Tailbone pain

Also called: Coccydynia

Relief and prevention Stretch Massage Strength

Pain at the very base of the spine, worst sitting and worst still getting up from sitting. It follows a fall, a childbirth or nothing at all - and an overactive pelvic floor is very often part of it.

How common: Around 1% of back pain presentations; 5x more common in women

Open the Back Pain/Bulletproofing routine All problems

What it is

Coccydynia is pain at the coccyx, the small triangular bone at the base of the spine. It is loaded directly when sitting, particularly leaning back, and it is the attachment point for several pelvic floor muscles.

That muscular attachment is the part most often missed. The pelvic floor pulls on the coccyx, and an overactive, guarded pelvic floor produces persistent coccyx pain with no bony abnormality at all. Treating only the bone - cushions and injections - leaves that driver in place.

What it feels like

Pain at the very base of the spine, right between the buttocks
Worst sitting, particularly on a hard seat or leaning back
Worst of all in the moment of standing up from sitting
Tender to press directly on the bone
Sometimes pain with bowel movements or with sex

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

A fall onto the tailbone: The classic mechanism - landing on the base of the spine on a hard surface. It can bruise, dislocate or fracture the coccyx, and pain can persist long after the bone has healed.
Childbirth: The coccyx moves backward during delivery and can be strained, dislocated or fractured. It is a common cause and it is frequently not connected to the birth when the pain appears months later.
Pelvic floor overactivity: Several pelvic floor muscles attach to the coccyx and pull on it. A guarded, hypertonic pelvic floor produces persistent coccyx pain with entirely normal imaging, and it is the most commonly missed driver.
Prolonged sitting: Hours on a hard or poorly shaped seat load the coccyx directly. Sitting leaning back tilts the pelvis and increases the pressure on it specifically.
Coccyx hypermobility or fixation: The coccyx should move slightly when sitting. Too much movement or none at all both produce pain, and dynamic imaging in sitting is how this is identified.
Rapid weight loss: Loss of the fat padding over the coccyx exposes it to direct pressure. It is a recognised and easily overlooked cause.
Body weight: Higher weight increases the load through the coccyx in sitting, particularly in seats that do not distribute pressure.
Repetitive strain: Cycling and rowing load the area repeatedly and are associated with coccyx pain in the absence of any single injury.
Rarely, something else: Infection, and very rarely a tumour, can present as coccyx pain. Constant pain unrelated to position, night pain or systemic symptoms need investigation rather than a cushion.

Who tends to get it

Anyone who has fallen onto their tailbone
Women after childbirth, particularly after a difficult delivery
People with an overactive pelvic floor, which frequently coexists
Anyone who sits for long periods on hard seats
People who have lost weight rapidly

What makes it worse, and what settles it

Makes it worse

Sitting on hard surfaces, and sitting leaning back
Prolonged sitting without a break
Kegels and pelvic floor squeezing when the floor is already overactive
Cycling and rowing during a flare
Ignoring the pelvic floor component, which is why many cases persist

Settles it

A wedge or coccyx cushion with a cut-out, which unloads the bone directly
Sitting upright or leaning slightly forward rather than back
Pelvic floor release work - learning to let go rather than squeeze - with a pelvic health physiotherapist
Diaphragmatic breathing, which relaxes the pelvic floor directly
Manual therapy to the coccyx and surrounding muscles, which is effective in experienced hands

What actually helps

The short version: Coccygeal irritation after a fall or childbirth, often with pelvic floor hypertonicity

Strength work: Core: Pelvic Floor - down-training, not strengthening; Glutes: Max

Stretching: Glutes: Piriformis; Hips: Flexors; Back: Lower Back

Massage: Glutes; pelvic floor release work

Also worth doing: Wedge or donut cushion; avoid prolonged sitting

What the evidence says: Cushioning plus pelvic floor down-training helps most. Strengthening a hypertonic pelvic floor makes this worse - the direction matters.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routineBack Pain/Bulletproofing

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Open this routine in my Checklist

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Pain after a fall in someone with osteoporosis; night pain; bowel changes

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Most cases settle over weeks to a few months with load management and, where relevant, pelvic floor treatment. Cases that persist for many months are usually the ones where the pelvic floor was never addressed - which makes an assessment by a pelvic health physiotherapist the highest-value next step rather than another cushion. Injection and, very rarely, surgical removal of the coccyx are options for the small number who do not respond.

Prevalence basis: Spine clinic series

Others the same routine covers

These share the Back Pain/Bulletproofing routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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