Tailbone pain (Coccydynia): Self-management and how it’s Treated
*This article is written in simple language so that everyone can understand it.
*author review and updates: November 2023, September 2023, January 2023
If you are wondering what Coccydynia is, see my previous article on the topic here: https://www.drcarpino.com/blog/tailbone-pain-coccydynia-what-why-and-how-its-diagnosed
Tailbone pain can be frustrating the first time you experience it. The good news it that this condition can be self-managed and only persistent cases need to get help from a doctor. Most cases of Coccydynia resolve on their own within 3-6 months. If you have had Coccydynia for near this length of time or longer, this is when I’d suggest seeking help from an experienced doctor in this field.
In this article I am going to show you all of the treatment options I recommend for this kind of pain. We will cover self-management, treatment from a Chiropractor, Physiotherapist, and treatments from Medical doctors. *Note that I am not a Medical doctor, but I have extensive knowledge on this subject and I want you to know all of your treatment options. Of course, consult your medical doctor on what’s best for you if you go that route of care.
Self-Management
Management of tailbone pain is just that. The purpose is to reduce the amount that the pain affects your day-to-day life while your body does the work of healing yourself.
Coccyx cushions
Pillows that you sit on which take pressure off of the coccyx can be used to reduce the pain experienced while sitting. I recommend the shape which slants forward a little and has has a cut-out for the tailbone. See this example from Amazon:
You may have heard of using a donut pillow for this purpose. Donut pillows can work if you find a position that takes pressure off the coccyx, but they are designed more for anal pain such as that from hemorrhoids. Here is an example of a donut pillow which may work for coccyx pain since it has a groove for the tailbone:
TENS machine
TENS machines are used to place an electrical current over any painful area, which results in temporarily eliminating the pain sensation in the area. It is a safe and understood method which can be used for tailbone pain as well as other parts of the body. This is a temporary pain reduction technique which some people find helpful. Consult your doctor to learn how to properly use a TENS machine, especially around the tailbone area. Here is an example of a TENS machine:
Stretching
Our bodies can’t stretch the painful coccyx-sacrum joint, but we can stretch the surrounding muscles which are usually tight when we have Coccydynia. Doing this may help the tissues in the general area relax and increase your ability to move more comfortably. Stretch your gluteal (buttock) and low back muscles, as well as your front and back leg muscles if you are able. Stretches should be held for at least 20 seconds, and then repeat this hold 5-10 times.
Here are the stretches I recommend (modelled by people who definitely do not have tailbone pain):
Images: From Top left to top right, then bottom left to bottom right: i) stretch for the low back (Child’s pose), ii) stretch for the gluteal (buttock) muscles (Pidgeon pose), iii) stretch for the hip flexor muscle, iv) stretch for the low back, v) stretch for the front of the leg muscles, vi) stretch for the back of the leg muscles.
Manual Therapy
There are primarily two kinds of healthcare practitioners who can help you with manual therapy for tailbone pain: Chiropractors and Physiotherapists. Either person must have training in and be willing to treat Coccydynia since it involves working around a groin and anus area. It is easy for your doctor to accidently turn the treatment into an awkward encounter if they are not practiced in treating this condition, unfortunetely.
Coccyx Mobilization.
Chiropractors have the scope of practice to mobilize the coccyx joint. This procedure is excellent for eliminating pain, but may be uncomfortable during the process. This procedure involves the doctor using their finger to move the tailbone back and forth in order to restore normal movement to the joint and surrounding tissues. Depending on your personal tailbone shape, the doctor may or may not need to place the tip of their finger in the anus in order to have adequate leverage on the bone. The medical literature tells us that many cases of Coccydynia can be resolved with 4 treatment sessions of mobilization. In my personal experience, I’ve seen people who have had tailbone pain for many years have complete resolution of their pain after 3 treatment sessions. A few of my patients who had tried a course of other pelvic health therapies before undergoing this procedure found resolution in 1 or 2 treatment sessions (although they did a few more treatments to ensure the issue did not return).
Pelvic floor therapy.
Specially trained Physiotherapists and Chiropractors have pelvic floor rehabilitation within their scope of practice. This is another treatment option where the tissues of the pelvic floor (around the anus and genitals) can be treated just like any other muscle or tissue. Soft tissue relaxing and strengthening techniques are used to help the tissues around the painful tailbone, and there is good evidence showing that treating these tissues does a good job of reducing and sometimes resolving the pain without ever touching the sore tailbone itself. Some therapists may even prescribe exercises for the pelvic floor muscles (more than just Kegel exercises!).
Coccyx adjustments with a Chiropractic adjusting tool (“Activator”)
Some Chiropractors are trained and practiced in using a treatment tool called an Activator (Activator is both the tool brand name, and a description of the treatment). This tool applies a fast and specific force to joints and tissues, and in some instances can be used on the ligaments and muscles beside the coccyx to return normal tissue tension and motion to the area. A benefit to using this method is that the tool is used exclusively externally and force is not placed directly on the coccyx itself, which may lead to a slightly more comfortable treatment experience. The medical evidence is not clear on the efficacy of this type of coccyx pain treatment, but many Chiropractors including myself report having used these tools to treat and manage coccyx pain over the years.
Shockwave Therapy
When I originally reviewed the medical literature and wrote this blog, there was no evidence for using shockwave on the tailbone. Since then, there has been a growing number of published medical cases where shockwave therapy has been used to decrease tailbone pain, if not eliminate it. Shockwave therapy can be thought as using a miniature jackhammer-like machine to tap on and create local inflammation which results in tissue healing at the targeted area. The evidence isn’t strong enough yet for this modality to be my first treatment recommendation, but this is exciting for me since it offers my patients another non-invasive treatment choice if they are opposed to coccyx mobilizations where the finger tip usually has to be placed into the anus for the mobilization. The current science shows major reduction in tailbone pain after 3-6 treatments. One study showed shockwave therapy being more effective than a corticosteroid injection for tailbone pain. It’s too early to draw any conclusions, but this will certainly be an area of research which I’ll continue to keep my eye on.
Medical Interventions
Trained Medical Doctors have the ability to perform interventions which your Chiropractor and Physiotherapist do not. These are often more invasive strategies to reduce the pain, and are usually a second choice to manual therapy. If my personal manual therapy isn’t helping my patients as much as I would like it to, I refer to a medical doctor to assist with the next steps. The following medical procedures are referred to in the medical literature.
Painkiller Medications
Can be taken orally or applied on the skin. Your doctor has a variety of medications which they can recommend which can reduce the discomfort while your body heals itself.
Injections
Targeted injections of some medications can eliminate the pain sensation for a certain period of time. They help break our brain’s “bad habit” of sending the pain signal. Some people will have a painkiller injection applied to the area before undergoing manual therapy or rehabilitation if the pain is too severe to do these procedures otherwise. Injections can target the painful joint, painful tissue, nerves in the area, or the ganglion impar depending on the intended treatment strategy (see my previous article if you need a refresher on what the ganglion impar is). This method is particularly successful if a painful spicule (bump on the bone) is the cause of the pain.
The evidence shows that 85% of Coccydynia can be resolved with a Cortisone injection paired with coccyx mobilization. 60% of Coccydynia can be resolved with a Cortisone injection and with time.
Nerve Ablation
Purposely destroying the specific nerve fibers which are sending the pain signal can help with more severe cases of Coccydynia. Ask your medical doctor about it, and they may refer you to another expert in the area such a Physiatrist or a Neurologist. Nerves can be destroyed using an injection such as concentrated alcohol, or with radiofrequency/electrical techniques.
Surgery
The last resort for persistent Coccyx pain may be a coccygectomy- a procedure which simply removes the painful tailbone. This procedure needs more research, but a certain amount of people may benefit from the surgery if every other strategy has failed. With all surgeries, there is a risk of complications and of the surgery failing, so talk with your doctor about the risks and benefits. With that being said, coccygectomy has a 75% “Good” to “Excellent” results when a painful spicule is present on the tailbone. Surgery is more effective for acute coccyx traumas and unstable coccyx fractures.
Another procedure called a coccygoplasty was reported in the medical literature. This case report reported simply reducing the size of the coccyx and having success for tailbone pain. More research is needed in this area.
Psychotherapy
I don’t mean to put this treatment last, since I believe that we can all benefit from psychotherapy. But, sometimes getting help with understanding how our bodies interpret pain is enough to ease our distress and allow our body to heal itself without our own minds getting in the way.
*If you found this article helpful and you are ready to take action on your tailbone pain, please don’t hesitate to reach out to me if you’d like a consultation. See the contact section of my website at the top of the page.
References
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4. Kodumuri, P., Raghuvanshi, S., Bommireddy, R., Klezl, Z. Coccydynia- could age, trauma, and body mass index be independent prognostic factors for outcome of intervention? Ann Royal Coll Surg Engl. 2017. 100(1):12-15
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10. Andersen GØ, Milosevic S, Jensen MM, Andersen MØ, Simony A, Rasmussen MM, Carreon L. Coccydynia-The Efficacy of Available Treatment Options: A Systematic Review. Global Spine J. 2022 Sep;12(7):1611-1623
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