Tailbone pain is one of those things people rarely think about until it starts interfering with sitting, exercising, or even sex. It's often mistaken for low back or SI joint pain, which means it can go unaddressed for a long time. In this article, pelvic floor physical therapists Georgina Genovese and her co-host break down what the tailbone actually does, what causes it to become painful, and what has helped in both their clinical experience and personal lives.
Because the tailbone is where all of the pelvic floor muscles attach, tailbone pain is closely tied to pelvic floor health more broadly, including bladder, bowel, and sexual function.
The tailbone sits at the base of the spine, and according to Genovese, it's where all the pelvic floor muscles attach, along with the glute max. Because of these attachments, the pelvic floor is responsible for bowel, bladder, and sexual function, along with pressure management and overall stability. That makes the tailbone, in her words, a kind of keystone for the body.
It's also a body part that takes a lot of daily wear, mainly because so many people sit for long stretches at work.
A few common contributors came up in the conversation:
Genovese noted that patients often don't connect a childhood fall to their current tailbone pain because it's simply not a body part people think about.
According to the hosts, common signs include:
They also pointed out that people going to physical therapy for back, SI joint, or hamstring pain who aren't improving after several weeks may actually be dealing with a tailbone issue that needs pelvic floor–specific treatment.
Coccydynia is simply the clinical term for tailbone pain. "Coccyx" is the Latin word for tailbone, and "-dynia" means pain. Genovese described it as inflammation around the tailbone that causes pain, which she said is really just a fancier way of describing the same thing patients already know as tailbone pain. She noted this label can sound alarming to patients, even though it doesn't represent a different or more serious diagnosis.
A pelvic floor PT evaluates the tailbone both externally and internally, including going in through the rectum to mobilize the tailbone and check the surrounding muscles. Genovese explained that this internal work, releasing the muscles that attach directly to the tailbone, is what tends to help the most, more than external work alone. This is different from what a general orthopedic physical therapist is trained to do.
The hosts also noted that the low back and tailbone move together: when the low back extends, the tailbone should extend too, and when the low back curves, the tailbone should tuck under. If that coordinated movement isn't happening, the tailbone can be part of what's keeping other areas, like the low back, from improving.
The hosts discussed several cushion options and posture strategies:
They also recommended sitting upright on the sit bones rather than slumped, using a rolled towel, sweatshirt, or pillow behind the low back for support, and avoiding sitting in one position (or standing in one position) for too long.
Airplane seats came up specifically as a common trigger, since the hosts described them as close to a 90-degree angle that pushes the body into a tucked, slouched posture. One Dr. Genovese shared that she travels with a tailbone cushion and also brings a small carry-on bag to rest her feet on, since being short means her feet otherwise dangle, which undermines the benefit of the cushion. This is a personal strategy from her own experience rather than a universal recommendation.
If someone is in an active flare, the hosts generally suggested favoring low-impact movement:
They specifically advised against biking and high-impact activities like running or HIIT-style classes during a flare. Both hosts said they personally avoid biking due to the pressure it places on the pelvic floor, though they were clear this isn't a permanent restriction for people who enjoy it. If someone wants to return to biking, suggestions included raising the bike seat as high as possible, staying out of the seat during a spin class when possible, using a seat cushion, and getting professionally fitted for a more intensive riding setup.
For core work like boat pose, one host suggested placing the hands under the sit bones to take some direct pressure off the tailbone.
The hosts described diaphragmatic breathing as a foundational tool. On the inhale through the nose, the belly and pelvic floor should move down together, since the diaphragm and pelvic floor mirror each other. On the exhale through the mouth, the belly flattens, and it's important not to clench the abdomen or glutes during this phase, since that pattern can contribute to pelvic floor tightness and, in turn, tailbone pain.
They noted that clenching the glutes is a common, often unconscious habit, sometimes tied to stress or anxiety, or to weak glutes being compensated for by tensing.
It may be worth seeing a pelvic floor physical therapist if:
They emphasized that these other symptoms are often connected to the tailbone because the same pelvic floor muscles support the bladder, bowel, and sexual organs.
Is coccydynia different from tailbone pain?
No. Coccydynia is simply the clinical term for tailbone pain, described as inflammation around the tailbone.
Are donut cushions good for tailbone pain?
Generally not recommended by the hosts. The cutout can put more direct pressure on the tailbone rather than relieving it. They noted it may have a place after certain surgeries or postpartum, but isn't a go-to for general tailbone pain.
Should I stop exercising if I have tailbone pain?
Not necessarily. The hosts recommended shifting toward low-impact options like walking, swimming, elliptical, and yoga during a flare, and reducing higher-impact activities like biking, running, or HIIT until symptoms improve, then easing back in gradually.
Can bladder or bowel issues really be connected to tailbone pain?
Based on the hosts' clinical experience, yes. Because all the pelvic floor muscles attach at the tailbone and support the bladder, bowel, and sexual organs, dysfunction in one area can be connected to the others.
What is the pelvic wand, and is it safe to try at home?
It's a curved tool used to self-release deep pelvic floor muscles vaginally or rectally. The hosts said it can be a helpful at-home tool with water-based lubricant, starting with the thinner end, though they suggested first trying it with guidance from a pelvic floor PT if possible.
This article draws on insights from a conversation on Unlock Your Body. Listen to the full episode below for the complete discussion and additional context.
Tailbone pain is common, closely tied to posture and prolonged sitting, and often connected to broader pelvic floor function, including bladder, bowel, and sexual health. If pain in the back, hip, or hamstring area isn't improving with standard physical therapy, or if it comes with other pelvic floor symptoms, it may be worth having the tailbone specifically evaluated by a pelvic floor physical therapist.