Pain guide · Back pain
Tailbone pain (coccydynia) is pain and tenderness at the very base of the spine, usually worse when you sit, lean back or get up from a chair. It often follows a fall onto your bottom, childbirth or long spells of sitting, and it usually improves over a few weeks, though for some people it lasts much longer.
A good cushion, shorter spells of sitting and simple painkillers come first; physiotherapy and injections are the next steps. Exercise hasn't been shown to cure it, and this page says so: the gentle plan here keeps you moving and comfortable while it settles. Start with the warning signs.
Exercise is for pain that has been checked or is clearly mild and settling.
Tailbone pain (coccydynia) is pain and tenderness in the coccyx, the small bone at the base of the spine, near the top of your bottom. It is often a dull ache with occasional sharp pains, worse while sitting, when you sit down or stand up, when you bend forward or when you open your bowels, and it can disturb sleep.
The coccyx is one leg of the tripod you sit on, with your two sitting bones, and leaning back while you sit puts more weight through it.
The NHS lists pregnancy and childbirth, a fall onto the coccyx, long or repeated sitting such as driving or cycling, poor posture, being overweight or underweight, and a coccyx joint that moves too much or too little; sometimes no cause is found. Women are affected about five times as often as men.
In 208 people examined with X-rays standing and sitting, body weight shaped what went wrong: in people with obesity the coccyx most often slipped backwards when they sat, in thin people a bony spur was more common, and a fall in the month before the pain began made an unstable coccyx more likely. At one specialist clinic, childbirth caused 7.3% of the cases in women, and half of those births were forceps deliveries.
Uncommon causes to rule out include an infection such as a pilonidal sinus (an infected channel in the skin at the top of the buttocks), a growth, and pain coming from the spine.
Usually from the story and tenderness over the coccyx, and the NHS describes treatment without routine scans. When it doesn't settle, X-rays or MRI (magnetic resonance imaging) can look for a break, a growth or abnormal movement; specialist clinics compare X-rays taken sitting and standing, which found the problem in 69% of cases in one series.
The NHS says it may improve after a few weeks but can last longer, and a review says most cases resolve within weeks to months, with or without treatment.
Long-standing pain is a different picture. In 115 people treated at a French specialist service after more than 2 months of pain (18 months on average), pain eased by about 1.5 points out of 10 at 6 months and 2.8 points at 3 years, but half still had pain above 3 out of 10, or had had surgery, at 3 years. The longer the pain had lasted, the worse the outlook.
The NHS's first steps: sit with your lower back supported, use a coccyx cushion, lie on your side, try pelvic floor exercises, use an ice pack for 20 to 30 minutes or a heat pack for longer, take an anti-inflammatory such as ibuprofen, use a laxative if pooing hurts, and don't sit for long. A review adds that a wedge-shaped or cut-out coccyx cushion takes pressure off the coccyx, while a ring (doughnut) cushion can press on it. We found no trials of cushions: this is sensible advice, not tested treatment.
The NHS lists physiotherapy, in which the muscles around the coccyx are manipulated, among the first further treatments. In a trial of 102 people with long-standing tailbone pain, 3 sessions of internal manipulation (through the back passage) gave good results about twice as often as low-power external physiotherapy at 1 month (36% against 20%) and 6 months (22% against 12%), though the differences could have been chance. In a smaller study, about 1 in 4 had a satisfactory result at 6 months and at 2 years. A 2025 review found manual therapy worked best in recent pain, and its effect faded with time.
A 2025 review of 9 trials (532 people) found shockwave therapy reduced pain and improved function, sometimes for up to 6 months, though the trials had a moderate to high risk of bias. In one of them, 41 people had 4 weeks of shockwave or other physical treatments, and pain fell more with shockwave.
The NHS suggests pelvic floor exercises. The trials and case series used relaxation. Adding a reverse Kegel (relaxing the pelvic floor on the in-breath, 5 s at a time, 3 sets of 10) to usual care helped in a small trial. In a series of 124 people with no comparison group, relaxation-focused pelvic floor physiotherapy over about 9 sessions cut average pain from 5.1 to 1.9 out of 10. In 60 women with tailbone pain after childbirth, light therapy plus pelvic floor exercise did best.
If your pelvic floor feels tight, sex is painful or you struggle to empty your bowels, relaxing it comes before squeezing it, as the site's pelvic floor guide says.
No trial has tested an exercise programme on its own. A 2013 review couldn't recommend any non-surgical treatment over another. A 2022 review of 64 studies (1,980 people, only 5 of them randomised trials) found the smallest average improvements with stretching or manipulation (about 2 points out of 10) and with usual care, against 4 to 5 points for injections, shockwave and surgery, in mostly uncontrolled studies. A 2025 review found short-term benefits from several physical treatments and called for better trials.
Two small trials included exercise. In 48 people, 3 weeks of piriformis and hip flexor (iliopsoas) stretching raised pain thresholds and how long people could sit without pain. In 42 people with tailbone pain after a colonoscopy, piriformis and hip flexor stretches, clamshells and a seat cushion, 3 times a week for 4 weeks, cut pain from 7.3 to 5.7 out of 10; adding tape or reverse Kegels did better. So the plan on this page helps you stay active and comfortable; it isn't a cure.
The NHS lists corticosteroid and local anaesthetic injections into the joint between the coccyx and the spine among the first further treatments. In a 1991 study of 120 people, 60% responded to injections and about 85% to an injection with manipulation, while physiotherapy helped little. In the French cohort, an injection was the usual first treatment, and pain fell only modestly overall. Nerve blocks in front of the coccyx (ganglion impar blocks) eased pain across 17 studies (625 people), on very low-certainty evidence.
The NHS says surgery to remove part or all of the coccyx may be recommended if physiotherapy and injections don't help. In 21 mostly retrospective studies (826 people), pain fell by about 5 points out of 10 and stayed down beyond 3 years, but 8% had complications, mostly wound infections, and 3% needed another operation. In 37 people with an unstable coccyx on sitting X-rays, 34 had good or excellent results at 2 years, though improvement took 4 to 8 months. A 2014 review still called the operation generally not recommended because of its complications, so it is for carefully chosen people with stubborn pain.
Some discomfort during these exercises is fine. Aim for no more than about 5 out of 10, settling within an hour or so, and no worse the next morning; if it is worse, do less next time, not nothing. The 5 out of 10 figure matches this site's other pain guides and hasn't been tested for tailbone pain.
Judge sitting by time, not by pain: sit on your cushion for as long as you comfortably can, stand up and move before the pain builds, and stretch the time by a few minutes every few days. That's our suggestion; the NHS advises not sitting for long.
If lying on your back for floor exercises presses on the tailbone, use a softer surface or a folded blanket under the pelvis, or choose the side-lying and all-fours moves. Numbness around your bottom, weakness in your legs or bladder or bowel changes are not a pain-rule question: see the warning signs.
Start at the first stage. Each move opens a full guide with a 3D demo.
The first 2 weeks, or during a flare. Use a wedge or cut-out coccyx cushion, sit in short spells, sit upright or lean slightly forward rather than back, lie on your side to rest, try ice or heat, and use a laxative if pooing hurts. Walk instead of sitting where you can. The doses are editorial unless marked.
3D demoTreadmill walkingBeginner · Cardio machine10 to 20 min most days, or walk outdoors · The NHS advises not sitting for long
Harder: Treadmill jogging
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment5 min, once or twice a day · Let your belly and pelvic floor soften as you breathe in. The move's own dose
Easier: Breath reach · Harder: Crocodile Breathing (prone diaphragmatic breathing)
3D demoPelvic floor exercise (Kegel)Beginner · No equipment8 slow holds of up to 10 s and 8 quick squeezes, 3 times a day, relaxing fully after each · The NHS suggests pelvic floor exercises. If squeezing hurts, or the pelvic floor feels tight, switch to the pelvic floor relaxation routine
3D demoChild's Pose (Balasana)Beginner · No equipment1 to 3 min, breathing slowly · Knees wide. The move's own dose
3D demoCat-cowBeginner · No equipment8 slow waves · The move's own dose
Move on when: Sitting and standing up are getting easier, and the pain settles between sessions.
About weeks 2 to 6. The stretch and clamshell doses come from a small trial in which stretches, clamshells and a seat cushion, 3 times a week for 4 weeks, eased pain, and relaxing the pelvic floor or adding tape helped more. If lying on your back presses on the tailbone, put a folded blanket under your pelvis or use a softer surface.
3D demoReclined figure four (eye of the needle, Sucirandhrasana)Beginner · No equipmentHold 30 s each side, 3 times a week · A piriformis stretch. The trial's hold
3D demoHalf-kneeling hip flexor stretchBeginner · No equipmentHold 30 s each side, 3 times a week · The trial's hold for its hip flexor stretch, which it did lying on a table
Harder: Couch stretch
3D demoClamshellBeginner · No equipment3 sets of 10 each side, 3 times a week · The trial's dose
Harder: Lateral band walk
3D demoGlute bridgeBeginner · No equipment2 sets of 10 · Editorial dose
Easier: Pelvic tilt into bridge · Harder: Glute kickback (quadruped hip extension)
3D demoSit to stand from a chairBeginner · A bench or box2 sets of 8 to 10, leaning forward over your feet · Getting up from a chair is often the painful moment. Editorial dose
Harder: Bodyweight squat
Move on when: These are comfortable and you can sit a little longer each week.
From about week 6. Stretch your sitting time by a few minutes every few days with your cushion, and go back to cycling with short rides and a well-fitted saddle. The doses are editorial.
3D demoBird dogBeginner · No equipment2 sets of 6 to 8 each side
Easier: Bird dog, one limb at a time · Harder: Bear Crawl
3D demoSide-lying leg raiseBeginner · No equipment2 sets of 10 to 12 each side
Easier: Lateral band walk · Harder: Lateral band walk, band at the feet
3D demoBodyweight squatBeginner · No equipment2 sets of 10
Easier: Sit squat (partial squat) · Harder: Dumbbell goblet squat
3D demoStep-upBeginner · A step2 sets of 8 to 10 each leg
Easier: Low step-up · Harder: Dumbbell step-up
Move on when: Normal activity is comfortable. If the pain hasn't improved after a few weeks, or is stopping your daily life, see a GP about physiotherapy or an injection.
Sit with your lower back supported, on a wedge or cut-out coccyx cushion rather than a ring, and avoid leaning back, which puts more weight through the coccyx. Get up and move often, and lie on your side to rest.
An ice pack wrapped in a towel for 20 to 30 minutes, or a heat pack for longer; an anti-inflammatory painkiller such as ibuprofen if it suits you; and if pooing hurts, a laxative to soften your poo (ask a pharmacist which one).
Source 1
After birth, tailbone pain often follows a difficult or forceps delivery. Use a cushion, avoid long sitting, and see your GP, midwife or a pelvic health physiotherapist if it doesn't settle. In pregnancy, back pain in the second or third trimester, or with a fever, bleeding or pain when you pee, needs an urgent check. Pain round the back of the pelvis in pregnancy (pelvic girdle pain) has its own guide.
| Habit or position | Why it matters | Instead |
|---|---|---|
| Sitting for long spells | The NHS advises not sitting for a long time. | Stand and move every 20 to 30 minutes (our suggestion), and walk. |
| A ring (doughnut) cushion | It can press on the coccyx. | A wedge or cut-out coccyx cushion. |
| Slumping back when you sit | Leaning back puts more weight through the coccyx. | Sit upright with your lower back supported, or lean slightly forward. |
| Straining on the toilet | Pain is often worse when you poo. | A laxative to soften your poo, as a pharmacist advises. |
| Hard squeezing of the pelvic floor when it hurts | With pelvic pain, more squeezing may not help; relaxation comes first, as the site's pelvic floor guide says. | Slow breathing that lets the pelvic floor soften, and the pelvic floor relaxation routine. |
| Sit-ups, rolling Pilates moves and rocking on your back | Rolling presses on the tailbone, and the site's Pilates moves already say skip them with a sore tailbone. | Moves on your side or on all fours. |
| Long rides on a hard saddle | Cycling is one of the causes the NHS lists. | Shorter rides and a well-fitted saddle (our suggestion). |
An 8-minute routine for a tight pelvic floor: slow breathing and comfortable positions to help the muscles let go, with no strengthening squeezes.
8 minBeginner5 movesNo equipmentA 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentA gentle 25-minute routine for the first weeks after birth: pelvic floor, breathing, tummy and hip exercises on the floor, sit-to-stands and a walk.
25 minBeginner12 movesA bench or box, Cardio machineA 25-minute glute workout with bodyweight and a mini band: bridges, clamshells, band walks, kickbacks and lunges.
25 minBeginner9 movesA wall, A bandA 3-minute standing break to repeat every 30 to 60 minutes at your desk: sit-to-stands, calf raises, marching, an upper-back turn and chin tucks.
3 minBeginner5 movesA bench or box, A wallThe usual causes are a fall onto your bottom, pregnancy and childbirth, long or repeated sitting such as driving or cycling, and being overweight or underweight. Sometimes there's no clear cause, and women get it about five times as often as men.
It often improves within a few weeks to months. Pain that has lasted more than a few months can be stubborn: at one specialist service, half still had significant pain 3 years later, so get help if it isn't settling.
Use a wedge or cut-out coccyx cushion, sit upright with your lower back supported or lean slightly forward, and get up often. A ring cushion can press on the coccyx.
Walking, gentle stretches for the hips and buttocks, clamshells and pelvic floor relaxation were part of care in small trials and may help you sit and move more comfortably. No exercise programme has been shown to cure tailbone pain on its own. If it isn't improving, physiotherapy and injections are the next steps.
The NHS suggests them. If your pelvic floor feels tight, sex is painful or pooing is hard, focus on relaxing it rather than squeezing; a pelvic health physiotherapist can help.
It might be bruised, cracked or moving more than it should, but the first treatment is the same. Get it checked if the pain is severe, isn't improving after a few weeks, or comes with any warning sign.
Physiotherapy, including manual therapy of the muscles around the coccyx, and a steroid and local anaesthetic injection are the usual next steps; surgery to remove the coccyx is for pain that hasn't responded. In one trial, good results were about twice as common after internal manipulation as after low-power physiotherapy, though the difference could have been chance.
Many people improve after a steroid and local anaesthetic injection, but the studies had no comparison group. Nerve blocks in front of the coccyx also eased pain, on very low-certainty evidence.
For carefully chosen people with stubborn pain, removing the coccyx cut pain by about 5 points out of 10, with complications, mostly wound infections, in about 8%. It's a last resort.
Childbirth, especially a difficult or forceps delivery, can strain or shift the coccyx. Use a cushion, avoid long sitting, and see your GP or a pelvic health physiotherapist if it doesn't settle; the postnatal exercises are a gentle place to start.
Call 999 for numbness around your genitals or bottom, new bladder or bowel problems, or numbness or weakness in both legs. Get an urgent GP appointment or call NHS 111 for a fever or feeling unwell, or a painful lump between your buttocks leaking pus. If you have had cancer and the pain is new and severe, contact your cancer team or GP the same day, and see a GP soon for weight loss or pain that's worse at night.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
