Understanding Pain at the Base of the Spine
Coccydynia is pain in the coccyx, or tailbone, the small triangular bone at the very bottom of the spine. It usually hurts most when sitting, especially when leaning back, and when standing up from a seated position. It is more common in women and often follows a fall or childbirth. Most cases improve with cushions and time, and targeted injections help pain that persists.
Causes
A fall onto the buttocks.
Childbirth.
Prolonged sitting on hard surfaces, or activities like cycling or rowing.
An unstable or overly mobile tailbone.
Increased or decreased body weight, which changes how pressure falls on the tailbone.
Rarely, infection or a tumor.
Symptoms
Localized pain and tenderness at the tailbone.
Pain when sitting, especially leaning back, that eases when leaning forward or standing.
Sharp pain when rising from sitting.
Pain with bowel movements or intercourse in some people.
Imaging Studies to Consider
Standing and sitting X-rays of the coccyx (dynamic views) can show abnormal tailbone movement.
MRI is used to look for inflammation, fractures, or other causes.
Physical Therapy, Home Exercise & Other Conservative Techniques
Physical Therapy
Pelvic floor physical therapy, including muscle relaxation.
Manual therapy to the coccyx and surrounding muscles.
Home Exercise Program
Gentle pelvic floor relaxation and stretching.
Hip and piriformis stretches.
Other Studied Techniques
A wedge or U-shaped (cut-out) cushion.
Leaning forward when sitting.
Heat or ice.
Interventional Treatment Options
Coccygeal injection: A steroid and local anesthetic placed near the painful area under imaging guidance.
Ganglion impar block: An injection at the small nerve bundle in front of the tailbone that carries pain signals from the area.
Radiofrequency ablation or pulsed radiofrequency of the ganglion impar: For longer-lasting relief after a successful block.
Surgical referral: Rarely, coccygectomy (removal of the tailbone) for severe pain that persists after other treatment.
Neuromodulation: Spinal Cord & Peripheral Nerve Stimulation
Neuromodulation is uncommon for tailbone pain but may be considered in select cases of chronic pelvic pain, including sacral nerve root or dorsal root ganglion stimulation.
Evidence Base: Guidelines & Levels of Evidence
Cushions and conservative care: Level III · Observational studies; most cases resolve
Ganglion impar block: Level III · Prospective and observational studies
Ganglion impar radiofrequency: Level III · Observational studies
Coccygectomy: Level III · Surgical case series
Platelet-rich plasma (PRP): Not established · Not graded in the ASPN 2024 consensus guideline
Evidence levels and guideline citations above are summarized for general clinical reference based on the literature and major society guidelines available at the time of writing. Guidelines are periodically updated; please verify current recommendations before relying on this summary for clinical decision-making.
Pain Psychology Techniques
Cognitive behavioral therapy (CBT) for pain.
Relaxation training and diaphragmatic breathing, which also help relax the pelvic floor.
Mindfulness-based stress reduction.
Biofeedback for pelvic floor muscle tension.
Non-Opioid Medication Options
Anti-inflammatory and analgesic options
NSAIDs like ibuprofen or naproxen.
Acetaminophen.
Other options
Stool softeners to reduce pain with bowel movements.
Gabapentin or a low-dose tricyclic antidepressant for persistent pain.
Topical treatments
Lidocaine patches or gel.
Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
