Tailbone pain (coccyx pain)

Written by Daan Lansdorp, physiotherapist and owner of FysioGrow. Specialist in treating tailbone pain with EMCC and NIMOC.

Do you often have pain in your tailbone? For example when sitting or doing ab exercises? Did you know there’s a good chance your tailbone is out of alignment, with all the painful consequences that brings? And more importantly: did you know this problem can be put right fairly easily, without surgery or any other internal procedure?

At FysioGrow in Rijswijk, near The Hague, I treat people with tailbone pain (coccygodynia) every day. On this page I explain how I can realign your tailbone with the EMCC and NIMOC techniques. I also explain where tailbone pain comes from and what the treatment options are.

What is tailbone pain?

Tailbone pain is a problem that can have a huge impact on your quality of life. Fortunately, it can be treated well more and more often these days. On this page I tell you more about the symptoms, causes and effects of tailbone pain, and about the treatments I use to improve it. I try not to throw around too many scientific terms, because I want to keep it accessible for every reader. If you want, you can go through the additional scientific articles in the references at the bottom of this page.

Symptoms: recognising tailbone pain

Tailbone pain (coccygodynia) shows up in different ways. You mainly feel it around the tailbone, at the bottom of your spine. Common symptoms are:

• Pain around the tailbone, especially when sitting for a long time
• Increasing pain when getting up from a chair or sofa
• Tenderness when the tailbone is touched
• Pain when running, cycling, rowing or horse riding
• Pain during sex or bowel movements
• Pain radiating to the lower back, pelvis or buttock muscles
• The feeling of a knot or sore spot on the tailbone
• Pain that gets worse when bending forward or doing ab exercises

If you recognise these symptoms and they last longer than a few weeks, it’s wise to see a physiotherapist. Book an appointment right away or have a look at our other pain problems. The sooner we start, the better the chance of lasting recovery.

Causes of tailbone pain

There are several causes of tailbone pain. The most common cause is an abnormal position or mobility of the tailbone, also called the coccyx. This often happens after a fall or accident, or after giving birth. In most cases this makes the tailbone shift to the left. There are different theories about why the tailbone ends up pointing to the left, but it’s still not really clear.

After a fall, the tailbone can also bend inwards. This is also called a ‘hooked coccyx’. Often there’s a combination of a left shift and a hooked coccyx, together with a rotation to the right.

Other causes of tailbone pain are chronic overload of or pressure on the tailbone. This can come from sitting slumped for long periods, cycling, rowing or horse riding. Obesity can also put too much pressure on the tailbone, which can cause the pain or make it worse.

There are also causes such as wear of the cartilage in the joint with the sacrum (the sacrococcygeal joint), ganglions, tumours and joint inflammation. These causes are a minority and can’t be treated well with manual techniques. That’s why I leave them out of this page.

Effects of tailbone pain

Tailbone pain can have a big impact on your health and quality of life. The main position in which the pain occurs is sitting.

The body sees the misaligned tailbone as a problem. The misalignment puts a lot of tension on the surrounding tissue: the muscles, ligaments and other connective tissue. The tension rises even more when the tailbone presses against the seat of a chair or sofa while you sit. The surrounding nerves send an alarm signal to the pain centre in the brain, which can cause enormous pain.

Because the misalignment often doesn’t go away by itself, it can cause long-lasting irritation. The pain then becomes chronic and the body sometimes becomes even more sensitive to touch of the tissue around the tailbone. It’s like a vicious circle that keeps getting stronger as long as the tailbone stays out of position. Pain can also occur during sex, when getting up from a chair or during sport.

Treatment of tailbone pain

Tailbone pain can be treated in a number of ways. There’s no guideline yet for tailbone pain used by physiotherapists, manual therapists or pelvic floor therapists. But in recent years more and more scientific evidence has been gathered to arrive at an effective treatment for tailbone pain.

Roughly speaking, there are two types of treatment: conservative or surgical.

Conservative means there’s no surgery, and the pain is improved in other ways. The most commonly used treatments for tailbone pain are:

• External Manual Coccyx Correction (EMCC)
• Non Invasive Mobilisation of the Os Coccyx (NIMOC)
• Internal correction
• Exercise therapy or pelvic floor physiotherapy
• Shockwave
• Aids such as a ring cushion
• Pain medication or injections

Surgical means a so-called coccygectomy is performed. In this operation the tailbone is surgically removed. It’s a very drastic operation with a painful recovery. Complications can also occur. In practice, surgery is only an option when all other possibilities have been exhausted.

At FysioGrow I treat clients with tailbone pain using the EMCC and/or NIMOC method. This method often works very well for clients with tailbone pain.