Even in the day of standing desks, walking pads, and ergonomic chairs, we still get the question: Why does my tailbone hurt?

Which is followed quickly by, “What cushion should I use?” Or “Can you help me?”

The answers are: We will tell you in a little bit, and YES! So keep reading!

So, why does your tailbone hurt? You can most likely thank your pelvic floor and your sitting posture for this. 

First, let’s point out the tailbone. (circled in red)

The tailbone, or coccyx, is a triangular shaped bone (composed of a few fused vertebral bones) that is located at the end of the spine. The tailbone is the attachment site of many pelvic floor and hip muscles and ligaments. 

All images used with permission from Pelvic Guru®, LLC

as a member of the Global Pelvic Health Alliance Membership (GPHAM)

Due to being a main attachment site of the pelvic floor muscles, tension in the pelvic floor can cause tailbone pain and injury to the tailbone can cause pelvic floor pain. More on that below!

We tend to see tailbone pain as a result of three things:

1. A fall onto the tailbone
2. Poor sitting posture
3. Tight pelvic floor muscles

1. Falling onto the tailbone

Pain as a result of falling onto your tailbone makes sense for most people. Especially for those who live in states where winters are harsh and ice is a common issue. Whether you have fallen onto your tailbone once, or many times, the result can be a displacement of the tailbone (meaning it is bent inward or to the side) or chronic pain at the sacrococcygeal joint (tailbone meets sacrum). 

Typically the symptoms heal after some tailbone rest (we are looking at your coccyx cushions), however pretty bad or repetitive falls can create lingering issues due to the new position of the tailbone. Other times, we work with patients who have pelvic floor pain and can pinpoint a certain fall from ‘years ago’ that they never realized may be playing a role in their current symptoms. For these patients we may palpate (touch) the deeper pelvic floor muscles (coccygeus or pubococcygeus) and reproduce their tailbone pain.This indicates that pelvic floor therapy is the best course of action to help eliminate tailbone pain.

Okay, so the fall makes sense, right? But, why the other two?

2. Poor posture

In the therapy world we call this poor sitting posture ‘sacral sitting’ meaning instead of sitting upright with your weight through your sit bones (ischial tuberosities), most of the pressure coming down from the spine goes into the sacrum/tailbone area. As with any prolonged positioning of a joint, it can get achy or painful. Imagine if you sat on the floor for a long time in a criss cross position, your ankles and knees will probably be sore or achy but the time you go to get up. The same thing is happening in your tailbone (sacrococcygeal joint) with prolonged sacral sitting. 

To correct for this, try to maintain an upright posture with weight into your sit bones (TOP RIGHT) and/or utilize a lumbar support (like a bolster or rolled up towel - BOTTOM).

3. Tight pelvic floor muscles

Due to their attachments to the tailbone, when the pelvic floor muscles are tight or guarded (contracted) they can pull on the tailbone putting a similar stress through the sacrococcygeal joint (tailbone meets sacrum) thus causing pain. As with any joint, an abnormal stress or pull can start to create symptoms. This is where pelvic floor therapy is again key. We will help to determine which muscle attachments are causing your tailbone pain and then provide you with treatment both in-clinic and for-home to help decrease your tailbone pain.

This will likely include:

• Hands-0n manual therapy in clinic to address the pelvic floor muscles, ligaments, and tailbone position
• Coaching on sitting posture
• Stretches to the hip musculature, especially gluteus maximus
• Advice on using a tailbone cushion

So, let’s chat more on tailbone cushions!

Previously, providers would give patients a donut cushion to sit on when they experienced an injury to the tailbone. This is kind of like fitting a square peg onto a round cushion. Due to the placement of the hole, you would have to sit in the center of the donut (see diagram below) which can feel awkward or unstable. Most of us want to sit back on the cushion so we feel more supported but this still places pressure onto the tailbone. 

Lucky for us, technology has improved and we now have access to better cushions that feature a tailbone cut out and support so you can sit all the way back in the chair in a more natural position while still leaving room for some tailbone relief. 

Our top recommendations for tailbone cushions are Cushion Lab, Tush Cush, & Cushion Your Assets.

In Review
Whether your tailbone hurts due to a fall, poor sitting posture, or tight pelvic floor muscles, pelvic floor therapy is here to cover your tail….bone. We will perform a thorough assessment to ensure we are addressing any cause of your symptoms and have you back to feeling pain free as soon as possible.

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions, including tailbone pain, so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

• The Ultimate Guide to Pelvic Floor Physical Therapy: Everything You Want or Need to Know
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• The 3 Treatment Methods of Pelvic Therapy