Tailbone pain, known medically as coccydynia, most often comes from some form of trauma to the coccyx. A history of direct injury accounts for 50 to 65% of all cases. But plenty of people develop tailbone pain without any obvious injury, and the cause can range from how you sit to how your pelvic floor muscles behave to changes in your body weight.
Falls and Direct Injuries
The most common trigger is a backwards fall that lands force directly on the tailbone. Depending on how hard the impact is, the result can be a sprain of the surrounding pelvic floor muscles, a crack in one of the small coccygeal segments, or a full dislocation where the tailbone shifts out of its normal position at the joint connecting it to the sacrum. Even a relatively minor fall can leave the area inflamed and tender for weeks or months, because the coccyx bears weight every time you sit down, giving it little chance to rest.
Prolonged Sitting and Repetitive Pressure
You don’t need a dramatic injury to develop tailbone pain. Sitting for long stretches on hard, narrow, or poorly cushioned surfaces puts steady pressure on the coccyx, and over time that repeated compression can irritate the joint, the surrounding ligaments, or the small discs between the coccygeal bones. This was recognized as far back as 1950, when a physician nicknamed it “television disease” because of the new habit of sitting for hours in front of a screen.
Leaning back while seated makes it worse. When you recline, your weight shifts off the sit bones and onto the tailbone itself. Cycling is another common culprit. The saddle compresses the area between the sit bones, and when riders shift their weight backward to relieve perineal pressure, they increase the load directly on the coccyx. The repetitive rocking motion of pedaling can push the tailbone into excessive flexion or even partial dislocation over time, especially in certain coccyx shapes that are more vulnerable to this kind of stress.
Childbirth
The tailbone sits right behind the birth canal, which makes it vulnerable during delivery. In a study of 57 women with postpartum tailbone pain, forceps-assisted deliveries accounted for over half the cases, and another 12% involved spontaneous but difficult labors. Imaging showed that nearly 44% of affected women had a dislocated coccyx, and about 5% had an outright fracture. Vacuum-assisted deliveries contributed as well, though less frequently. The second stage of labor, when the baby’s head passes through the pelvis, puts the most direct force on the coccyx, and instrumented deliveries amplify that pressure significantly.
Pelvic Floor Muscle Problems
Several pelvic floor muscles attach directly to the coccyx, and when those muscles go into spasm or lose their normal coordination, they can pull on the tailbone and keep it painful long after any initial injury has healed. Research comparing women with and without tailbone pain found striking differences: nearly 78% of those with coccyx pain had spasm in the coccygeus muscle (one of the deep pelvic floor muscles that anchors to the tailbone), compared to only 17% of those without pain. Impaired pelvic floor muscle coordination was present in about 78% of the pain group as well.
Pain in the ligament connecting the anus to the coccyx was found in 64% of affected women versus just 9% of controls. This means that for many people, the tailbone itself may not be the primary problem. Tight, overactive pelvic floor muscles can create and sustain the pain even when imaging of the coccyx looks normal.
Body Weight and Bone Shape
Both higher and lower body weight increase your risk. A BMI above 27.4 in women or 29.4 in men is a recognized risk factor. Extra weight increases the pressure inside the pelvis when you sit, which can push the tailbone into a partial backward dislocation. In people who carry more weight, this type of dislocation is the more common pattern of coccyx instability.
On the other end, rapid weight loss can also trigger tailbone pain. When you lose the natural fat pad that cushions the coccyx, the bone sits closer to the skin surface and absorbs more direct force from chairs and other surfaces. Thin individuals are more likely to develop a different problem: excessive forward flexion of the tailbone when sitting, where it bends more than 25 degrees under pressure.
The shape of your coccyx matters too. People are born with different coccyx configurations, and certain shapes are significantly more common in those with chronic pain. About 14% of people with tailbone pain have a small bony spur projecting from the back of the coccyx, which irritates the soft tissues over it and can lead to chronic inflammation, especially with prolonged sitting.
Less Common Causes
Degenerative changes in the small discs between the coccygeal bones have been found in roughly 41 to 44% of tailbone pain cases, both in people with and without a history of injury. This is essentially arthritis of the tailbone joints, similar to disc degeneration elsewhere in the spine. Infections, though rare, can settle in or near the coccyx. Pilonidal cysts, which form in the skin crease near the top of the tailbone, cause pain in the same general area but produce visible swelling, redness, and sometimes drainage rather than the deep, bony tenderness typical of coccyx joint problems.
Pain can also be referred to the tailbone from other sources. A herniated disc in the lower spine or irritation of nearby nerves can create a sensation of tailbone pain even though the coccyx itself is fine. In these cases, pressing directly on the tailbone during an exam typically doesn’t reproduce the pain, which helps distinguish referred pain from a true coccyx problem. In rare cases, tumors near the base of the spine can present as persistent tailbone pain.
How Tailbone Pain Is Diagnosed
A physical exam that reproduces your pain with direct pressure on the coccyx is the hallmark finding. Beyond that, the most useful imaging involves X-rays taken in two positions: standing and sitting. Comparing the two reveals how your tailbone moves under load. Abnormal motion, either too much or too little, shows up in about 69% of people with coccyx pain. A tailbone that barely moves (less than 5 degrees of flexion) can be just as problematic as one that moves too much, because a stiff coccyx absorbs impact rather than flexing to distribute it.
What Helps Tailbone Pain
Most tailbone pain improves with conservative measures, though it often takes patience. A coccyx cushion, the wedge-shaped or cutout type that offloads pressure from the tailbone while you sit, is typically the first step. Anti-inflammatory medications help manage flare-ups. Avoiding prolonged sitting, or at least taking frequent standing breaks, reduces the repetitive loading that keeps the area inflamed.
Physical therapy targeting the pelvic floor can be particularly effective, especially when muscle spasm is part of the picture. Techniques like internal massage and stretching of the pelvic floor muscles have shown pain reduction that holds up over two years. These approaches outperformed joint mobilization of the coccyx itself in longer-term follow-up, which makes sense given how often pelvic floor dysfunction accompanies tailbone pain.
For people who don’t respond to conservative treatment, injections of local anesthetic and steroid around the coccyx can provide relief. When pain persists despite months of structured treatment, surgical removal of the coccyx (coccygectomy) becomes an option. A large analysis covering 793 patients found satisfaction rates around 80 to 90% after surgery, with wound complications averaging 10 to 13%, mostly minor. The best surgical candidates are people with a clear history of trauma, visible dislocation or excessive motion on imaging, and reproducible tenderness on exam. For those with a posterior dislocation of the coccyx that hasn’t responded to other treatments, some experts now recommend considering surgery sooner rather than enduring prolonged conservative care that is unlikely to resolve the underlying structural problem.