1. Introduction / Plain Theory

Coccydynia refers to pain around the tailbone (coccyx) — the small triangular bone at the very bottom of the spine, just below the sacrum.
Although small, the coccyx plays an important role in weight-bearing, balance, and pelvic floor support, especially when sitting or transitioning from sitting to standing.

Coccyx pain can result from trauma, prolonged sitting, childbirth, or repetitive strain.
Because of its location and function, even minor dysfunction can cause significant discomfort and difficulty in daily activities.

While most cases resolve naturally, persistent tailbone pain may indicate joint restriction, ligament irritation, muscular tension, or altered biomechanics in the pelvis or lumbar spine.

2. Typical Symptoms and Functional Impact

• Localised pain or pressure at the base of the spine, often near the anus.

• Pain when sitting, especially on hard surfaces.

• Discomfort when leaning back, cycling, or during bowel movements.

• Pain or stiffness when standing up from a seated position.

• Sometimes radiating discomfort into the sacrum, buttocks, or pelvic floor.

Functional impact:
Tailbone pain can make sitting, driving, or desk work extremely uncomfortable.
In chronic cases, it may cause guarding in the pelvic floor muscles and contribute to secondary low back, sacroiliac, or perineal tension.

Red flags:
Unexplained weight loss, fever, rectal bleeding, or neurological symptoms require immediate medical assessment to exclude infection, tumour, or systemic disease.

3. Contributing Factors / Underlying Causes

Coccydynia can arise from several mechanical and soft-tissue causes, including:

• Direct trauma: falls onto the buttocks or childbirth-related strain.

• Prolonged sitting: especially on firm surfaces or poor posture.

• Joint dysfunction: hypermobility or subluxation of the sacrococcygeal joint.

• Pelvic floor tension: reflex tightening or spasm from pain or stress.

• Referred pain: from sacroiliac, lumbar, or visceral dysfunction.

• Postural or biomechanical asymmetry: uneven pelvic weight distribution.

• Scar tissue or fascial restriction: following surgery or childbirth.

From an osteopathic point of view, tailbone pain rarely exists in isolation — it’s often a manifestation of deeper pelvic imbalance, diaphragm restriction, or altered spinal load distribution.

4. Osteopathic Approach

Osteopathic treatment for tailbone pain is gentle, individualised, and holistic, addressing both local irritation and the broader mechanical and fascial connections of the pelvis.

An osteopathic assessment may include:

• Thorough case history to identify cause and exclude medical red flags.

• Observation of posture, pelvic balance, and lumbar-sacral mechanics.

• Gentle mobilisation of the sacrococcygeal joint (externally).

• Myofascial and soft-tissue techniques for gluteal, pelvic floor, and sacral fascia.

• Diaphragm and lumbar work to improve tension balance through the spine and pelvis.

• Breathing and relaxation techniques to calm the nervous system and reduce muscle guarding.

• Postural and ergonomic advice (e.g., coccyx cushions, sitting posture adjustments).

Internal coccygeal techniques are not performed in all cases and only considered with full consent, medical clearance, and when appropriate.
Osteopathic treatment focuses on improving mobility, reducing pain, and restoring functional balance to the pelvic region.

5. Scientific Evidence & References

Evidence supports the use of manual therapy and movement retraining for the conservative management of coccydynia.
Studies show improvement in pain and function through approaches targeting the pelvis, sacrococcygeal joint, and associated musculature.
Osteopathic techniques are particularly suited for managing chronic, non-surgical cases where biomechanics and soft tissue play a key role.

References

1. Fogel GR, Cunningham PY 3rd, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12(1):49–54. Link

2. Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–87. Link

3. Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of pelvic floor muscles and postural factors. Spine. 2000;25(23):3072–3079. Link

4. Thiele GH. Coccygodynia and pain in the superior gluteal region: etiology and treatment. JAMA. 1937;109(16):1271–1275. [Historical reference – foundational pelvic manual therapy.]

5. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for pelvic pain and dysfunction: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

6. Khan SA, Nunez D, et al. Conservative management of coccydynia: systematic review and meta-analysis. Eur Spine J. 2021;30(8):2138–2154. Link

7. Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for low back and pelvic pain: systematic review and meta-analysis. Pain Physician. 2021;24(3):205–216. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for coccydynia: network meta-analysis. Front Pain Res. 2024;15:1507352. Link