Coccydynia – Causes, Symptoms, and Effective Physiotherapy Treatments

Coccydynia (tailbone pain), its causes, symptoms, and the most effective physiotherapy treatments, including exercises and manual therapy, for pain relief

Introduction

Coccydynia” is the medical term for tailbone pain (“coccyx” = tailbone, “dynia” = pain). Your coccyx (tailbone) is at the very bottom of your spine, and it consists of three to five fused vertebrae (bones).

Your tailbone has a few important jobs. When you sit down, it helps steady you and support your weight. It’s also where several tendons, ligaments and muscles in your body connect. But when your tailbone hurts, it’s a real pain in the rear — and it can interfere with daily routines and quality of life.

Tailbone pain is common. It’s five times more likely to occur in females than males. Adolescents and adults get it more often than childr

Causes of Coccydynia

Falls or trauma
Repetitive strain injuries (RSI)
Pregnancy and childbirth
Prolonged sitting or sitting on hard surfaces
Weight-related issues (both excess weight and insufficient cushioning)
Rare causes like tumors or infections

Signs & Symptoms of Coccydynia

pain in and around the coccyx without significant low back pain or pain radiation or referral
Pain when sitting down, standing up, or bending forward
Pain when having sex or using the bathroom
Pain that worsens over time
Difficulty sleeping
Difficulty carrying out daily activities
Swelling, bruising, or muscle spasms in the lower back or pelvic area
A sense of pressure in the rectum

Diagnosis of Coccydynia

Medical History

Symptoms, including when and how they started
Any recent injuries, like falls or difficult childbirth
Any history of gastrointestinal issues
Any other muscle or nerve problems

Physical Examination

Palpation of the coccyx for tenderness, swelling, or lumps
Rectal exam to assess mobility of the sacrococcygeal joint
Pelvic exam to assess pelvic floor strength
Inspection of the skin around the coccyx for signs of infection

Imaging

X-ray to check for fractures
Magnetic resonance imaging (MRI) or computed tomography (CT) scan to check for bone, tissue, or nerve problems
Nuclear bone scan to check for bony destruction from cancer or osteomyelitis

Other Tests

Blood tests to rule out infection or autoimmune conditions
Local anesthetic injection under fluoroscopic guidance to confirm the diagnosis

Differential Diagnosis (DD) of Coccydynia

Sacroiliac Joint Pain
Coccyx fracture
Lumbar spondylosis or disc herniation
Levator ani syndrome
Piriformis syndrome
Descending perineal syndrome
Perianal abscess
Rectal tumor or teratoma
Pilonidal cyst
Sciatica
Hemorrhoids
Piriformis Syndrome
Pelvic floor muscle pain
other considerations include fractures of the coccyx, pelvic organ prolapse, and ischial bursitis.

Treatment of Coccydynia

Pain Relief Methods: NSAIDs, ice/heat therapy
Posture Modification: Use of donut cushions to reduce coccyx pressure
Injection Therapy: Corticosteroid or ganglion impar block for severe cases
Surgical Options (Last Resort): Partial or complete coccygectomy if conservative treatments fail

Physiotherapy Treatment for Coccydynia

Manual Therapy & Mobilization

Coccyx or sacroiliac joint manipulation
Soft tissue massage (Levator Ani and Piriformis muscles)
Mobilization of sacrococcygeal and thoracic spine

Targeted Exercises for Tailbone Pain

Pelvic Floor Exercises – Strengthens core stability and reduces pain
Reverse Kegels – Helps release tension in pelvic floor muscles
Piriformis & Iliopsoas Stretching – Improves mobility and reduces muscle tightness
SI Joint Mobilization – Helps stabilize the sacroiliac joint

Advanced Physiotherapy Techniques

- Transrectal Osteopathic Manipulation – Shown to improve chronic coccydynia
- Kinesiotaping – Supports pelvic floor muscles and reduces strain
- Primal Reflex Release Technique (PRRT) – More effective than stretching in pain management