You lower yourself into a chair and brace for it. You sit slightly to one side, lean forward over the desk, and dread the moment you have to stand up again, because that is when the sharp, deep ache at the very bottom of your spine bites hardest. Tailbone pain is one of those problems people quietly rearrange their lives around and rarely mention to anyone.
It has a name, coccydynia, it is common, and the encouraging part is that the large majority of cases settle with conservative care. Here is what is going on, why sitting is the trigger, and what helps.
In this article
What is coccydynia?
The coccyx is the small, slightly curved set of fused bones at the very bottom of the spine, below the sacrum. Most people call it the tailbone. Coccydynia simply means pain arising from the coccyx and the small joint that connects it to the sacrum above. The pain is typically felt right at the base of the spine, between the buttocks, and is often described as a deep ache that becomes sharp with certain movements.
The coccyx is not just a leftover. Several pelvic floor muscles and ligaments attach to it, and when you sit it forms one leg of a three-point tripod, with the two sitting bones, that carries your body weight. That is why it is so exposed to load, and why the problem so often begins with a fall or with long hours in the wrong chair.
Why does sitting make it worse?
Because sitting loads the tripod directly, and leaning back loads the coccyx most of all. A hard seat, a slumped posture with the pelvis rolled backwards, or a long drive all press the coccyx into the surface beneath it. The moment of standing up is often the sharpest because the coccyx flexes slightly as the pelvis tilts, and an irritated joint objects to that movement.
This is also why people instinctively perch on one buttock, lean forward, or sit on the edge of the chair. Those strategies unload the coccyx, which is useful in the short term, but they also load the hips and lower back unevenly, which is part of why our physio Mount Gravatt team looks at the whole pelvis and not only the sore spot.
Who gets it, and how often does it settle?
Most cases settle without surgery
A clinical overview in the Ochsner Journal reports that conservative treatment is successful in about 90% of cases, and that many resolve without any medical treatment at all. Injections and surgery are reserved for the small minority that do not respond.
The female predominance is thought to relate to pelvic shape and to childbirth, which is one of the common triggers. Whatever the cause, the headline is reassuring: for most people, tailbone pain is a problem that responds to sensible, conservative management.
Tired of perching on one cheek? A physiotherapy assessment at ACE Sports Medicine in Upper Mount Gravatt can identify what is driving your tailbone pain and start unloading it this week.
What causes tailbone pain?
The three most common triggers are a fall onto the backside (stairs, a wet floor, a bike, a skateboard), childbirth, where the coccyx is pushed backwards during delivery, and prolonged sitting on hard or poorly shaped surfaces, which is the slow-burn version common in desk workers, drivers and cyclists. Rapid weight change can also play a part by changing how the coccyx is cushioned and angled when you sit.
In a proportion of people the coccyx moves too much or too little at its joint with the sacrum, and in others the pain is referred from the pelvic floor muscles or the lower back rather than the bone itself. That is why a proper assessment matters: the treatment for a stiff, bruised coccyx is different from the treatment for overactive pelvic floor muscles that happen to pull on it.
What actually helps?
Unload it. A cut-out or wedge cushion that lets the sitting bones take the weight while the coccyx floats free is the single most useful early change. Lean forward slightly to stand rather than pushing back, break up long sitting, and avoid the soft couch that rolls your pelvis backwards.
Treat the drivers. Physiotherapy for coccydynia typically includes hands-on treatment to restore normal movement at the coccyx and sacrum, assessment and treatment of the pelvic floor and hip muscles that attach around it, and a graded exercise programme for the hips, glutes and trunk so the pelvis is better supported when you sit and stand. Many people improve well with this kind of care.
Escalate only if needed. Imaging, injections and, rarely, surgery are options for the small group whose pain persists despite a proper course of conservative treatment, and your physiotherapist will tell you if and when a referral for those makes sense.
When should you seek help?
Tailbone pain after a minor knock that is easing within a couple of weeks can reasonably be managed with a cushion and common sense. Beyond that, earlier assessment shortens the story.
Consider getting assessed if
The pain has lasted more than a few weeks or is changing how you sit, work or drive; it followed a significant fall or a difficult birth; it is present at night or when you are not sitting; you have a fever, unexplained weight loss, or any change in bowel or bladder control, which need prompt medical review; or you are simply tired of rearranging your day around a chair.
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Helping You Perform at Your Best
Our physiotherapy team at ACE Sports Medicine in Upper Mount Gravatt assesses and treats tailbone pain for people across Brisbane's southside, from the post-natal mum to the desk worker to the cyclist who came off at the weekend. It is common, it is treatable, and you do not need to be embarrassed to ask.