See a pelvic floor physical therapist: Seeing a pelvic floor PT can provide direction and education on the main contributing factors to your specific tailbone pain. Pain at the tailbone can be primarily caused by joint mobility issues, soft tissue issues, weakness, or increased muscle tone/guarding, nerve issues, and referred pain from a neighboring area in the body such as the low back. Rarely, tailbone pain can be caused by an underlying medical issue that is best treated with a referral out to a physician. A physical assessment by a physical therapist should include looking at posture and spinal position, muscle strength testing, tailbone mobility testing, and assessment of the soft tissues (muscles, ligaments) surrounding the tailbone and pelvis and functional movement assessment (how you sit or stand etc). In some cases one may benefit from a pelvic floor assessment if urinary, bowel, or sexual dysfunction is present.
Improve back mobility: The tailbone (or coccyx) is a continuation of the spine and connects to the bottom of the sacrum. The lumbar spine and tailbone mirror each other in movement. Some people with tailbone pain, especially after a fall, will present with limited mobility at the tailbone or have it stuck in a flexed or tucked under position. Working on spinal extension in postures such as cow pose, or cobra can help increase movement at the tailbone towards extension. The opposite is often true when the injury happened during a vaginal delivery, positioning the tailbone in an extended position.
Sit with support and slightly leaning forward: The tailbone is not meant to be a weight bearing bone. The pelvis has big bony support surfaces called ischial tuberosities or “sits bones” to take most of the weight while sitting. If you find yourself slumping while working or resting back on the tailbone while sitting on the couch it can put more pressure on an already sensitive tailbone. Using a wedge seat cushion can be helpful to keep weight off the tailbone when it is extremely sensitive.
Build glute strength: Building strength in the gluteus maximus and medius, not only promotes more blood flow for healing in the general area of the tailbone, but it also increases the muscular support around the pelvis. Strength training can also reduce muscle trigger point tenderness (see previous post here) in sensitive tissue surrounding the tailbone.
Relax pelvic floor muscles: Some muscles of the pelvic floor attach to the tailbone. Learning to relax or lengthen these muscles can often provide tailbone pain relief as well as reduce pain with bowel movements or intercourse. Relaxing the pelvic floor is the opposite of a “Kegel” or contracting as if stopping the flow of urine. The easiest way to relax the pelvic floor is to imagine the muscles around the anus gently lengthening as if passing gas. This is a gentle movement and should not be forceful. Trying to relax the pelvic floor while on hands and knees or child’s pose can be helpful to widen the base of the pelvis and provide more space for tailbone mobility.
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