Tailbone pain when you sit: why it lingers and what helps.

Tailbone pain is easy to describe and hard to ignore: a sharp or bruised feeling right at the bottom of the spine when you sit, worse on hard chairs, worse still when you stand up from them. Some people can point to a fall on the ice or a hard landing; others have no idea how it started.

The good news is that most tailbone pain gets better without surgery or injections. Here is what is going on, what makes sitting easier while it settles, and when it needs a doctor.

What is tailbone pain?

The tailbone is the small, triangular group of bones at the very bottom of the spine, below the sacrum. When you lean back in a chair, it takes part of your weight, and several muscles and ligaments of the pelvic floor attach to it. Pain there is called coccydynia, from coccyx, the medical name for the tailbone.

The typical pattern:

• Pain sitting, especially leaning back or on a hard surface.
• A sharp jolt standing up from sitting, which often eases once you are up.
• Tenderness to touch right at the bottom of the spine, between the buttocks.
• Sometimes pain with bowel movements or during sex, because of the muscles attached nearby.

According to the Cleveland Clinic, it is about five times more common in women than in men, partly because of the shape of the pelvis and partly because of childbirth.

What causes tailbone pain?

• A fall onto your backside. Slipping on ice or stairs and landing seated is the classic cause (one more reason to salt as you shovel), and it can bruise, sprain or occasionally fracture the tailbone.
• Childbirth. The tailbone moves backward during delivery, and the ligaments around it can be strained. Our article on postpartum recovery covers the months after birth.
• Long hours sitting, especially slouched, so that your weight rolls back onto the tailbone instead of the sit bones. Drivers and desk workers see this often.
• Tight pelvic floor muscles, which pull on the tailbone and can keep it sore after the original cause has settled. Pelvic floor dysfunction explains that link.
• Sometimes nothing obvious. In a fair share of people, no single cause is found.

Most tailbone pain is not a broken bone; it is a sore one being sat on all day. Change how you sit and you take away most of what keeps it angry.

Tailbone pain or something else?

• Pain higher up, to one side of the bottom of the spine near the dimple, is more often the SI joint; pain above the belt line on one side has its own set of causes, covered in pain on one side of the lower back.
• Pain deep in the buttock that travels down the leg points to the sciatic nerve or the piriformis muscle, not the tailbone.
• A tender, swollen lump at the top of the buttock crease, especially if it is red, warm or draining, can be a pilonidal cyst, an infected pocket under the skin. That needs a physician, not a cushion.

What helps tailbone pain at home

1. Use a wedge or cut-out cushion. A wedge-shaped cushion with a gap at the back lets the tailbone float free. Donut-shaped rings are not the best choice: a review of coccyx pain notes they can still put pressure on the tailbone.
2. Sit on your sit bones. Lean slightly forward rather than back, sit evenly on both buttocks, and avoid slouching into the couch. Shift weight to one cheek briefly if you have to sit long.
3. Stand up in stages. Slide to the front of the chair, lean forward and push up with your legs rather than rocking back on the tailbone.
4. Break up sitting. Stand or walk for a minute or two every 30 minutes. A standing desk or a high stool for part of the day helps; see standing desks and back pain.
5. Ice early, heat later. Ice for 15 minutes a few times a day in the first days after a fall, then heat to relax the muscles around it.

When should tailbone pain be checked?

It is worth an assessment if the pain is not easing after two or three weeks of a better cushion and sitting habits, or if it is making work, driving or sleep hard.

See a physician after a hard fall with severe pain, bruising or pain that makes it hard to walk, since an X-ray can check for a fracture. See one promptly for a red, warm or draining lump near the tailbone, fever, unexplained weight loss or a history of cancer.

Go to the emergency room for numbness in the groin or inner thighs, or new trouble controlling your bladder or bowels.

What a visit here looks like

Dr. Andersen asks how it started and what sitting, standing and the rest of your day do to it, then checks the low back, the SI joints, the hips and the muscles around the pelvis, because the tailbone is rarely sore on its own for long. If the history points to a fracture or anything that is not mechanical, we send you to your physician first. If the pelvic floor muscles are a big part of the picture, we can point you to a pelvic health physical therapist as well.

Care usually focuses on what keeps loading the tailbone: precision spinal adjustments where the low back or pelvis has stiffened, soft-tissue work for the glutes and hips, and changes to how you sit at work and in the car.

How long does tailbone pain take to heal?

A bruised tailbone often improves over a few weeks. Pain that has been there for months can take longer, and how quickly varies from person to person. The NIH-published review above reports that conservative care, meaning cushions, sitting changes, medication and hands-on treatment, works in about 90 percent of cases. Injections and, rarely, surgery are options a physician considers when that does not help.