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Tailbone Pain (Coccydynia)

Tailbone pain (coccydynia) is pain at the very bottom of the spine, usually worse when sitting down or standing up from a seat. It often follows a fall, childbirth or long periods of sitting, and sometimes has no clear cause. Many cases settle with simple measures, but some last for months. A few warning signs — especially loss of bladder or bowel control or numbness in the “saddle” area — need emergency care.

Go to the emergency room or call 911 right away if you have tailbone or low back pain together with any of these:

The NHS advises not driving yourself: ask someone to drive you or call for an ambulance (NHS). Left untreated, cauda equina syndrome can cause permanent paralysis and incontinence, and treatment within 48 hours of the start of symptoms gives a significant advantage in recovery (AANS).

Get medical help promptly (the same day if you can) for:

  • A painful lump or sore at the top of the crease between your buttocks that is swollen, bleeding or leaking pus — possibly an infected pilonidal sinus. The NHS advises an urgent appointment, because the symptoms can develop over a few days and signal infection (NHS). See the pilonidal section below.
  • Back or tailbone pain with feeling hot, cold, shivery or generally unwell, or severe pain that starts suddenly or is getting worse quickly — the NHS advises urgent medical advice. Very rarely, back pain is a sign of a broken bone, cancer or an infection (NHS).
  • Pain with unexplained weight loss, a lump or swelling in your back, or pain that is worse at night or does not ease with rest. The NHS lists these as reasons to see a doctor (NHS), and reviews say infections and tumors of the tailbone area, though less common, need to be ruled out (Lee et al., 2023). MBHA suggests not waiting for a routine appointment.

Do not wait for a chiropractic, acupuncture or massage appointment, and do not try an herb or supplement first, if you have any of these signs.

What is tailbone pain?

The tailbone, or coccyx, is the last segment of the spine: three to five small bones at the bottom of the sacrum, with several muscles and ligaments attached (Elezović et al., 2023). Coccydynia (also spelled coccygodynia) means pain felt there, typically worse when you sit and when you move from sitting to standing (Staartjes et al., 2026), with tenderness when the spot is pressed (Foye, 2017). It is not fatal in itself, but it can affect quality of life a great deal, especially when you need to be seated (Elezović et al., 2023). How common it is remains unknown (Benditz & Thoma, 2025); women are affected about five times as often as men (Elezović et al., 2023).

What causes it?

What does it feel like, and how is it diagnosed?

People often describe severe, searing or cutting pain at the tailbone that sitting makes worse and that does not typically spread into the back or down the leg. It can also hurt during sex or a bowel movement (Elezović et al., 2023). Standing up from a seat can cause a brief, intense spike (Lee et al., 2023). If pain travels down the leg, see our sciatica guide; for pain higher in the back, see our back pain guide. The two can be confused: referred pain from the lower back is often mistaken for tailbone pain (Lee et al., 2023), and in two studies 28% to 31% of people were first given a different diagnosis (Staartjes et al., 2026).

Diagnosis rests on a history and a hands-on exam for tenderness over the tailbone. Ordinary x-rays are mainly useful to exclude fractures or other serious problems, and normal x-rays do not prevent a good response to treatment. Some providers order x-rays taken sitting and standing to see how much the tailbone moves; MRI or CT is generally kept for injury, warning signs, or suspected tumor or infection (Staartjes et al., 2026, Benditz & Thoma, 2025).

How long does it last?

Estimates differ. One review says many cases resolve without medical treatment and that simple, non-surgical care works in about 90% of cases (Lirette et al., 2014). A newer review found that, depending on the study, 10% to 51% of people still had pain after non-surgical treatment (Staartjes et al., 2026), and others warn that the pain can become chronic (Benditz & Thoma, 2025).

When to see a provider (not an emergency): after a fall or blow to the tailbone; if the pain makes it hard to sit, work or sleep; if it is not improving after a few weeks of home care (the NHS gives the same advice for back pain, NHS); or if it keeps coming back. A provider can check the tailbone and look for other causes.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Education, sitting less and using a cushion, over-the-counter pain relievers, physical therapy (including shock wave therapy and pelvic floor work). For pain that persists: injections or nerve procedures, and rarely surgery to remove the tailbone (coccygectomy). Medicare Part B covers medically necessary outpatient physical therapy (20% coinsurance after the deductible). Other costs: being researched. Many cases settle with simple measures; reviews also report that a sizeable minority keep having pain. Research is limited and mostly small. Physical therapy has the most support; injections help many people; surgery helps most who have it but can cause wound infection.
Chiropractic Spinal or tailbone adjustments, sometimes with exercise and sitting advice. About $55 to $100 per follow-up visit paying cash, per The Pricer. Medicare covers only spinal adjustments for a subluxation (20% coinsurance after the deductible). We found only single-patient case reports on chiropractic care for tailbone pain. A trial of a different manual technique found mild benefit. Never a substitute for emergency care if you have bladder, bowel or saddle-area changes.
Acupuncture A course of needle treatments, usually over several weeks, alongside other care. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain; tailbone pain isn’t listed, so ask first. We found little research on acupuncture for tailbone pain: a few old or single-patient reports. Evidence for back pain in general is more encouraging. Few serious problems with sterile, single-use needles.
Herbal medicine No herb has been shown to help tailbone pain. Some products tested for low back pain include cayenne cream, devil’s claw and white willow bark. Cost estimate being researched. We found little research on herbs for tailbone pain. Herbs can interact with medicines and some carry real risks, so check with a doctor or pharmacist first.
Massage therapy Gentle hands-on work for tight muscles in the buttock and low back. A specific pelvic floor muscle technique (levator ani massage) has been studied. One national chain: about $70 to $90 a month on a 12-month membership, per The Pricer. Medicare doesn’t cover massage therapy. Pelvic floor muscle massage and stretching helped some people in small studies, but general massage hasn’t been tested for tailbone pain. MBHA suggests avoiding direct pressure on a sore or recently injured tailbone.
MBHA Wellness Coach Practical help with sitting habits, cushions, pacing activity, a healthy weight, stress and pain-coping skills, and preparing for appointments. Cost estimate being researched. Supports — never replaces — medical care. Reducing pressure on the tailbone is a standard part of care, though cushions have not been studied on their own.

Approach 1 of 6

Conventional medicine (AMA)

A 2026 review of 42 studies proposed a step-by-step approach: education, ergonomic advice, taking weight off the tailbone, simple pain relievers and physical therapy first; injections or nerve procedures if pain persists; and surgery only for long-lasting, disabling pain. The authors call it a framework rather than a formal guideline, and most of the studies were at risk of bias (Staartjes et al., 2026). Another review agrees that the evidence comes mainly from observational studies plus a number of small trials (Benditz & Thoma, 2025).

1. Home measures

See the home care section below. No study has measured the separate effect of cushions or of pain medicines (Staartjes et al., 2026) — they are widely used, but unproven.

2. Medicines (by type)

We don’t list doses; ask your doctor or pharmacist what, if anything, is safe for you.

3. Physical therapy

This is the best-supported non-drug option, but the studies are small.

  • Shock wave therapy (ESWT). In a trial of 41 people, pain fell more after 4 weeks of ESWT than after other physical therapy modalities, and satisfaction was higher; disability scores improved in both groups, with no clear difference between them (Lin et al., 2015). In a trial of 34 people, three weekly sessions of ESWT were compared with a steroid injection; both lowered pain, and ESWT was more lasting over 6 months (Ahadi et al., 2022).
  • Reviews. A 2025 review of nine trials (532 people) found ESWT reduced pain and improved function, with benefits lasting up to six months in some cases, and that manual therapy worked best in recent-onset pain; however, the trials had moderate to high risk of bias and the authors said they could not draw firm conclusions (Blanco-Diaz et al., 2025). A second 2025 review of 10 studies (515 adults) found short-term gains in pain and function from several physical therapy approaches, and called for better long-term studies (Sidiq et al., 2025).
  • Stretching. In a trial of 48 people, stretching of two hip and buttock muscles (with or without mobilization of the upper back) improved pain-free sitting time and tenderness more than a package of seat cushioning, a sitz bath and an ultrasound-based treatment (phonophoresis), which did not improve significantly (Mohanty & Pattnaik, 2017).
  • Pelvic floor physical therapy. See the massage section and the pregnancy section below.

4. Injections and nerve procedures

For pain that does not settle, the common categories are:

  • Steroid injections placed around the tailbone, usually mixed with a numbing medicine and ideally guided by imaging (Lee et al., 2023). In a review of 277 patients with long-lasting pain treated with steroid injections, of whom 241 were followed for about three years, only 9% had no pain at the 3- to 4-month check; counting people who felt well or much better and had not had surgery, long-term success was 15% after one injection and 29% after a second, and it was better when symptoms had lasted less than a year. No complications were seen (Finsen et al., 2020). Another review says injections can markedly improve symptoms for many patients (Benditz & Thoma, 2025).
  • Ganglion impar block — an injection near a small bundle of nerves in front of the joint between the tailbone and sacrum, usually given under x-ray guidance (Elezović et al., 2023). A 2026 review of 17 studies (625 people) found pain lowered for more than six months with no serious adverse events, but the certainty of the evidence was rated “very low” (Jevotovsky et al., 2026).
  • Radiofrequency procedures, which apply heat or short pulses of energy to nerves, may be considered at specialized centers for long-lasting pain that responded to an injection; comparisons between the procedures are scarce (Staartjes et al., 2026).
  • The caveat: a 2022 review found no high-quality data supporting steroid injections, nerve blocks or radiofrequency ablation, only small studies suggesting benefit; it also found no randomized trials of implanted nerve stimulators, only case reports (White et al., 2022).

5. Surgery (coccygectomy)

Surgery to remove the tailbone is kept for people with long-lasting, disabling pain who have not improved with other care (Staartjes et al., 2026, Benditz & Thoma, 2025). A 2022 review of 21 studies (826 people, mostly retrospective) found average pain scores fell by about 5 points on a 0–10 scale at every follow-up, including beyond 36 months; 8% had complications — most often wound infection or the wound reopening — and 3% needed another operation (Sagoo et al., 2022). Another review gave wound-infection rates mostly between 5% and 15%, up to 36% in some case series, because the wound is close to the anus (Staartjes et al., 2026). Ask a surgeon about infection risk, recovery time and the odds in your case.

What it costs

Medicare Part B covers medically necessary outpatient physical therapy when your provider certifies you need it. After the Part B deductible you pay 20% of the Medicare-approved amount, with no yearly limit on medically necessary therapy (Medicare.gov). Physical therapy without insurance, shock wave therapy, medicines, injections and surgery: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractors treat the spine and joints, often with spinal manipulation: a controlled thrust applied by hand or with a device (NCCIH). Medicare’s chiropractic benefit describes the same: adjustments by hand or with a device called an “activator” (Medicare.gov).

What the research says

  • We found little research on chiropractic care for tailbone pain. Our PubMed searches found a 1999 report of a single woman whose three-week-old tailbone pain eased after chiropractic adjustments with an activator instrument (Polkinghorn & Colloca, 1999) and a 2025 report of one cyclist who returned to cycling after 22 weeks of chiropractic care (Hamilton & Mangos, 2025). Single cases cannot show that a treatment works.
  • Related manual treatment. The best trial of a hands-on tailbone technique tested manipulation of the tailbone through the rectum, guided by x-rays, in 102 people. Good results were more frequent after three sessions of it than after low-power physiotherapy at 1 month (36% versus 20%) and 6 months (22% versus 12%), but those differences were not statistically significant, and the authors called the effectiveness “mild” (Maigne et al., 2006). These studies tested other manual techniques, so they do not tell us how chiropractic adjustments compare.
  • For low back pain, NCCIH says spinal manipulation is one of several non-drug approaches that may lead to small improvements in pain and function (NCCIH); that does not tell us whether it helps the tailbone.

In plain terms: chiropractic care may help you with stiffness and posture, but it has not been shown to treat tailbone pain itself.

Safety

Mild side effects — more pain, stiffness or headache — are common after manipulation. Serious problems are rare but have been reported, and may be more likely in people who have underlying health problems. Tell the practitioner your health history and medicines. If you are pregnant, discuss the risks with your health care provider first (NCCIH). Because a fracture, infection or tumor can look like simple tailbone pain, MBHA suggests having a medical provider check the warning signs from the top of this page before any adjustment, and telling your chiropractor about any recent fall.

Medicare coverage

Part B covers only spinal adjustments by a chiropractor to correct a subluxation. It does not cover X-rays, massage or acupuncture ordered by a chiropractor. After the deductible you pay 20% of the Medicare-approved amount (Medicare.gov).

What it costs

Paying cash, a follow-up visit typically costs about $55 to $100 and a first appointment about $90 to $200. An initial exam followed by several weeks of treatment can turn a $60 visit into a $500 to $1,000 course of care (The Pricer). Ask how many visits to expect.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is a technique in which practitioners insert fine needles into the skin; in the United States it is most often used for pain such as back, joint or neck pain (NCCIH). Reviews of tailbone pain list acupuncture among the possible non-drug options (Elezović et al., 2023).

What the research says

  • We found little research on acupuncture for tailbone pain. The few reports we found are single-case or very small: a 2020 case report of one young woman whose pain after a tailbone fracture improved over 24 weeks of weekly low-level laser acupuncture (Lin et al., 2020); a 1989 Russian-language series of 37 patients who all received physiotherapy, nerve-block injections and massage, with acupuncture added in 24 of them, so acupuncture’s own effect cannot be separated out (Gataullin & Samitov, 1989); and a 2014 Chinese report of 26 cases (Sun & Sun, 2014), for which we could read only the title.
  • For back pain in general, NCCIH says acupuncture may help several pain conditions, including back or neck pain (NCCIH). That is encouraging, but it was not tested on the tailbone.

In short: acupuncture is a reasonable thing to discuss alongside — not instead of — a medical check, but we cannot say it treats tailbone pain.

Safety

Relatively few complications have been reported, but non-sterile needles or improper treatment can cause infections, punctured organs and nervous-system injury. The FDA requires needles to be sterile and single-use, and most states license acupuncturists (NCCIH). MBHA suggests telling your acupuncturist if you take a blood thinner or are pregnant, and asking them to avoid needling over a sore, recently injured or swollen area.

Medicare coverage

Part B covers acupuncture (including dry needling) only for chronic low back pain: pain lasting 12 weeks or longer, with no known cause such as spread cancer or an inflammatory or infectious disease, and not linked to surgery or pregnancy. Tailbone pain is not listed, so check before assuming coverage. Where it applies, Medicare covers up to 12 treatments in 90 days (20 in 12 months if you improve), cannot pay licensed acupuncturists directly, and you pay 20% after the deductible (Medicare.gov).

What it costs

Published cash prices run about $125 to $230 for a first private visit and $90 to $185 for follow-ups; community clinics can be near $50 to $90 a visit (The Pricer). Ask about package prices and insurance.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found little research on herbs or supplements for tailbone pain. Our PubMed search for herbal remedies and coccydynia returned a single article, a review of tailbone anatomy, so no herbal remedy has been shown to help it.

What is known from low back pain research

NCCIH reviewed herbal products tested for low back pain, which is not the same as tailbone pain. It found evidence that cayenne used on the skin reduces pain and said devil’s claw or white willow bark by mouth, and comfrey, Brazilian arnica and lavender oil on the skin, might help, while cautioning that herbal products can cause side effects or interact with medicines (NCCIH). Whether this applies to the tailbone is unknown.

Safety

“Natural” does not always mean “safe.” Supplements can interact with medicines or pose risks if you have certain medical problems or are going to have surgery, and some may increase the risk of bleeding. That matters if you take anti-inflammatory pain relievers or a blood thinner. Some products sold as supplements have been found to contain prescription drugs or ingredients that are not listed on the label (NCCIH).

Before you take any herb or supplement, show it to your doctor or pharmacist — especially if you take a blood thinner, an NSAID or other medicines, or are pregnant, breastfeeding or planning surgery. Many supplements have not been tested in pregnant women or nursing mothers (NCCIH). We don’t list doses, and no herb should delay care for the warning signs at the top of this page.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage can feel good when your buttock and low back muscles are tight and sore. The research on massage for the tailbone is thin, and it centers on one specialized technique rather than a general massage.

What the research says

  • Pelvic floor muscle massage and stretching. In a pilot study of 3 manual treatments for tailbone pain, massage and stretching of a pelvic floor muscle (the levator ani) worked better than joint mobilization, though overall only about one in four people was satisfied at 6 months, and the authors said none of the results was statistically significant (Maigne & Chatellier, 2001). A 2025 review found that levator ani stretching or massage reduced pain in the intermediate term and showed sustained improvement in the long term in the studies it included (Sidiq et al., 2025).
  • Pelvic floor physical therapy. A university clinic reviewed 93 adults with tailbone pain who attended pelvic floor physical therapy aimed at relaxing the muscles. Among the 79 who finished (about nine sessions on average), average pain fell from 5.1 to 1.9 on a 0–10 scale. With no comparison group, though, we cannot tell how much was the treatment (Scott et al., 2017). In a separate trial of 30 women who all had a steroid injection, adding biofeedback to pelvic floor exercises gave no extra benefit (Ahadi et al., 2020).
  • General massage. We found little research on it for the tailbone. For low back pain, NCCIH says only weak evidence suggests massage may help; a 2015 review of 25 studies (3,096 people) found short-term pain improvement but the investigators had very little confidence in it (NCCIH).

MBHA suggests that if you try this, you look for a licensed therapist with pelvic floor training, and that you not allow strong pressure directly on a bruised, recently injured or swollen tailbone.

Safety

The risk of harm from massage appears low. Rare serious problems — a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous deep-tissue massage or in people at higher risk such as older adults (NCCIH).

What it costs

One national chain charges about $70 to $90 a month on a 12-month membership (The Pricer); prices elsewhere vary. Medicare does not cover massage therapy (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Most of what eases tailbone pain happens between appointments. An MBHA Wellness Coach can help you build these habits — alongside, never instead of, medical care. A coach does not diagnose or treat.

Take the pressure off, in small steps

Reviews list education, ergonomic advice and taking pressure off the tailbone (“offloading”) as the first steps of care (Staartjes et al., 2026). A coach can help you notice which seats, surfaces and positions set off your pain, set reminders to stand and shift, plan your day around the times you must sit, and try one change at a time so you can tell what helps.

Weight and activity

Both obesity and rapid weight loss are linked with tailbone pain (Elezović et al., 2023, Lee et al., 2023). So a coach will not push crash diets: the aim is gradual, steady habits. See our weight control guide. A coach can also help you keep up the stretches or exercises a physical therapist gives you.

Coping and pacing

Long-lasting pain is tiring and worrying, and it can change how you work and socialize. A multidisciplinary approach — physical therapy, ergonomic changes, medicines, injections and, possibly, psychotherapy — is described as giving people with stubborn tailbone pain the best chance of success (Lirette et al., 2014). A coach can offer support, accountability and ideas for relaxation and pacing, and can help you prepare questions for your doctor or physical therapist. If you feel low or hopeless, tell your doctor; see our depression guide.

Another approach

Home care: sitting, cushions & heat

These are the common first steps in reviews. Evidence that they work is limited, because researchers have rarely tested them alone (Staartjes et al., 2026).

Another approach

Pregnancy & after childbirth

Childbirth is a well-known cause of tailbone pain, though it was not studied much until recently (Maigne et al., 2012). At one specialist tailbone-pain clinic, about 7% of women seen had pain linked to childbirth. The pain began as soon as they sat down after delivery. Many had instrument-assisted (forceps) or difficult deliveries, and dislocation of the tailbone was found on x-ray in 44% of them (versus 17% of women whose tailbone pain had other causes). A body mass index above 27 and two or more vaginal births were linked with more dislocation (Maigne et al., 2012). A review describes treatment as starting with pain relief, rehabilitation and pelvic floor massage, then injections, psychotherapy or, finally, surgery (Márquez-Carrasco et al., 2019).

In a trial of 60 women whose postpartum tailbone pain had lasted at least six weeks, adding a light therapy (photobiomodulation) to pelvic floor exercises and hot packs gave greater reductions in pain and disability than the light therapy plus hot packs, or the exercises plus hot packs and a placebo light (Abdoelmagd et al., 2025). This was a single study.

During pregnancy

Back and pelvic pain are very common in pregnancy because ligaments soften and stretch to prepare for labour (NHS). The NHS lists lifting with bent knees, flat shoes, rest, a massage or warm bath, and a back-care class as helpful, and says paracetamol (acetaminophen) can be taken for back pain in pregnancy unless your doctor or midwife says not to (NHS). Pregnancy-related pelvic girdle pain can be felt across the lower back and between the vagina and anus (NHS), so not all pain in that area comes from the tailbone. Our pregnancy guide covers pregnancy in more detail.

Pregnancy warning signs

Call 911 or go to the emergency room if you have back pain and lose feeling in one or both legs, your bottom or your genitals. Contact your provider urgently for back pain in the second or third trimester (it could be early labour), or back pain with a fever, vaginal bleeding, pain when you pee, or pain under your ribs (NHS). If you are pregnant and interested in spinal manipulation, discuss the risks with your health care provider first (NCCIH).

Another approach

Pilonidal sinus: a look-alike

A pilonidal sinus is a small hole or tunnel at the top of the crease between the buttocks. Most people do not notice it unless it becomes infected, which causes pain and swelling and sometimes a pus-filled abscess that makes sitting difficult (NHS). Because it sits near the tailbone, pilonidal disease is on the list of conditions providers consider when someone has tailbone pain, and pilonidal cysts are named among the less common causes of it (Elezović et al., 2023, Staartjes et al., 2026).

  • What to look for: a small lump or opening in the crease that is painful, bleeding or leaking pus. The NHS says to ask for an urgent appointment, as the symptoms can develop quickly and signal infection (NHS).
  • Treatment: an infected, swollen abscess usually needs to be cut open and drained, and antibiotics may be given. A sinus that keeps coming back may need surgery. If the sinus is not infected, the NHS advises watching it and keeping the area clean, and not shaving the area unless a doctor advises it (NHS).
  • Who gets it: it is not clear what causes it. It is more common in men, who tend to be hairier, and sitting for long periods may increase the chance (NHS).

See also our cysts guide.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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