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Tailbone · Coccydynia (Tailbone Pain)

Tailbone Pain

Pain coming from the coccyx, the small tailbone at the very bottom of your spine. It’s usually that bone and the soft tissue around it getting irritated, often set off by sitting (especially leaning back) and by standing up. It often follows a fall onto the tailbone, childbirth, or a lot of sitting, and sometimes there’s no clear cause.

Sitting back loads the tailbone directly, and the small muscles of the pelvic floor that attach near it can become tight and overactive, which keeps the area sore. That’s why the plan is the opposite of ‘strengthen it’: take the pressure off (a wedge/cut-out cushion, leaning forward, not sitting too long) and help the pelvic floor RELAX and let go rather than tighten.

How it typically shows up

Mechanical pain localized to the tailbone (coccyx), classically worse sitting (especially leaning back or on hard surfaces) and on standing up, tender on tailbone palpation, usually after a fall, childbirth, or prolonged sitting (or idiopathic), with pilonidal/skin disease, levator-ani / pelvic pain, and referred low-back/SI/piriformis pain excluded. Confirmation needs a clinician (palpation incl. intrarectal, dynamic radiographs), so a self-screen can only TRIAGE.

How long recovery takes

Most tailbone pain settles with simple care over weeks to months. Offload the tailbone, adjust sitting, gently relax pelvic-floor muscles, and ease pain. About 9 in 10 improve with these measures, much through natural healing, so persist patiently.

The phased recovery approach

  1. Phase 1 · 4–9 weeks

    Your path

    This part depends on your goal. Your program follows one of these.

    • Sitting comfortably at work and driving

      4–9 weeks for this path

      1. Calm

        1–3 weeks

        Take the weight off the tailbone with a cushion and better sitting posture, and let the pelvic floor relax so the sore area settles.

        What you get back: sitting with less of an ache.

        • Diaphragmatic Breathing: 1 set × 3 min of activity · Let the pelvic floor soften downward with each breath. This is a relaxation drill, not a workout. · Lie or sit with one hand resting on your belly.
        • Reverse Kegel: 3 sets × 10 reps · Release as if passing wind, never bearing down hard. · Sit or lie in a comfortable position.
        • Child’s Pose: 3–4 sets × 20–30s hold · Sink only as far as is comfortable, then breathe out and soften. Never force it. · Kneel on the floor with your knees apart.
        • Half-Kneeling Hip-Flexor Stretch: 3 sets × 30s hold · The stretch belongs at the front of the hip, not in the low back. Keep the tailbone tucked and breathe. · Kneel on one knee on a folded towel or pillow, other foot flat in front.
      2. Daily life

        3–6 weeks

        Keep the calm-down and offload habits going and ease back to comfortable sitting and everyday life, this stage is not a strength push.

        What you get back: comfortable sitting and everyday life.

        • Graded Walking: 1 set × 20–30 min of activity · Walk regularly with relaxed effort, keeping your lumbopelvic area moving and symptoms comfortable during and afterward. · Walk at an easy pace, keeping symptoms comfortable during and afterward.
        • Diaphragmatic Breathing: 1 set × 3 min of activity · Let the pelvic floor soften downward with each breath. This is a relaxation drill, not a workout. · Lie or sit with one hand resting on your belly.
        • Reverse Kegel: 3 sets × 10 reps · Release as if passing wind, never bearing down hard. · Sit or lie in a comfortable position.
        • Child’s Pose: 4 sets × 30–40s hold · Sink only as far as is comfortable, then breathe out and soften. Never force it. · Kneel on the floor with your knees apart.

    • Sleeping without the ache

      4–9 weeks for this path

      1. Calm

        1–3 weeks

        Take the weight off the tailbone with a cushion and better sitting posture, and let the pelvic floor relax so the sore area settles.

        What you get back: sitting with less of an ache.

        • Diaphragmatic Breathing: 1 set × 3 min of activity · Let the pelvic floor soften downward with each breath. This is a relaxation drill, not a workout. · Lie or sit with one hand resting on your belly.
        • Reverse Kegel: 3 sets × 10 reps · Release as if passing wind, never bearing down hard. · Sit or lie in a comfortable position.
        • Child’s Pose: 3–4 sets × 20–30s hold · Sink only as far as is comfortable, then breathe out and soften. Never force it. · Kneel on the floor with your knees apart.
        • Half-Kneeling Hip-Flexor Stretch: 3 sets × 30s hold · The stretch belongs at the front of the hip, not in the low back. Keep the tailbone tucked and breathe. · Kneel on one knee on a folded towel or pillow, other foot flat in front.
      2. Sleep

        3–6 weeks

        Sleep off the tailbone in side-lying and keep the pelvic floor relaxed, so the ache is not still with you at bedtime.

        What you get back: nights without the tailbone waking you.

        • Graded Walking: 1 set × 20–30 min of activity · Walk regularly with relaxed effort, keeping your lumbopelvic area moving and symptoms comfortable during and afterward. · Walk at an easy pace, keeping symptoms comfortable during and afterward.
        • Side-Lying Offload & Breathe: 2 sets × 60–90s hold · Do this in bed at bedtime. If it eases your nights, sleep on your side with the pillow between your knees. · Lie on your side with your knees softly bent.
        • Diaphragmatic Breathing: 1 set × 3 min of activity · Let the pelvic floor soften downward with each breath. This is a relaxation drill, not a workout. · Lie or sit with one hand resting on your belly.
        • Reverse Kegel: 3 sets × 10 reps · Release as if passing wind, never bearing down hard. · Sit or lie in a comfortable position.

Exact exercises, sets and progression depend on your severity, equipment and goal. This is the shape of the program, not a one-size prescription.

What matters while you recover

  • Take pressure off your tailbone

    Use a wedge or cut-out cushion (not a donut) or a folded towel under each thigh. Lean slightly forward. Stand up every 30 to 60 minutes and walk a little when it aches.

  • Settling at night

    Lie on your side with a pillow between your knees. To get out of bed, roll onto your side first, then push yourself up with your arms.

  • Relax the pelvic floor, don’t strengthen it

    Tailbone pain can come with a tight pelvic floor. Relax it with a reverse Kegel, gently widening as you breathe in, the opposite of a squeeze. Hard Kegels make it worse.

Common questions

Should I do Kegels / strengthen my pelvic floor?
No, and this is the key thing people get wrong. Tailbone pain often goes with a TIGHT, overactive pelvic floor, so the aim is to RELAX and lengthen it (reverse Kegels, slow belly breathing), not to squeeze and strengthen it. Standard Kegels can make it worse.
What cushion should I use, a donut?
Use a WEDGE or coccyx cut-out cushion (a shaped cushion with the area under the tailbone removed) so your weight goes through the sit-bones, not the tailbone. A ring/donut cushion is commonly suggested too, but the evidence favours the wedge/cut-out shape. Sit leaning slightly forward and avoid long stretches of sitting.
Can you be sure it’s just coccydynia?
A self-check cannot prove the exact pain source, but it can show whether this pattern fits: pain centered on the tailbone, worse with sitting or rising, and eased by taking pressure off it. Use a cushion, lean slightly forward, and break up long sitting to take pressure off the tailbone.

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