The coccyx, commonly known as the tailbone, is the final segment of the vertebral column, a small, triangular bone situated beneath the sacrum. This structure is composed of three to five fused vertebrae and serves as an attachment point for several ligaments, tendons, and muscles of the pelvic floor, including the gluteus maximus and the levator ani muscle group. Pain localized to this area is medically termed coccydynia, a condition characterized by tenderness and discomfort that can range from a dull ache to a sharp pain. Coccydynia is a common problem, often becoming debilitating because the coccyx acts as part of a weight-bearing structure when a person is seated.
When Professional Assessment Is Necessary
Coccyx pain is often triggered by a direct fall onto the buttocks, the trauma of childbirth, or repetitive strain from activities like cycling or prolonged sitting. While many cases of acute coccydynia resolve with simple home care, the pain frequently involves inflammation of the surrounding tissues and joints, not simply a bone that is out of place. Attempting to self-adjust the coccyx is strongly discouraged and can be dangerous, as it risks further injury to the bone or the surrounding soft tissues. The first step before any intervention is a professional medical evaluation to determine the precise cause of the pain.
You should see a healthcare provider if the pain is severe, persists for more than a few weeks despite at-home treatments, or significantly affects daily activities. A doctor can perform a physical examination and may use imaging tests, such as dynamic radiographs or MRI, to rule out less common but serious causes. These tests can identify a fracture, a tumor, or a joint change that requires specialized treatment. Furthermore, a professional diagnosis helps distinguish between true coccyx pain and pain referred from other areas like the lower back or pelvis.
Manual Coccyx Adjustment Procedures
Professional manual adjustment of the coccyx is a specialized technique performed by clinicians such as osteopathic physicians (D.O.s), chiropractors, and physical therapists with advanced training. The goal of these procedures is to restore mobility to the joint and alleviate tension in the attached soft tissues. The two primary methods used are external and internal manipulation, with the choice depending on the specific nature of the displacement or soft tissue involvement.
External Manipulation
External coccyx manipulation involves applying gentle, targeted pressure to the outside of the tailbone area to mobilize the joint and surrounding ligaments. This non-invasive approach focuses on improving the flexibility of the sacrococcygeal joint and relaxing external muscles like the gluteus maximus. This technique is often attempted first, and some therapists find it effective enough to resolve the patient’s symptoms.
Internal Manipulation
Internal manipulation, also known as intrarectal mobilization, is a more direct procedure where the clinician inserts a gloved, lubricated finger into the rectum. The coccyx is gently stabilized between the external thumb and the internal finger, allowing the clinician to apply precise, controlled movements to mobilize the sacrococcygeal joint or stretch the deeply attached muscles, such as the levator ani. This procedure is typically brief, lasting only a few minutes, and is reserved for chronic cases that have not responded to less invasive conservative treatments. In instances of severe pain or anxiety, the procedure can sometimes be performed under local anesthesia to ensure patient comfort and muscle relaxation.
Conservative Relief Measures
Several conservative, non-manipulative measures offer significant relief for coccydynia. Seating modifications are often the most immediate and practical step, involving the use of specialized cushions. A wedge-shaped or U-shaped cushion is recommended over a circular, donut-style cushion because the U-shape effectively removes pressure from the coccyx itself, redistributing body weight onto the ischial tuberosities (sit bones).
Pain can often be managed with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which help reduce both pain and local inflammation. Applying ice packs to the tailbone area for the first few days after an injury can also help minimize inflammation. For chronic pain, alternating between heat and ice may prove beneficial.
Physical therapy includes specific exercises and techniques aimed at reducing muscle tension that pulls on the coccyx. Therapists may instruct patients in pelvic floor relaxation techniques, which involve deep breathing and consciously relaxing the muscles that attach directly to the tailbone. Exercises that strengthen the core and mobilize the pelvis, such as gentle bridges or specific yoga poses, can help stabilize the area and alleviate chronic strain.