weeks to months ¹. Conservative care succeeds in about 90% of cases, a figure from a 2014 review article, not a trial ³. A minority develop longer-lasting pain ³, and for them the plan shifts to chronic pain management.

No study has tested how to stop tailbone pain coming back, so each of these goes after a known cause:

• Get off hard, narrow seats. Repeated or long sitting on hard, narrow or uncomfortable surfaces is a recognised cause of minor trauma to the coccyx ³. Think timber benches and stadium seats.
• Sit upright, and get up often. Leaning back in a chair puts more pressure on the tailbone ³. Long stretches of driving or cycling strain it too ², so break them up to stand and stretch ¹.
• Keep your weight steady. Obesity raises the risk ³. Rapid weight loss may as well, because you lose padding, though that's clinicians' observation and hasn't been studied ³.
• Lower your odds of a fall. A backwards fall is the classic cause ³. In people over 60, exercise programs cut the rate of falls by 23% across 59 trials, and the ones that worked were mostly balance and functional exercises ⁶.