The coccyx, commonly known as the tailbone, is a small, triangular bone located at the very end of the spine. Yes, the coccyx can be injured, including a fracture—often termed a “cracked” tailbone—or a dislocation. While a true fracture or displacement is less common, a severe bruise, or contusion, to the bone and surrounding tissues is a frequent result of trauma. Regardless of the specific injury type, the resulting localized pain, medically termed coccydynia, can be substantial because the bone is directly affected by sitting and many daily movements.
Anatomy and Types of Coccyx Injury
The coccyx is composed of three to five small vertebral segments that are usually fused together in adults, forming a single structure just below the sacrum. This position allows the coccyx to function as a minor weight-bearing point, stabilizing the body when sitting down alongside the ischial tuberosities (the “sit bones”). It also serves as an anchor for several important structures, including the gluteus maximus and the levator ani muscles of the pelvic floor.
Injuries typically arise from a sudden, direct impact that transmits substantial force to the bone. The most common mechanism is a backward fall onto a hard surface, such as slipping on ice or stairs. Other causes include direct blows sustained during contact sports or trauma during childbirth.
A coccygeal fracture involves a crack or a complete break in one or more segments of the tailbone and is generally the most painful injury. A coccygeal dislocation occurs when the coccyx shifts out of its normal alignment, often at the joint connecting it to the sacrum. In many cases, the injury is a severe contusion, where the bone and surrounding soft tissues are intensely bruised and inflamed without a structural break or shift.
Identifying the Symptoms and Diagnostic Steps
The characteristic symptom of a tailbone injury is localized pain and tenderness directly at the base of the spine. This discomfort is often described as a constant, dull ache that spikes sharply with certain movements or pressures. Pain intensifies when pressure is placed directly on the coccyx, especially when sitting or leaning backward.
Increased pain when transitioning from a seated to a standing position is a specific symptom, as the surrounding muscles pull on the injured bone. Due to the bone’s proximity to the rectum, patients may also experience discomfort or sharp pain during bowel movements. Swelling or visible bruising may be present in the immediate area following a traumatic fall.
Diagnosis begins with a thorough medical history and a physical examination focused on the tender spot. A medical professional will palpate the area to pinpoint the exact location of the pain and check for instability. In some cases, a digital rectal examination may be performed to assess the coccyx’s mobility and tenderness from the inside.
Imaging studies are often necessary to confirm the specific nature of the injury. Standard X-rays are used to look for a fracture or dislocation. To assess for dynamic instability—where the coccyx moves too much when bearing weight—special lateral X-ray views may be taken while the patient is both sitting and standing. More advanced imaging, such as a CT scan or MRI, is reserved for cases where X-rays are inconclusive or if the doctor needs to investigate soft tissue damage or nerve involvement.
Conservative Treatment and Recovery Timeline
Because the coccyx is a difficult area to immobilize, treatment for most tailbone injuries, including fractures, focuses on conservative management to reduce pain and inflammation while the body heals naturally. One of the most effective methods for pain relief is using specialized seating to remove pressure from the injured bone. This includes donut-shaped cushions or wedge cushions that feature a cut-out at the back to suspend the coccyx, allowing the person to sit without direct contact on the painful area.
Activity modification is a foundational part of the healing process, which involves avoiding prolonged periods of sitting and favoring a side-lying position when resting. For pharmacological pain management, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are often recommended to control both pain and swelling around the injury site. In cases of severe or persistent pain, a doctor may prescribe stronger analgesics or consider a local injection of corticosteroids mixed with an anesthetic directly into the area to provide targeted, extended relief.
Physical therapy can be beneficial, particularly for managing chronic pain that persists past the initial acute phase. Therapists may focus on exercises to improve the strength and flexibility of the pelvic floor muscles, which attach directly to the coccyx, and the core muscles to help stabilize the region. These exercises can help correct muscle imbalances that may be contributing to ongoing discomfort.
The recovery timeline varies significantly based on the injury type. A simple contusion or bruise may resolve relatively quickly, with most discomfort subsiding within four weeks. A coccygeal fracture or dislocation, however, requires a longer healing period. While significant improvement is often noticed within eight to twelve weeks, the bone can take several months to fully heal, and a small number of patients may experience residual pain for six months or longer. Consistent adherence to the supportive care measures is necessary to ensure the most efficient and comfortable recovery.