A broken tailbone, or coccyx, results from trauma like a hard fall, leading to a fracture or severe contusion in the small, triangular bone at the base of the spine. This injury makes any position that places direct pressure on the area, such as sitting or lying flat on the back, incredibly painful. Since the coccyx is an attachment point for several pelvic floor muscles and ligaments, movement and sustained pressure can disrupt healing and prevent restful sleep. Finding relief involves strategic modifications to your sleeping environment and routine to minimize coccygeal contact and strain on surrounding soft tissues.
Choosing the Best Sleeping Positions
Lying directly on your back often proves impossible because it focuses the entire weight of your upper body onto the injured coccyx. The most recommended alternative is side sleeping, which completely offloads the tailbone and is generally the most comfortable option. Adopting a gentle fetal position, with the knees slightly drawn toward the chest, helps to naturally tilt the pelvis and further reduce tension on the lower spine. To maintain optimal alignment throughout the night, place a medium-firm pillow between your knees to keep your hips stacked and prevent the upper leg from rotating downward.
While side sleeping is usually preferred, resting on your back can be managed with specific support to keep the tailbone suspended. Position a wedge pillow or several firm pillows underneath your knees to elevate them significantly. This elevation straightens the lumbar spine and allows the lower back, including the coccyx, to relax into the mattress without bearing full weight.
Stomach sleeping, or the prone position, is a third option that inherently removes pressure from the coccyx, making it comfortable for some individuals. However, this position can introduce strain by forcing the neck to turn sharply to the side for breathing. To mitigate this neck and back stress, use a very flat pillow, or no pillow at all, underneath your head. A more advanced modification involves placing a supportive cushion or a thin pillow directly under the hips and lower abdomen to maintain a neutral spine curve.
Essential Supportive Tools and Modifications
Specialized coccyx cushions feature a U- or V-shaped cutout designed to suspend the tailbone while sitting. When in bed, these cushions are not typically used for deep sleep, but they can be invaluable when propped up for activities like reading or relaxing before attempting to sleep. A large wedge pillow can also be utilized to elevate the upper body, allowing you to sit semi-upright in bed without the coccyx touching the mattress surface.
A full body pillow can provide continuous support along the torso, between the knees, and under the arm to keep the spine horizontally straight during side sleeping. When lying on your side, the pillow between the knees should be thick enough to keep the hips parallel and prevent the pelvis from twisting, which can pull on the muscles attached to the injured coccyx.
A surface that is too soft allows the hips to sink, potentially creating a pressure point at the tailbone. Conversely, a mattress that is too firm can create excessive pressure on the hip bones and shoulders when side sleeping. A medium-firm mattress generally offers the best balance, providing enough support to keep the spine aligned while still offering sufficient cushioning to prevent painful pressure points.
Getting in and out of bed requires deliberate, slow movement to avoid jarring the injury. The “log-rolling” technique is recommended, which involves moving your entire body—shoulders, torso, and hips—as a single unit. To get up, first roll onto your side, keeping your spine straight, then use your arm strength to push your upper body up while simultaneously lowering your legs over the side of the bed. This coordinated movement minimizes the twisting and sudden muscle engagement that can cause a spike of pain in the coccyx.
Pre-Sleep Pain Management Routine
If using over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, they should be taken approximately 30 to 60 minutes before your planned bedtime. This timing ensures that the medication reaches its peak effect, providing maximum pain relief as you are attempting to transition into sleep.
Temperature therapy is an effective preparatory step, with ice and heat serving different purposes. Applying a wrapped ice pack to the area for about 15 to 20 minutes before bed can help to numb the local nerves and reduce any inflammation from the day’s activity. Alternatively, gentle, moist heat can be used to relax the tight gluteal and pelvic floor muscles that connect to and pull on the coccyx. The heat source should be placed gently around the area, not directly on the injury site.
Gentle movements can help alleviate stiffness that accumulates during the day without aggravating the injury. A simple “Figure Four Stretch” can be performed while lying on your back by crossing one ankle over the opposite knee and gently pulling the thigh toward the chest. This action lightly stretches the piriformis and gluteal muscles, which can become painfully tight and pull on the tailbone. Any movement should be performed slowly and stopped immediately if it causes a sharp increase in discomfort.