Tailbone Pain: Symptoms, Causes, and Treatments

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Key Takeaways

The tailbone is located in your lower back and can be damaged, dislocated, or fractured due to an injury (such as a fall) or significant stress placed on it.
Tailbone pain is characterised by sharp or dull pain in the lower back, which worsens when you try to stand or sit.
Simple, nonsurgical treatment measures can help the tailbone heal over time, but more severe cases will require partial or total removal.
Good posture, weight management, and lifestyle modifications can help you prevent the risk of tailbone pain.

What is Tailbone Pain?

The tailbone, or coccyx, is located near the base of the spine, a bony structure comprised of three to five fused bones held in place by various joints and ligaments. The tailbone serves as this attachment point while stabilising the spine as you are seated.

Tailbone pain (coccydynia) mainly stems from injuries such as falls, which carry a risk of causing damage to the tailbone that can lead to pain and discomfort. It is also possible to injure your tailbone with repetitive motions or even sitting down for long periods, especially on hard, uncomfortable surfaces. Tailbone pain affects anyone at any age, though women (especially pregnant women) are at higher risk.

Symptoms of Tailbone Pain

The most apparent symptom is a sharp or dull pain in the lower back near the base of the spine. It may sometimes worsen whenever you sit down from a standing position, or vice versa, and after prolonged standing or sitting. Other symptoms include:

Tenderness around the affected area.
Swelling and bruising around the affected area.
Tingling and numbness around the affected area.
Difficulty sleeping due to pain in the affected area.
Heightened pain during your period.
Pain while you are crouched, sitting down, or lying on your back or stomach.

What Causes Tailbone Pain?

The most common cause of tailbone pain is injury from a fall, where you fall backwards and land where your tailbone is. If you fall on a hard surface, the force of the impact may be enough to dislocate or fracture the tailbone and cause you significant pain. In other cases, repetitive strain injuries from various activities (such as cycling or lifting heavy objects) can also cause gradual wear and tear on your tailbone and the surrounding tissue from overuse or excessive strain.

Pregnancy is also a risk factor. During the third trimester, the body produces hormones that soften the area between your tailbone and sacrum (located just above the tailbone), giving the tailbone additional flexibility during childbirth. While this is a natural process, there are instances where the surrounding muscles and ligaments get stretched too far to the point that they become strained and cannot support your tailbone effectively.

As the baby develops in the womb, changes in a pregnant woman’s weight, coupled with poor posture as the weight increases, can also place more pressure on the tailbone and gradually cause a tailbone injury.

Lastly, sitting down for too long also places plenty of stress on the tailbone, especially if sitting on a hard surface without any padding to soften your seating position. Proper posture can also ensure you do not place undue stress on your entire spine, which can cause wear and tear over time.

How is Tailbone Pain Diagnosed?

Physical Examination

Your doctor will start with a physical examination to look for signs of tailbone pain. They may ask questions about your tailbone’s condition and whether you have had any prior tailbone injuries before they examine the affected area gently. Let them know if you feel pain or discomfort during their examination, and provide as much information as possible.

If necessary, they may also perform a rectal exam, in which they carefully insert a finger into your rectum and apply light pressure to feel around the tailbone area directly; this can help determine the presence of a dislocation or fracture.

The Straight Leg Raise (SLR) Test

The SLR test is commonly employed to look for signs of back pain, including tailbone injuries. The test can be performed while you are lying down. Your doctor will first test one leg by keeping your knee straight while they slowly raise your leg until you feel pain or tightness at a specific point. Your doctor will note your leg’s range of motion when you feel the pain before they test your other leg.

During the procedure, you may also be asked to gently extend your foot and flex your neck to stretch the nerve roots and see if that may cause pain or discomfort in your tailbone area.

Diagnostic Tests

Additional tests may be needed to confirm the diagnosis, especially if the physical exam does not give a satisfactory result. These tests could point out other complications contributing to your current symptoms.

X-ray scan: An X-ray can identify signs of a dislocation or fracture in your tailbone.
CT scan: If necessary, a computed tomography (CT) scan may reveal the extent of damage to your tailbone and show additional details that an X-ray might not have been able to capture.
Magnetic resonance imaging (MRI): This scan may be ordered instead of a CT scan to find signs of inflammation and other concerns about the tailbone area.

Treatment of Tailbone Pain

Treating Tailbone Pain Without Surgery

Mild tailbone pain is often effectively treatable without requiring extensive surgery, especially with comprehensive support from your doctor.

Treating Tailbone Pain via Physiotherapy

Physiotherapy can help you reduce pain and swelling, strengthen your muscles to support your spine, and slowly restore your range of motion, resilience, and flexibility. Your physiotherapist will show you various exercise methods to help with this and also passive modalities to help manage any pain or discomfort you experience, such as using heat and ice packs intermittently.

Various therapies can help relieve your tailbone pain, allowing you to restore your range of motion and reduce pain and discomfort, which can also help prevent future complications. After being discharged, you can continue these therapies to enjoy unhindered mobility and independence. Be sure to start with simple exercises first, as suggested by your physiotherapist. As your condition improves, you can slowly build up the intensity and duration of your workouts.

Knee to chest pulls: First, lie down with your back on the floor and keep your legs straight. Gently lift one leg, bringing the knee close to your chest until you can hug it. Pull your leg in as far as possible while you tighten your abdominals and keep your spine pressed onto the floor. Hold this position for 5 seconds, repeat for your other leg, and cap it off by pulling both legs. Repeat the entire process ten times.
Pelvic floor exercises: These are ideal for pregnant women and can be done lying down with your knees bent. First, find your pelvic floor muscles by imagining yourself trying to hold in your urine midstream. Using those muscles, draw them upwards and in, then tighten them for about 3 seconds. Repeat this process 10 times, once every morning and once every evening.

Your physiotherapist will also teach proper sitting and standing postures to minimise strain on your tailbone.

Treating Tailbone Pain via Medications

Medications can provide much-needed relief to your condition. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin can relieve pain and reduce swelling in and around your tailbone area. Ensure that you follow your doctor’s instructions on dosage to avoid complications.

Treating Tailbone Pain via Coccygeal Manipulation

This procedure involves your doctor carefully manipulating the tailbone with a finger placed in the rectum, moving it back and forth to return it to its original position. The procedure may be uncomfortable, but it can help relieve pain in your tailbone area.

Treating Tailbone Pain With Surgery

For more severe conditions of tailbone pain, surgery is a last resort measure to ensure your gradual recovery when nonsurgical methods are unable to provide relief.

Treating Tailbone Pain via Coccygectomy

A coccygectomy is a surgical procedure that removes a part of or the entire tailbone, depending on the severity of your symptoms. The procedure requires that you be placed under general anaesthesia as the surgeon makes an incision in the area above your tailbone to carefully cut off a part of, or the entire, tailbone. Meanwhile, the bone to which the tailbone connects will also be smoothed off to prevent complications or further pain after the procedure.

The procedure takes about 30 minutes to complete, and you will need to stay in the hospital for a few days for observation. Your doctor will give you advice on how to help with recovery and minimise any discomfort you feel after the surgery, including using heat or ice packs where needed.

Can You Prevent Tailbone Pain?

It can be challenging to prevent tailbone pain, but you can still follow these tips and tricks to help you minimise the risk and keep yourself safe and sound.

Enjoy regular exercise every 20 to 30 minutes three times a week. Speak to your doctor or physiotherapist about handy tips to help you with your exercise routine, manage pain, and recommend exercises that help your condition.
Maintain a healthy diet with sufficient nutrients to nourish your body. Include more calcium-rich food and reduce fat, sugar, and salt intake.
Maintain a healthy weight to help improve your general well-being and reduce pressure on your tailbone.
Adopt proper posture to minimise strain on your tailbone. If necessary, use a soft pillow to prop your back up.
Stretch as often as possible, even if you are not participating in physical activities.
Remove tripping hazards from your home, such as rugs, and ensure your pathways and staircases are free of any items you could trip on. Keep your home well-lit, too, to minimise the risk of accidents.
Hold on to a railing when navigating stairs and avoid slippery surfaces like wet sidewalks.
Be mindful of your surroundings, especially if you are outside. Avoid getting distracted by your phone or other things, and pay attention to what is ahead of you.
Wear protective gear when participating in any sporting activities, such as bicycling. Ensure you also wear the appropriate shoewear to avoid slips and falls.

Getting Professional Medical Attention

If your tailbone pain persists, worsens, or is accompanied by pain around the lower back, you may consider consulting a back pain specialist for further assessment. A medical evaluation can help identify the source of your symptoms and determine an appropriate treatment approach. Contact us to book an appointment and receive personalised care, where we will diagnose your condition and recommend the best course of action.

Our Orthopaedic Doctor and Surgeon for Tailbone Pain

Dr. Razmi

FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)

Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.

Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.

Frequently Asked Questions (FAQ)

Is it possible to know if you only lightly injured your tailbone?

It can be difficult to tell, so you should seek professional medical attention immediately. The most telling symptom of tailbone pain is the pain you feel around where your tailbone is located (in the lower back), but the degree of pain you feel may not necessarily tell you if you may have dislocated or fractured it.

Can a tailbone injury heal on its own?

Yes, but it will take time. Some people may take a few weeks or months to get better, and recovery varies from person to person. Be patient and avoid rushing your recovery to minimise complications. Speak to your doctor if you have any questions or doubts.

Is tailbone pain a permanent issue?

Thankfully, tailbone pain is not permanent and can be treated with sufficient medical support and lifestyle changes to help with recovery and long-term management.

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