A Pain in the Tail…bone (Part 2: Treatment)

“Due to the dearth of research available and the low levels of evidence in the published studies that were located we are unable to recommend the most effective conservative intervention for the treatment of coccydynia. Additional research is needed regarding the treatment for this painful condition.” 

This statement comes from a 2013 systematic review on conservative treatments for coccydynia… isn’t it so encouraging? We discussed what coccyx pain meant, the causes, and the examination approach last week in Part 1 of “A pain in the tail…bone.”  Today’s post will take a close look at my approach for treating people with tailbone pain and what we do know in the current research. Unfortunately, as you see from the comment above, research for the best treatment for tailbone pain is significantly lacking…so we’ll have to rely on my clinical experience as well as the knowledge from courses I have attended and practitioners I have collaborated with in the past.

So, what should treatment for tailbone pain include?

1. Pain reducing strategies: Day one of treatment should always include recommendations for reducing pain by changing some basic daily habits. Typically, this includes:

  • Cold packs/hot packs: Basic, I know, but they feel good and can help a sore coccyx feel better after a long day. I prefer ice, but others prefer heat. I recommend using for about 10-15 minutes, a few times per day or as needed. Recent recommendations always include using cold/heat as needed.
  • Alignment, & Cushions when needed: Alignment, especially in sitting, is very important for reducing pressure on the tailbone in the initial phase of treatment. Slumpy postures actually put more pressure against the tailbone and neutral postures distribute weight to the bony parts of our pelvis more evenly. Along with this, firm comfortable chairs tend to support a more neutral posture, but cushy couches or chairs usually promote a more slumped posture. As I mentioned in my previous post, many people with tailbone pain tend to develop a side-twisted sitting posture. It makes sense– they’re trying to unweight the tailbone–but over time, this “wonky” sitting can lead to low back pain, and that’s not fun for anyone! So, we need to learn to sit up comfortably, and a good tailbone cushion can be a helpful tool for that. Note: Donut cushions don’t tend to help as much with tailbone pain unless the pain is totally referred from the pelvic floor musces. These unweight the perineum due to the center cut-out, but they don’t unweight the coccyx.  A cushion that has a back cut-out, like the ones pictured tend to be more helpful.
  • Coccyx cushion from Amazon.com

    Aylio Seat Cushion

  • Body Scanning or “Check-ins”: Many people with tailbone pain will clench muscles around the tailbone as a protective strategy–usually the glutes and the pelvic floor to be precise. As we discussed previously, these muscles can refer to the coccyx, so it is important that we decrease this hypervigilant clenching pattern. I typically recommend scanning the body, or checking-in, a few times a day to feel if muscles are clenched hart or relaxed. If you feel any clenching, try to drop the muscles and allow them to let go.
  • Pelvic Floor Drops: As mentioned previously, many people with coccyx pain have tender and over-contracting pelvic floor muscles. Pelvic floor drops are exercises that encourage a completely relaxed pelvic floor. Typically, these pair well with breathing exercises as functional diaphragm use can encourage appropriate pelvic floor relaxation.
  • Stretches: My favorite stretch for someone with coccyx pain is what I call “The frog.” This stretch not only helps to stretch out the buttock muscles, but also is a position of optimal relaxation for the pelvic floor! Other stretches to open the pelvic or stretch the muscles around the pelvis can also be helpful–but this one is my go-to on day
Performed with arms holding knees, dropping open to the side (should not be painful or uncomfortable!)

Performed with arms holding knees, dropping open to the side (should not be painful or uncomfortable!)

2. Manual Therapy Techniques: The goal of manual therapy should be to decrease soft tissue sensitivity/pain and to improve the mobility of the coccyx, SI joint and low back if indicated. Typically we do the following:

  • Soft tissue treatments: This should not be a horribly painful experience! Skilled clinicians can help to improve sensitivity and tender spots in the buttocks, hips, low back muscles and pelvic floor muscles. For the pelvic floor, this can be done externally, vaginally (in women) or rectally. Specifically, the coccygeus, iliococcygeus, pubococcygeus and obturator internus muscles should be evaluated and treated. Sometimes dry needling can be helpful also in reducing soft tissue sensitivity.
  • Coccyx Mobilization: The coccyx can be mobilized some externally with a person in sitting (I use what is called the “closed-drawer technique” here). The best way to mobilize the coccyx is with internal rectal treatments. Internal rectal mobilizations or manipulations can include direct mobilization into flexion or extension, distraction of the coccyx and mobilization into sidebending. The most recent review I found published in 2013 found 3 studies looking at intrarectal manipulation for coccyx pain and all of them did show some improvements in pain for patients…but from a research standpoint, 3 studies is hardly anything and to be honest, the studies weren’t that good. So, we’re stuck with some of my clinical opinion 🙂 I believe intrarectal mobilization can be hugely beneficial for patients! And, I shouldn’t have to say it–but it should always be done by someone trained and skilled in performing it.
  • Lumbar & SI treatment: I highlighted in part 1 that many men and women would tailbone pain often have low back and SI pain as well. In these cases, these areas should be addressed and treated through manual therapy techniques as well as specific exercise recommendations

I often will also use a little bit of taping to help support what I do manually and give my client some input on what I want their bodies to do. I like kinesiotape the best for this and use a few different techniques depending on the person. McConnel tape can also work well.

3. Retrain the Nervous System: Our brain rules– remember, pain is our brain’s alarm system to tell use there is a problem and to protect. A person who has had coccyx pain for a long period of time may develop a sensitized nervous system–and it is so important that this be addressed! So as not to re-invent the wheel, you can read more about it in my previous post reviewing the book, Why Pelvic Pain Hurtsand in my previous post summarizing my presentation to the Atlanta Interstitial Cystitis Support Group. 

Side-note: Pain neuroscience is currently not discussed often enough in the research regarding treatment for coccydynia. I think this is a huge problem–we know that experiencing pain for a long period of time truly impacts the nervous system and we can’t ignore that! This case study showed 2 patients treated for tailbone pain–one was acute, treated immediately and got better quickly. The second had pain for over a year before being treated and did not get as good results– could this “brain retraining” be the missing piece? I think it can’t be ignored.

4. Manage Bowel, Bladder and Sexual Problems: Remember, the pelvic floor muscles attach to the tailbone, so it is so common for people with tailbone pain to notice bowel, bladder or sexual symptoms.  This should always be addressed with good behavioral education and appropriate treatment techniques. I’ll leave it at that…because each one could be a few blog posts in and of themselves.

5. Return to Normal Function: I talk about this in almost every post, but ultimately, our goal is always to get you back to moving, sitting, exercising, etc. as quickly and effectively as we can. As pain decreases, our goal is to retrain the system to function optimally. We do this by retraining proper patterns of muscular activation (yep, diaphragm, pelvic floor, abdominals, low back…with all of the other muscles!), teaching movement with lots of good variation, and a lot of education.

So, that about sums it up… PTs out there, did I miss anything important? I would love to hear from you and start a discussion!

For those of you out there dealing with tailbone pain–please let us know how we can help you better! If you have not tried working with a pelvic physical therapist in the past, I do strongly recommend it!

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60 responses to “A Pain in the Tail…bone (Part 2: Treatment)

  1. Thank you for your amazing blog and this post on pain in the tailbone. I often get this pain and follow many of strategies you recommend. My favorite stretch to help with tailbone pain is actually child’s pose with my knees spread slightly wider than hip distance. I describe this and another pose similar to what you call “the frog” in my post called Child’s pose and happy baby are for adults too.

    Thank you for all that you do!
    Sarah4Hope
    WhenSexHurtsThereIsHope.com

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    • Sarah, Thank you so much for your kind comments! The modified wide child’s pose is a fantastic stretch! I see that as a “flipped frog” hopefully accomplishing a similar goal! The other stretch that sometimes helps is a deep squat for those that can attain it. I’ve read several of your blog posts–great information and so insightful! Thanks for all YOU do!
      ~ Jessica

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  2. katie ireland

    hi Jessica, i am a physical therapist working with a 10 year old girl with tailbone pain. she developed it a few months after a fall on the tailbone and buttock. i am address he movement dysfunctions and pelvic malalignment. after 3 treatments no change. only pain is with sitting. on visit 3 i was actually able to apply pressure to trigger points around sacrum and glutes, otherwise she is too ticklish and shy to do more. i am not trained for internal mobilizations. can you provide me with any other approaches for trigger points or muscle sensitivities and stretches . thanks katie

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    • Hi Katie! Thanks for commenting– I’m happy to provide some insight into your patient. First, internal mobilization/exam of a 10 year old is typically contraindicated. For a younger child, I would recommend educating her about the pelvic floor muscles and teaching her how to perform diaphragmatic breathing to use that to reflexively encourage relaxation of the pelvic floor. Generally, that type of breathing alone can be very very helpful for coccyx pain or pelvic floor problems. Gentle manual treatment to the glutes and near the coccyx at the pelvic floor can also be helpful, as long as she understands exactly what you’re doing and why you’re doing it.

      Posture and alignment are super important with this population as often times, they live in that slumped “C” posture. I would recommend working on that– possibly having her sit on a wedge with a tailbone cut-out (like the tush cush) as this can encourage better alignment, but also can be a position of relief as it unweights the tailbone.

      In terms of stretches, the frog stretch (knees to chest, opening the knees while breathing slowly) is a great one– also stretching the piriformis and the glutes.

      If you try all this and she is still having pain at the tailbone, you may want to refer her to someone with training in treating the pelvic floor muscles (preferably someone with pediatric experience). She may benefit from using EMG biofeedback to better learn to relax the pelvic floor and some other more specific external treatments for the coccyx.

      Hope that is helpful!

      Kind regards,

      Jessica

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  3. HI, I’M SO GLAD I FOUND THIS INFO. I HURT MY TAIL BONE THIS PAST WEEKEND(TODAY IS ONLY MONDAY) WHEN I MISJUDGED HOW FAR DOWN THE CEMENT LEDGE WAS THAT I WAS PREPARING TO SIT ON AND SURE ENOUGH IT WAS FURTHER DOWN THEN I THOUGHT. I FELL DOWN HARDER THAN EXPECTED AND MY TAILBONE HAS BEEN HURTING. I USED SOME MOTRIN BUT WANTED TO KNOW MORE. I WILL ICE WHEN I GO HOME THIS EVENING AND DO THE EXERCISES.
    THANKS AGAIN.

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  4. Hi, I’m also happy I found your blog. I’ve been having what I think is tail bone pain for about 2 months and it won’t seem to ease up. I’ve used heat patches and my doc has me on naproxen. However, I’ve been growing a bit worried and I would like to be able to focus on fixing the problem rather than covering the pain. I’ve never used a PT before and I am not sure how to identify a good one–I am VERY concerned about making sure I see someone who has experience with this issue. Do you think I need to see a specialist or is this something I can manage on my own? Do you have any suggestions for identifying a good PT? Or any recommended PTs based in Chicago? Thanks!

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    • Hi there! Glad you enjoyed the blog and found it helpful! I agree, seeing someone who is skilled with experience is very important! I would really recommend seeing someone who specializes in pelvic health. Thankfully, Chicago has so so many great pelvic PTs! Off the top of my head, I would definitely recommend Sarah Haag and Sandy Hilton with Entropy Physio (http://entropy-physio.com). Check them out, but really there are so many great ones in Chicago! Feel free to check out my post on finding a pelvic PT to locate one close to you! Hope that helps, and that you are able to get better soon!

      Jessica

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  5. Hi …. I had a tumble while crossing a stream out on a run 7 days ago and landed on my tail. I did continue to run another 8 miles with some discomfort but nothing major. Currently I still have pain when sitting and more so when getting up or moving position. I have been out for a couple of runs while mildly uncomfortable more so when just starting or going downhill without any problems. Im in the middle of a training program for my 1st 100mile race and realize you cant really comment specifically on my case. Do you believe running after a traumatic bruised tailbone injury would aggravate the condition or slow down the healing process and could a visit to a PT help with a traumatic injury.
    Thanks

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    • Hi Ian, Of course, it is difficult to comment specifically without knowing more of your history/examining you myself. I do believe that working with a skilled pelvic PT would be a good option for you. Let me know if you need a recommendation to find one! In terms of running, running is a dynamic task that involves the coordinated activation of muscles throughout the body– I would bet the discomfort you feel is likely due to the pelvic floor muscles activating (they are part of the stabilizing system after all) and pulling on your tender tailbone. I would recommend scheduling a visit with a pelvic PT so they can evaluate you specifically and help you with progressing in your running without aggravating your tailbone. Hope that helps! ~ Jessica

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  6. Hi, I had a trip back in Oct/Nov. didn’t fall but almost. Did the catch yourself dance for sure. Since then tailbone pain that seems to radiate entire buttocks off and on, including the “no go zone” I’m wondering if I could have misaligned it without actually hitting the ground? Sometimes I think the worry factor is making it worse.

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    • Hi Donna, it would be difficult to say without examining you. I will say it’s important to remember that the tailbone itself is often not the source of the problem. I would definitely recommend seeing a pelvic PT to be evaluated. It’s likely there are multiple issues going on, as well as likely some neural sensitivity (very intuitive to note that worrying could be making your symptoms worse!) hope that helps!! – Jessica

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  7. Pingback: 2015 in Review! Happy New Year! | Jessica Reale, PT, DPT, WCS

  8. Hi Jessica,
    I am so thankful to have found this website and I am in desperate need of a skilled PT in Redondo Beach, Los Angeles, Ca. July 2014 I was drugged by a bartender and fell. I have been to 2 ortho docs and one PT but they have only prescribed pain meds and excercises. I believe my tailbone was broken off right under the saccrym and it is so uncomfortable and pain when I lay flat. If you have a referral for a PT that will do an internal exam or internal manipulations I would be very appreciative. If there’s not one in Los Angeles I’m willing to travel. This gives me hope. Thank you 😊

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  9. Hi Jessica,
    Thank you for your articles – they are very informative.
    Since child birth (12 years ago), I’ve experience what a doctor told me is coccydynia, but on an intermittent but very intense basis. Approximately half a dozen times a year, I get a deep pain around the coccyx area that is not exactly acute, but distracting. Almost feels like the need to pass a stool, and sitting on a toilet helps ease the pain a little, but standing, lying or normal sitting doesn’t help. The episodes only ever last between 5 – 20 minutes, mostly around 10 – 15 and then it just goes away. Pushing on my coccyx isn’t comfortable but not acutely painful. Pushing into my butt cheeks to the muscles helps somewhat. I’ve never really followed it up because it has gotten no worse over the years, but would love to know what it is. I’ve never been sure if it’s lower back, coccyx or pelvis. I did get an anal fissure after childbirth too, which flares up every now and then, and have to watch my diet as suffer from constipation easily. (have had colonoscopy and all good in that regard). Could a physiotherapist help with this? I do have weakish pelvic floors – repetitive jumping at the gym isn’t great 🙂
    Thanks!!!
    Cath (from Down Under)

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    • Hi Cath, I apologize for not responding sooner! I was at a conference last week and am just now settling back in :). I’m sorry you’ve been hurting– very interesting presentation with only having half a dozen episodes a year. I would recommend seeing a physio who specializes in pelvic floor dysfunction. A skilled practitioner should be able to help you identify what the cause of your pain is and provide you with treatment options. I’m not sure where you live, but I have a few excellent colleagues in Australia. If you let me know where you are, I can reach out to them and see if they have recommendations. Hope that is helpful! ~ Jessica

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  10. Hi Jessica
    So glad I found this blog. Fell 1 week ago, where I slipped, socks on lamenate floor while cleaning as we are moving. I did not go to Dr as it was just a dull ache and I landed more on my right side, so didn’t think it was the tailbone. I have continued to pack and clean, and now I am experiencing pain in the tailbone area. I have iced and cut back on the moving process. I feel a lot of pressure like I have to have a bowel movement and my butt cheeks feel numb. When I press on the tailbone area, the pain goes away. I have to start back to work in about a week. Any advise on where to go from here. Should I go to the ER and have this checked out or are they going to tell me ice and rest. Guess all the bending stretching, carrying, and all that goes with moving brought the real problem to light. Thank You for any advise

    Sarah

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    • Hi Sarah,
      Thanks for commenting. I’m glad you enjoyed the article. It’s difficult to make a recommendation without examining you. Since you had a fall and are experiencing numbness in your buttock area, I would recommend following up with a physician to be examined. It sounds like your muscles around the buttock and tailbone are tender and irritated from the fall, so that should hopefully improve with just ice and rest…however, it would be worth seeing someone just to play it safe. I hope that is helpful!

      Kind regards,
      Jessica

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  11. Hi I am happy to have found your articles. I’ve been living with coccyx pain for 20 years when I gave birth to my daughter. I’ve recently had an X-ray and I indeed broke it and it’s healed wrong. My pain is applified because I now live in Dubai and its roughly an 18 hour flight back home. It literally kills me. Now I’ve developed horrible and sometimes debilitating lower back pain. I do exactly as you said and constantly am sitting slumped from one side to the other. I’m having trouble sleeping because I cannot lie on my back and it hurts to lie on my sides too. I’ve also developed a bit of a weak bladder. I’ve not been able to find anyone in Dubai who specializes in the tailbone. Do you recommend a chiropractor or physio therapist? Thank you.

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  12. Hi Jessica
    Thank you so much for your blog. I recently started at the gym when i felt a weird pain in my lower back. After X-rays it was confirmed that I had dislocated my coccyx and this happened during childbirth 7 years prior. A ring cushion and physio for 5 months has helped tremendously. However I’m considering going back to the gym but am scared that I will injury my coccyx even further by working out. Do you have any advice on what i can and can’t do? Any advice would be greatly appreciated.
    Many thanks. Fifi.

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    • Hi Fifi,
      It’s difficult to give specific recommendations without knowing your case. I would recommend chatting with the physio you worked with previously to come up with a good plan for progressing you back to the exercises you’d like to do at the gym. Hopefully that will help! Feel free to be in touch with any additional questions! ~Jessica

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  13. hello, thank you for this information. i am struggling with this issue and wondering if you are able to recommend a pt in the Detroit area (near Rochester, Michigan). take care, sarah

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  14. Hello, I felt like I was alone with this pain hahaha! I have been having this pain for about six months and it’s been off and on, but just lately it feels like it’s been flaring up and I’m also feeling a lot of pressure in my tailbone area, is that normal? I’m a little concerned.

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    • Hi Zarina! Definitely not “normal” to be feeling that, but very common in men and women with tailbone pain! If you’ve been hurting for 6 months, I would definitely recommend seeing your physician and a skilled pelvic PT to help you! Best of luck in your recovery! ~ Jessica

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  15. Hi
    I am go relieved I found this information. I have been dealing with pain in my “tailbone area” ever sine I had my last baby 2 years ago. I have gone to numerous doctors and none had even heard of this problem before and had no idea what it could possibly be. I found a pain management doctor who gave me numbing and steroid epidural injections. After the initial pain of the procedure, I got relief for 4 months. Now the pain is back and seems worse. I feel it when I tense up my muscles and when I completely relax them. I am so thankful for the information you gave. I was feeling hopeless like I had a problem nobody heard of. Can you recommend a good pelvic floor specialist and PT in the New Orleans area? If not I would gladly take a trip to come see you. I feel so hopeful after finding this. Lately I have been in excruciating debilitating pain. I was thinking my only option was to have the injections again.

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    • Hi Gina,
      I’m so sorry to hear you have been hurting for so long! Unfortunately, I don’t know anyone personally in New Orleans, but I did find a few options for you online: Jennifer Vaughan, DPT with Dynamic Physical Therapy (P: (504) 371-4226 E: jennifer.w.vaughn@gmail.com) or Pamela Janssen, PT in private practice (P: (504) 412-1600 E: pjan709671@aol.com ). Hopefully they will be a good place to start! Feel free to e-mail me if you have any questions or need additional help, and I’ll be happy to help as much as I can!

      Best of luck in your recovery!
      ~Jessica

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  16. Sheryle Birdsong

    Hello– so happy to find this!! I’m a speech pathologist in an inpatient rehab and we work with mostly CVAs, head injuries, and their effects. I’ve asked all my PT friends, etc- but this pain and condition seems to have little following. That’s sad because it’s so debilitating! No injury shows on my MRI and XRays. No accident or fall has occurred. But—I’ve been obese for a long time and recently have lost almost 100 lbs. I had this tailbone pain acutely for 3 years —- had series of coccyx shots— now it’s back! Shots have not helped. I’ve asked my OB- Gyn for assistance– but she’s not familiar with this. Could you direct me to someone in Oklahoma City, Edmond, Norman in Oklahoma who has insight into this and training? Please I am desperate and ready to get started. Thank you– if you have any questions, please contact me! Sheryle Birdsong

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    • Hi Sheryle, I’m so sorry I missed this comment!! I’m sorry you’ve been hurting! I agree, these problems can often be missed/misdiagnosed for so long and people are often offered little help. I don’t know anyone personally in your area, but a quick search found 2 pelvic PTs in Edmond who likely have some background in tailbone pain. Check out Debra Clark at http://www.fundamentalpt.com or Holly Jones (in private practice) (405) 475-7080. Hopefully one of them will be able to help you! Feel free to e-mail me further if you need any additional help! Best of luck in your journey! ~ Jessica

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  17. Hi Jessica — need your advice on a pelvic floor PT in San Antonio. I was going to someone who I thought was trained in this area but I find out fast that they have no idea what they are doing. While trying to mobilize(?) my hip they put pressure on my tailbone and yanked on my leg. The first they did it I felt better but the second I left in pain. They pushed on my tailbone and now it’s very tender to palpation and feels swollen on one side of my buttocks. Ugh!! She thought it was sciatic at first and after today she thinks its coccyx disfunction. I need someone who knows what they are doing and can dx accurately. Much help needed and appreciated!!!

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    • Hi there! I agree, it can be so difficult finding a person with good background in treating tailbone pain. My best recommendation would be to head to Austin to see my colleague Sara Sauder for an evaluation. Sara is an incredible pelvic PT with Sullivan Physical Therapy in Austin, and I’m sure would help to guide you in the right direction. If you need someone in San Antonio, here are a few names: Carissa Poole, Hargroder PT, and Cynthia Boyer. I can’t vouch for them as I do not know them personally or professionally, but that could be somewhere to start in SA. Hope that helps!! Wish you all the best in your recovery! ~ Jessica

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  18. Hello hopefully you can give me some insight. I have been dealing with this pain for 4+ years now. I have gone to PT for a short time frame when the pain traveled clear up my back and down my legs. After a few weeks the back and legs eased up greatly but now for the last 2 months I now only get a sharp pain in my tailbone when I sit down and after long periods of standing but it is not sore to the touch. Also and possibly unrelated but for the same duration of the tailbone pain I’ve had odd BMs as in they are frequent each day seldom more then small amounts each time looks as if it was squeezed from a half empty tube (hope this makes sense) and looks as if it has fibers of some kind along it. My doctor wont give me an MRI and xrays havent shown any issues. I try to keep up with the stretches from PT though not as frequent as theyd have me and have forced myself to be up moving longer as ive built a tolerance to it after 4 years as long as its not spread through 50% of my body. I intend to push for the MRI again even if I have to visit the emergency dept to do so because of my state health insurance. I hope this is enough to point me in the right direction as im fed up with being limited in life. Thank you for your time and my apologies for the long post.

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    • Hello Ken! Thanks for writing- I’m sorry to hear that you have been hurting for so long. It sounds like the PT you saw was someone skilled in working with orthopedic problems like low back pain/leg pain, but may not have directly addressed what was occurring with your tailbone. This is common, and is always why I suggest seeing a physical therapist who has advanced training in the management of pelvic floor dysfunction (which would include coccyx pain). The bowel dysfunction you are mentioning is extremely common with coccyx pain, so a good clinician should be able to help you with that as well. Where do you live? If you’d like, I can try to help you find a skilled pelvic PT locally who will be able to evaluate you and provide you with comprehensive care. I hope this helps! ~ Jessica

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  19. Oh did forget this pain began from trying to move a large bundle of steel with a prybar and at the time I heard a rather loud pop. At least im assuming that was the cause. Thanks again

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  20. Hi Amanda, I apologize for taking a few days to respond. That mechanism of injury is very very common with tailbone pain! I’m glad that the initial stretches in PT are helping you. Are you seeing someone who specializes in pelvic floor dysfunction, including internal examination? If you are still having quite a bit of pain after sitting for a long period of time, and have not been treated internally (generally, vaginally and/or rectally for specific tailbone mobilization) that would likely be the next helpful thing for you. Of course, I can’t make specific recommendations without seeing you myself, but I would start by making sure you are seeing someone with background in pelvic health, including both tailbone pain and pelvic floor dysfunction. Where in Maine are you located? I believe I have a few contacts there! I hope this is helpful! Please feel free to e-mail me if that is easier! ~ Jessica

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  21. Jessica, as others have already said, I am very glad to have stumbled across your site. I believe my pain may be coccydynia because of posture issues. I have an hereditary neuropathy (CMT) and spend a lot of time sitting with my legs elevated. Of course, I’m sure that I have a very slumped posture, especially since lately my papasan chair has been my favorite place to lounge and there’s no way to maintain good posture in one of them 🙂 I’ve been taking pain medication (Vicodin and Fentanyl patches) for years due to the neuropathy (not the coccyx) and I believe that they are causing my chronic constipation issues which may be contributing to the coccyx pain. I also have a chronic cough and, every time I have a coughing attack, my tailbone region suffers. When palpated, the pain feels like my coccyx has been pushing on the muscles while sitting because it’s the surrounding muscles that hurt. That probably isn’t what is happening; that’s just my description of how it feels. Anyway, I’ve wondered for a while about what type of medical professional to even see for this. I’m near Houston, Texas, and would greatly appreciate any recommendations you might have.

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    • Hi Kelly, I’m so sorry you have been hurting! It sounds like there are several factors involved. Chronic constipation, prolonged sitting, and chronic coughing can all be interconnected issues. Thankfully, I actually have a fantastic colleague in Houston who I am sure would be happy to see you. Her name is Uchenna Ossai (she goes by UC), and she practices at the Houston Methodist Hospital Center for Restorative Pelvic Medicine. You can easily find her online with a quick google :). She’s amazing and will rise great care of you! Best of luck in your recovery! Please feel free to be in touch if you have any questions!! – Jessica

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  22. Thanks Jessica! That’s the hospital/clinic facility that I use for all my doctors so she should be perfect!

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  23. Oh, and I purchased the Aylio cushion in your article above. I love it. It’s saving my aching…

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  24. Hello Jessica.

    So glad found your blog here.
    I slipped on floor a month ago and did an X-ray. A positive sacrococcyx fracture.
    Pain is lessen compared to month ago, but when i sit too long , the pain will show up. Although i bought the cushion as you attached above.
    Lying on my back is ok but not for long time.
    I saw a doctor asking about doing Accupuncture or Physiotheraphy. He said dont waste my money.
    I did Pilates with diaphragmatic and pelvic floor as you mentioned above.
    Oh btw i live far away, i live in Jakarta / Indonesia.
    Do you have anyone to help my recovery a bit faster?
    And also other any suggestion for my case?

    Thank you so much Jessica.
    Looking forward to hear from you

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    • Hi there- I’m so sorry for my slow response. I’ve been reaching out to colleagues to try to find someone near you, but unfortunately, have not had very much luck! 😦 Have you tried asking your physicians and searching online near where you are? I was told there were some courses taught over there by a reputable physiotherapist, but just couldn’t get any names! I really do think seeing a skilled physiotherapist would be of benefit to you! Let me know if I can do anything else to help! Wish you all the best in your recovery! ~ Jessica

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  25. Thanks for the great post! I’m 35.5 weeks pregnant and found out recently in a physical therapy session that my tailbone is jammed inward causing excessive hip and tailbone pain during my pregnancy (and most likely preventing natural childbirth). I had forgotten about the injury to my tailbone from years before (due to slipping on ice) and had no idea my tailbone was injured enough that it could affect me now and even lead to me having to have a csection. I’m curious if the internal rectal alignment method (suggested by my PT) is safe during pregnancy and whether at this point in my pregnancy it could allow me to give birth naturally? Thanks!

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    • Hi there! Congratulations on your pregnancy and your upcoming sweet baby! My daughter just turned 12 weeks old– it is an excellent adventure and a HUGE blessing, that’s for sure!!

      I’m sorry you are having tailbone pain! Are you working with someone trained in women’s health? It would be important to see someone specialized to really evaluate where your tailbone pain is coming from. To answer your question, yes, rectal treatment of the tailbone is typically fine during pregnancy (however, without evaluating you myself- I always to add that you should talk to your OB provider and your own PT to determine the best, and safest treatment for you!)

      I don’t necessarily think a tailbone injury would require a C-section delivery. Of course, I don’t know your specific situation, so for sure, consult with your OB. There are modifications for when you push which can be helpful if you are having tailbone pain. And hopefully your pain can be reduced over the next few weeks with some good treatment. This would be something your WHPT and OB provider would be able to help you with to really make sure you are able to have the type of delivery you want! I hope this is helpful! Please feel free to e-mail me directly if you have any additional questions!

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  26. Hello Jessica,

    I am a 47 yo female and have been suffering from a very painful tailbone for about 18 mos. I don’t recall a single traumatic injury, but I did have a traumatic birth with my daughter 26 years ago. Over the past 18 months, I’ve been experiencing very sharp pain at my tailbone when sitting, driving, or trying to stand from a sitting position. When lying on my side, it feels as though my tailbone is being pulled by gravity and is quite painful. I’ve been to my doctor, a physical therapist, and a chiropractor who took x-rays and found nothing wrong( although I am not fully convinced that the x-rays were of my tailbone). None of these experts have helped the pain. The pain is interfering with my quality of life and I feel I’m at my wits end. Is there someone in the Des Moines, IA area you could recommend? Thanks so much for taking the time to respond.

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    • Hi TJ, I’m so sorry your tailbone has been bothering you so much! As I mentioned in my post, although tailbone pain can occur after trauma (like a fall, or something like that), it can also happen without a specific known cause. Of course, your traumatic birth could play a role, but there are likely several factors involved. Was the PT you saw specialized in pelvic health? If you saw a general practitioner, they often lack the specific training to really treat tailbone pain effectively. Unfortunately, it does seem to be a diagnosis that is often misunderstood and poorly treated.

      I reached out to colleagues to find a personal recommendation for you. A quick search found me Kelly Brown, MSPT, WCS who has a board specialization (the same one I have). Here is her website: http://www.iowaclinic.com/doctor/kelly-brown/ I will let you know if any of my colleagues have specific recommendations for you!

      Best of luck in your recovery! Please feel free to be in touch along the way!
      ~ Jessica

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    • Oooh, just got one! A colleague Tarra Richard at Unity Point Health. She said they have 3 clinicians specializing in pelvic health at their location. Her office number is: 515-224-5225. Hope that helps!

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  27. Great read. I’m having tail bone after a long flight from London to Atlanta yesterday. Hurts to sit and go from sitting to standing. Your blog is very helpful. I will go see a doctor soon, but until then I will try ice/heat and ibuprofen to cope with the pain. Thanks

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  28. My wife has had tremendous lower back and tailbone issues since a snowboarding accident in 2015. Treatment has been horrible in the DC area for this injury. First pain management centers were brought into the picture which wasn’t solving the issue and only wanted to inject her. Then physical therapy was sought, which helped with her being able to sit comfortably. But sexual activity has been extremely painful for her. She’s going through physical therapy that is focusing on the internal manipulation, but it’s not covered by insurance and is expensive. She hasn’t had much improvement over the last month or so and the therapist isn’t a tailbone specialist. Pain has re-emerged externally as well and sexual activity is still unbearable. Do you have any advice?

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    • Hi Josh! I’m so sorry your wife has been dealing with pain! Sometimes it just takes time for people to get better when they’ve had problems for a long period of time. If you would like, you and your wife are welcome to email me and give more specifics for what she has done already in physical therapy, and I may be able to provide additional insight! It’s hard to make recommendations when I don’t know what has been focused on. I hope that is helpful! ~ Jessica

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  29. Hi there, I came across your site while researching an explanation for the possible link between deep-tissue massage and tailbone pain. Four days ago I had an 85 minute deep tissue massage for the first time in a long time. The therapist did not massage my buttocks at all, or lower back in isolation at all, just the upper and mid back, neck and shoulders intensely. Hot stones were used also moving north and south on my back (never directly on my spine). The day after I started experiencing tailbone pain that gradually got difficult to bare. The following day it was excruciating to walk, sit or do anything that involved movement. I’ve had to start taking pain medication to function. This has never happened to me before and I’m wondering if it’s the cause of the massage. I’d appreciate your advice so I can take the proper measures to heal.

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    • Hi Maria,

      I’m so sorry you’ve been hurting, and apologize for my delayed response. It’s difficult to say what happened without examining you. Were you tense during the massage (as can happen when something is painful?) it could be that somehow your pelvic floor became irritated? It could have been non- related as well with some other cause? It’s so difficult to say though… I wish I could just examine you! if you are still hurting now, I would seek medical advice, and go from there! Wish you the best for your recovery! – Jessica

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  30. Hello, Jessica, I am so glad to have found this site. I am 70 years old. About 1 1/2 weeks ago I began having coxxyx pain. I think it must be related to sitting on an old soft couch. I still work full time, at a standing desk, and get tired, so it is too bad that when I have a chance to relax, I am in pain. I have a great deal of medical anxiety due to congenital medical issues, as well as misdiagnosis. Will a simple xray rule out cancer? I do not want a physical exam, just reassurance. I read that doctors make fun of, and do not take patients seriously, who have “tail bone” pain. I don’t have a general practice Dr. I don’t know if a walk in clinic will have someone qualified to read an xray properly, and of course would have to have a Dr refer me for an MRI. Thank you so much.

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    • Hi Kathy, I’m glad you enjoyed the blog! I know tailbone pain is misdiagnosed frequently, but I would hope doctors aren’t making fun of patients with tailbone pain! That is awful! In terms of ruling out anything pathological, i would encourage you to see a physician, maybe an orthopedist if you don’t have a primary care? A physical exam is often necessary to determine the best tests(imaging, etc) that would be indicated. I hope you’re able to get help and reassurance soon! – Jessica

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