Tailbone pain that flares when you sit is usually coccydynia, and most cases settle without surgery: non-surgical care works in about 90% of coccyx injuries. Start by taking pressure off the coccyx, using a wedge-shaped cushion and taking simple pain relief as directed. If it does not ease, we at Elaris Chiropractic can assess you in person.
TL;DR:
- A wedge or gel cushion reduces pressure; ring cushions can create pressure points, while standing or shifting regularly helps avoid prolonged static sitting.
- Clinicians usually diagnose coccydynia through history and examination; X rays mainly rule out serious problems, while MRI or CT is reserved for selected concerns.
- Seek urgent assessment for fever, rectal bleeding, severe constant pain, new weakness or numbness, bladder or bowel control problems, or a suspected fracture.
- A bruise often heals in about four weeks, while a fracture may take eight to twelve weeks; persistent pain warrants GP review and possible physiotherapy.
Table of Contents
- What causes tailbone pain when you sit?
- How is coccydynia diagnosed?
- What can you do at home to ease the pain?
- When do physiotherapy, shockwave and injections come in?
- Which warning signs need prompt medical help?
- What else could be causing pain at the base of the spine?
- How should you set up your desk to protect your tailbone?
- Which exercises and stretches help tailbone pain?
- How we assess and treat tailbone pain at Elaris Chiropractic
- Book a first consultation with us
- FAQ
- Sources
What causes tailbone pain when you sit?
Sitting loads the coccyx directly, so any irritation of the bone or the joints and ligaments around it tends to show up when you perch on a hard chair or lean back. The common triggers are:
- A fall onto your bottom, which can bruise, dislocate or fracture the bone.
- Childbirth, where the coccyx is pushed backwards during delivery. Coccydynia may follow injury or childbirth, or come on gradually after prolonged sitting.
- Repetitive or prolonged sitting, especially slumped, which keeps the tailbone under constant pressure.
- Body weight changes. Obesity increases coccygeal pressure, while rapid weight loss reduces the fat cushioning under the bone. The same source reports tailbone pain is about five times more common in women than men.
- No clear cause at all. Up to one-third of patients have no identifiable traumatic or anatomical cause, so not remembering an injury does not mean the pain is imaginary.
Mechanically, the coccyx moves slightly as you sit and stand. Too much movement (hypermobility) or too little (a stiff, fixed joint) can both make that everyday loading painful, which is why the ache is often sharpest when you move from sitting to standing.
How is coccydynia diagnosed?
Typical symptoms, as the NHS describes them, are:
- Pain localised to the base of the spine, worse on sitting or rising from a seat.
- Discomfort during bowel movements, and sometimes during sex.
- Tenderness, and occasionally bruising or swelling after an injury.
Diagnosis is mainly clinical. A clinician takes your history and presses on the area to locate the pain. Standard X-rays mainly exclude serious pathology, and a dynamic pair of films, one sitting and one standing, may be used when a mechanical problem is suspected. MRI or CT scans are generally kept for trauma, red-flag features, suspected infection or tumour, or when earlier results are inconclusive.
In practice, that means a GP visit usually involves questions and an examination rather than a scan. Imaging follows only if something in the picture does not fit simple mechanical pain.
What can you do at home to ease the pain?
Most people notice a difference by taking pressure off the bone and keeping moving. Work through these steps:
- Choose the right cushion. A wedge-shaped or gel cushion is often preferred, because a ring or doughnut cushion can create pressure points or let the tailbone hang unsupported. A wedge tilts your pelvis forward so your weight rests on the sitting bones instead.
- Keep changing position. Stand regularly, shift your weight and lean slightly forward. The same Leicester hospitals guidance says these micro-movements help recovery more than long, static sitting.
- Use ice, then heat. MedlinePlus aftercare advice is to apply ice for the first 48 hours after an injury, then ice or heat as comfort dictates, wrapping packs so they never touch bare skin.
- Take simple pain relief. The NHS suggests anti-inflammatory painkillers such as ibuprofen, if suitable for you, taken as the packet directs.
- Look after your bowels. Constipation can worsen pain, so increase fibre and fluids and ask a pharmacist about a stool softener if straining hurts.
- Add pelvic floor exercises, as the NHS recommends alongside posture changes.
- Build activity back gradually, alternating sitting positions as the pain settles.
Pro Tip: Set a phone timer to stand or shift regularly, and lean slightly forward when you sit so your weight sits on your sitting bones.
Give these steps a few weeks. If there is no improvement by then, the NHS advises seeing your GP.
When do physiotherapy, shockwave and injections come in?
Contemporary management starts with education, ergonomic offloading, anti-inflammatory medication and physiotherapy. When self-care is not enough, the usual escalation looks like this:
- Physiotherapy: manual therapy, stretching and pelvic floor rehabilitation. Reviews of physiotherapy for coccydynia report clinically significant benefits for many patients, though study sizes and protocols vary.
- Extracorporeal shockwave therapy (ESWT): acoustic pulses directed at the painful area. It has the strongest support of the physiotherapy options, and you can read more about how shockwave therapy works from a clinic that offers it.
- Injections or radiofrequency treatment: considered for persistent pain, and in some cases used to help judge who might benefit from surgery.
- Coccygectomy (removal of the coccyx): a last resort for a small minority.
Improvement in pain and function has been reported with device-based therapies such as ESWT, though the evidence base is limited by small studies and a need for standardised protocols.
Because the evidence is moderate rather than overwhelming, decisions between these options are best made together with your clinician. Many people respond to conservative care well before invasive options are even discussed.
Which warning signs need prompt medical help?
Some symptoms mean you should not wait for self-care to work:
- Fever, or rectal bleeding.
- Severe, unrelenting pain.
- New numbness, weakness or other neurological symptoms.
- Trouble passing urine or controlling your bowels.
- Suspected fracture after a fall.
For these, seek urgent assessment, in line with NHS guidance. For persistent pain after a few weeks, or pain that disrupts daily life, contact your GP and ask about physiotherapy referral, with imaging only if indicated. As a guide to timing, a bruised coccyx typically heals in about 4 weeks and a fracture in 8–12 weeks.
What else could be causing pain at the base of the spine?
Not every ache at the bottom of the spine is coccydynia, and ruling out other causes is part of a proper assessment. Clinicians keep a short list of alternatives in mind, particularly when the story or examination does not fit simple mechanical pain.
A pilonidal cyst is one example. It forms in the skin of the cleft just above the buttocks and can feel like tailbone pain, but it is often accompanied by swelling, redness or discharge, and it needs treating as a skin problem rather than a spinal one. Infection in the area can also cause deep, throbbing pain, often with fever and tenderness. Tumours involving the coccyx are rare, but pain that is relentless, worse at night or progressively worsening deserves proper investigation.
Referred pain is another possibility, with the problem sitting in the lower spine, hips or pelvic floor but felt at the tailbone. Coccyx pain is frequently mechanical, worsened by sitting and rising, but infection and malignancy are recognised, if less common, causes. That is exactly why history and examination come first, and why scans are reserved for selected cases.
Practical clues that point away from a simple mechanical cause include pain that is not affected by sitting or standing, fever, unexplained weight loss, a lump, discharge or new nerve symptoms. If any of these sound familiar, do not keep experimenting with cushions: get it examined.
How should you set up your desk to protect your tailbone?
A good workstation reduces how long the coccyx is loaded and how hard it is pressed. Start with the chair: choose one with a firm seat that lets you sit tall, with your hips slightly above your knees if possible. A wedge cushion with its thicker edge at the back helps tilt your pelvis forward, and a seat cut-out or gel pad can take pressure off the bone itself.
Next, set your height and distance. Your feet should rest flat on the floor or a footrest, and your screen should sit at eye level so you are not tempted to slump into a “C” shape that pushes weight straight onto the tailbone. Keep your keyboard close enough that you are not leaning backwards for support, and use the backrest to support your lower back rather than reclining on the base of your spine.
The most effective adjustment, though, is variety. A height-adjustable desk lets you alternate sitting and standing, and even without one you can take calls on your feet, walk to talk to colleagues and stand while reading. Our own article on posture correctors explains why gadgets alone rarely fix posture, and why regular movement matters more than any single device.
Which exercises and stretches help tailbone pain?
Gentle movement can ease the muscles around the coccyx, but stop any exercise that sharpens the pain. Avoid forcing deep stretches in the first days after an injury.
- Pelvic tilts: lying on your back with knees bent, gently flatten and then arch your lower back. This mobilises the pelvis without loading the coccyx.
- Knee-to-chest stretch: bring one knee towards your chest, hold for a few breaths and swap sides, easing tight buttock and hip muscles.
- Piriformis stretch: lying on your back, cross one ankle over the opposite knee and draw the leg towards you, releasing the deep buttock muscle that attaches near the coccyx.
- Cat-cow on hands and knees: move slowly between rounding and arching your spine, keeping the motion small and comfortable.
- Pelvic floor relaxation: the NHS recommends pelvic floor exercises, and some people with tailbone pain have tight, overactive pelvic floor muscles. Practise relaxing as well as squeezing, ideally with guidance from a physiotherapist.
Do these once or twice a day for a few minutes, rather than pushing for long sessions. If a stretch increases tailbone pain, leave it out and ask your clinician for an alternative suited to you.
How we assess and treat tailbone pain at Elaris Chiropractic
At Elaris Chiropractic we treat the cause, not just the symptom. Our Elaris Method™ looks at the structural, neurological and emotional factors that can keep pain going, so two people with the same sore spot may get quite different plans.
Your first consultation includes a hands-on examination and neurological testing, followed by a written treatment plan that we explain in plain terms. We see you ourselves at each visit, so you are not handed on between practitioners. Conservative care comes first. If your pain does not behave as expected, or we spot warning signs, we will refer you on for imaging or specialist care rather than carry on regardless.
A lot of what we see in practice is people who have tried cushions and tablets for months and simply want someone to look at the whole picture.
— steve
Book a first consultation with us
If self-care has not settled your tailbone pain, or it is getting in the way of work, driving or sleep, we are happy to look at it with you. A first consultation and examination costs £105 and includes:
- A full history and hands-on assessment of your spine, pelvis and surrounding muscles.
- Neurological testing and a personalised written plan.
- Chiropractic care for related problems such as low back pain if they are part of the picture.
Get in touch through our clinic page to check availability and book your appointment.
This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.
FAQ
Can you walk around with a fractured tailbone?
Yes, most people with a fractured tailbone can walk, though sitting is usually the most painful activity. Fractures typically take 8–12 weeks to heal, so seek assessment if you suspect one after a fall.
What is coccyx bone pain?
Coccyx bone pain, or coccydynia, is pain at the very base of the spine, usually worse when sitting or moving from sitting to standing. It can follow a fall or childbirth, build up from prolonged sitting, or appear with no clear cause.
Can constipation cause tailbone pain?
Constipation can make tailbone and pelvic pain worse, particularly when straining on the toilet. More fibre, plenty of fluids and a stool softener, where suitable, are the main strategies to reduce pain with bowel movements.
Why does my tailbone hurt after I lost weight?
Rapid weight loss reduces the fat padding under the coccyx, so the bone takes more pressure when you sit. Rapid weight loss is recognised as a risk factor, and a wedge or gel cushion can help compensate.
Sources
- Managing tailbone (coccyx) injuries or
- Coccyx Pain - StatPearls - NCBI Bookshelf
- [Tailbone (coccyx) pain