Hurts to sit? If you have pain in your lower back near your rear end, you may have coccyx (tailbone) pain. Tailbone pain can make sitting difficult, along with many other everyday activities like cycling, walking, or other types of exercising. 

It can be frustrating when tailbone pain makes even the simplest parts of your daily routine difficult — say, plopping down in your desk chair to work or curling up on the couch to veg out. But there’s a lot you can do to relieve tailbone pain and start feeling better. That starts with understanding what might be causing it, and trying simple at-home remedies and exercises to relieve it.

Here, learn more about what causes tailbone pain when sitting and how to prevent and treat it — especially with at-home exercises from our Hinge Health physical therapists.

What Is Tailbone Pain?

Tailbone pain is pain in the coccyx, a small, triangle-shaped bone at the bottom of your spine. It’s located right above the cleft of your buttocks.

Your coccyx is the attachment site for pelvic and gluteal (butt) muscles, tendons, and ligaments. Some of these structures play a role in pelvic floor support, pelvic pain conditions, and bladder and bowel control. It’s also one of three weight-bearing areas (along with your ‘sit bones’ on the bottom of your pelvis) that support you when you sit. So tailbone pain, or coccydynia, often means you also have pain while sitting. 

What Causes Tailbone Pain When Sitting?

Sometimes the cause is obvious, like a fall or going through labor and childbirth. But you can also develop tailbone pain when sitting without having an injury. Some tailbone pain can creep up on you due to issues with your pelvic floor muscles or other musculoskeletal (MSK) issues. Some of the most common tailbone pain causes include:

• Falling onto your back or bottom 

• Repetitive pressure or strain to the area (e.g, biking, horseback riding, or prolonged sitting)

• Sitting on hard surfaces

• Pregnancy (due to loosening of pelvic ligaments and increased pressure from the growing baby)

• Childbirth (due to pressure on the tailbone during delivery) 

• Pelvic floor muscle pain 

• Obesity or underweight

• Constipation

• Other issues with the coccyx (bone spurs, nerve pain, joint hypermobility, and degeneration from arthritis)

In some cases, a tailbone fracture or cyst can cause tailbone pain. Rarely, it can be from infection or cancer.

When to See a Doctor

Many causes of tailbone pain are not serious, but some conditions require care by a physician. See your doctor if your pain is severe or doesn’t improve after several days. 

How to Relieve Tailbone Pain When Sitting

Treatment for tailbone pain will depend on the cause and the nature of your symptoms. Common treatments include:

• Self-care home remedies like heating pads, ice packs, baths, or massage

• Chair cushions or coccyx pillows with a cutout to relieve pressure in the tailbone area

• Lean forward while sitting to reduce pressure on your tailbone 

• Medication

  • Over-the-counter (OTC) pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for tailbone pain. It’s important to make sure that you are safely able to take these medications, based on your medical history. 

  • Prescription pain medications

• Physical therapy and exercise therapy including gentle stretches like the ones described below

• Lifestyle strategies like relaxation techniques and improved sleep habits

Most people get relief from coccyx pain while sitting with at-home treatments. In some cases, further interventions can help, including:

• Steroid and anesthetic injections

• Nerve blocks

• Surgery (rarely), including coccygectomy, or removal of your tailbone

Physical Therapy and Exercise for Tailbone Pain Relief

You may not automatically associate exercise with relieving tailbone pain, but it is often a key part of treatment. That’s because some pelvic pain and tailbone pain conditions are caused by issues with your pelvic floor. Your pelvic floor is made up of layers of muscles, ligaments, and fascia (connective tissue) that stretch from your pubic bone in front of your body to your tailbone in the back. Your pelvic floor muscles can become tight, inflamed, weak, or stop working as they should. 

Issues with these muscles (such as spasms) can pull the tailbone out of alignment and cause discomfort. While there’s no such thing as “perfect” posture, alignment issues with your pelvis and low back or posture-related strain can also cause tailbone pain.

That’s where pelvic floor physical therapy and exercise therapy for tailbone pain (and other symptoms) comes in. It’s a comprehensive treatment that includes education, behavioral and lifestyle strategies, movement and exercise, and manual therapy. You can see a pelvic floor physical therapist (PT) in person or use a program like Hinge Health to access a PT via telehealth/video visit. Your Hinge Health physical therapist can customize your exercise plan to address tailbone pain related to musculoskeletal issues.

Depending on your symptoms, a pelvic floor physical therapist may recommend:

• Stretching exercises, including tailbone stretches, to relax tense muscles and increase flexibility

• Pelvic floor exercises

• Whole-body exercises to strengthen areas that support your pelvic floor, spine, and tailbone 

• Stress management techniques

• Nutritional changes

• Sleep strategies

Many people with pelvic floor-related tailbone pain see improvement after a few weeks of pelvic floor physical therapy. Ask your doctor if pelvic floor physical therapy for tailbone pain could be right for you.

Prevent Tailbone Pain: Avoid Falls

Not all tailbone pain is preventable, but avoiding falls is one way to reduce your risk. Our Hinge Health physical therapists highlight exercise to improve your strength and balance as one of the most effective measures you can take against falls. Removing tripping hazards, decluttering your living spaces, and wearing non-slip footwear can also help. Hearing and vision can play a part in falls, too. So get your hearing and vision checked and talk to your doctor about conditions or medications that might affect your fall risk.