How to diagnose and
treat tailbone pain

How do clinicians diagnose tailbone pain?

Tailbone pain can feel sharp, sore, or bruised when you sit, shift positions, or get up from a chair. Many people also notice discomfort during long drives, bowel movements, or sexual activity. When you meet with a clinician, the goal is to understand how the pain affects your daily life and what movements make it better or worse.

Your visit often starts with a simple conversation. Your clinician will ask when the pain began, whether you had a fall or childbirth injury, and how sitting or leaning back affects you. They may ask about bowel habits and pelvic floor symptoms since these areas share the same muscles and ligaments. Point tenderness over the tailbone helps confirm the location of the problem¹.

A physical exam usually includes checking hip and lower-back movement, posture, sitting tolerance, and sometimes pelvic floor tone (contracting the pelvic floor muscles and observing or finger feeling for a proper "squeeze and lift" and the ability to fully relax). In certain cases, a rectal exam may be used to feel how the coccyx (tailbone) moves or to rule out other causes of pain¹.

Imaging is not always needed. Many people improve with time and activity changes. If pain lasts longer than 6 to 8 weeks, is severe, or presents with warning signs, your clinician may consider imaging. The first study is often a special sitting-and-standing X-ray that looks for too much or too little coccyx movement, or a shape that creates extra pressure². An MRI may be used if there is concern for infection, a mass, or unusual symptoms².

Injection tests can help confirm the source of pain. A small amount of anaesthetic placed at the tailbone joints or near a nerve called the ganglion impar can show whether the area is contributing to symptoms[3]. These injections are also sometimes part of treatment.

Clinical insight

Research shows that many cases of persistent tailbone pain involve small movement changes in the coccyx that only appear when a person sits or stands. These issues often do not show up on regular resting X-rays, which is why dynamic imaging (standing and sitting) can be helpful in select cases². Knowing this can reduce confusion if a standard X-ray looks normal even though symptoms are real and significant.

What are the treatment options for tailbone pain?

Tailbone pain is usually treated step by step. Most people start with simple, non-invasive options and improve without needing injections or surgery.

1. Education and activity changes: Many people feel better by adjusting how they sit. Leaning slightly forward, choosing chairs with support, and taking regular standing breaks can reduce pressure on the coccyx. Cushions with a cut-out (like a U shape) or wedge design often help because they shift weight away from the painful area⁴.
2. Exercise-based rehabilitation: A structured exercise plan is one of the most effective approaches for lasting improvement. Programs usually focus on hip strength, core control, posture, and graded sitting tolerance. When tissue tension is part of the problem, relaxation and coordination training can reduce pain with sitting and bowel movements⁵.
3. Medications: Short courses of anti-inflammatory drugs or acetaminophen can help during flare ups. Long-term use is not recommended. If constipation increases pain, gentle bowel management strategies may also help⁶.
4. Injections: If pain continues despite conservative care, image-guided injections at the tailbone joints or around the sensitive nerve may provide relief for weeks to months. Some injections also help confirm the exact source of pain³.
5. Other therapies: Shockwave therapy has shown benefit in several studies and may improve pain and function in some people with chronic tailbone pain⁷. Taping, biofeedback (mind-body technique you use to control some of your body's functions, such as your muscle responses), or gentle manual therapy may be added depending on symptoms.
6. Surgery: Surgery is rarely needed. It is typically considered only after at least 6 months of structured non-surgical care and when imaging clearly shows a mechanical issue like instability or a sharp bony spur. When done for the right reasons, surgery can help many people, but it carries risks like wound infection⁸.

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

• Care that adapts to your progress in real time
• Licensed experts guiding every step
• Simple, non-invasive, evidence-based programs
• Proven results for pain relief, movement, and satisfaction

How can I find pain relief for tailbone pain?

There are several everyday steps that many people find helpful:

• Adjust your sitting position. Lean forward slightly or use a cushion with a cut-out to offload pressure.
• Take movement breaks. Standing up every 20 to 30 minutes can reduce irritation from long sitting.
• Try gentle walking. Light movement usually helps circulation and reduces stiffness.
• Relax the pelvic muscles. Slow breathing or pelvic floor relaxation techniques can help if tension contributes to pain⁵.
• Stay consistent with exercise. Strengthening hips, core, and posture muscles improves support around the coccyx over time.
• Talk to your clinician if symptoms persist. Ongoing or worsening pain may need a more targeted plan.

These strategies are safe for most people, but if pain suddenly changes or red flags appear, medical evaluation is important.