Kinematics Team FAQ: Coccyx Contusion (Tailbone Pain)
October 15thYou probably don’t think much about your tailbone until it hurts.
Then suddenly, every chair feels different. Getting into the car is an event. You find yourself lowering onto the couch carefully, wondering how one small spot can be quite so uncomfortable.
If you have taken a decent fall onto your backside and the soreness has hung around, you may have bruised your coccyx.
It is generally not a serious injury. The frustrating bit is the location. You can’t exactly stop sitting for the next few weeks while it settles.
Coccyx Contusion Definition aka Tailbone Pain. The coccyx is the small, curved bone at the very bottom of your spine. In everyday language, it is your tailbone.
A contusion simply means a bruise. With a coccyx contusion, the bone can remain intact while the tissues around it become irritated following an impact. One of those tissues is the periosteum, the thin layer that sits over the surface of the bone.
So, put simply, you have bruised the tailbone and irritated the tissues around it.
That can be enough to make sitting surprisingly uncomfortable. Every time you put your weight through the area, particularly on a hard chair or while leaning backwards, you are putting more pressure on an already irritated and sore spot.
Where will I feel pain with a coccyx contusion?
There is usually one spot that gives the game away. It is right down at the bottom of your spine, where the tailbone sits. For some people, pressing around the area is enough to find the exact point that is sore.
But it is not always a perfectly localised pain. An ache can spread into the lower buttocks or sit across the very bottom of your back. The tissues around the coccyx are all connected, with muscles and ligaments attaching into and around the area, so the discomfort can feel a little broader than the original point of impact.
What movements will I struggle to perform if I have contusion in my coccyx?
The first thing you are likely to notice is sitting. A hard office chair. A car seat. A wooden dining chair. None of them are particularly forgiving when your tailbone is bruised. Leaning back into the chair can make it worse because more of your body weight ends up travelling through the coccyx.
Then there is the moment you get up. You can be fine enough while sitting, only to feel a sharp reminder of the injury as you push yourself upright. Bending forwards can also be uncomfortable, as can rolling over in bed or getting up from the floor.
Bowel movements can be sore for some people, too. The pelvic floor muscles attach around the coccyx and are involved in that process, so it is not unusual for a bruised tailbone to make itself known there as well.
One useful detail is that walking and standing are often considerably easier than sitting. When those activities are relatively comfortable but a chair is your worst enemy, it gives us another clue about where the problem is coming from.
Will I feel pain in any other regions of my body?
It is possible. The coccyx sits within the network of tissues around your pelvis and lower back. When one area is sore, the muscles around it may change how they work, and you can end up noticing an ache through the hips, lower back or backs of the thighs. That is generally muscular discomfort rather than nerve pain.
If you start getting numbness, tingling or pain that travels down one leg, however, do not assume it is simply part of the bruising. That pattern is different and is worth having properly assessed by a healthcare professional.
How does a coccyx contusion happen?
The classic story is a fall. You slip on a wet floor. Miss a step. Come off your bike. Fall while skating or snowboarding. Contact sports can do the same thing, particularly when a fall sends you backwards onto your backside.
But sometimes there is no single dramatic incident to point to. A long flight spent on an unforgiving seat can irritate the area. So can hours on hard bleachers or a bicycle saddle that is not quite right for you.
In those cases, it is less about one big impact and more about the tailbone receiving repeated pressure that it is not coping particularly well with.
What things should I try initially once I’ve coccyx contusion?
Start with the thing you are probably noticing most: sitting. A cushion with a cut-out for the coccyx, or a wedge designed to shift pressure away from the tailbone, can make a noticeable difference. You can also try sitting slightly forwards rather than sinking back into the chair.
For the first couple of days, ice for 10–15 minutes at a time may help calm things down. You do not need to put yourself on bed rest. Gentle movement and short walks are generally reasonable, as long as you are not repeatedly aggravating the area.
Early on, the aim is to give the tailbone a chance to settle. Then, as things improve, you can start asking a little more of it again.
What things should I try to avoid in the initial stages of a coccyx contusion?
For a little while, be strategic about where and how you sit. Hours on a firm chair without any cushioning are unlikely to do the area many favours. Nor is spending the afternoon leaning backwards into the backrest.
High-impact exercise is another thing to put on pause while the initial soreness is still hanging around. Running and jumping are obvious examples.
Heavy lifting can be worth avoiding temporarily as well, particularly if it involves a lot of bracing or straining. That can increase pressure through the pelvic floor and lower spine.
You should be looking for gradual change rather than expecting the pain to vanish overnight. If a week or two has passed and things are not moving in the right direction, get it checked rather than continuing to work around the problem.
What type of exercises or movements do I need to be stronger at to rehab the coccyx?
Once the initial soreness has eased, the job changes a little. You are no longer simply trying to keep your tailbone out of trouble. You want the muscles around your pelvis and hips pulling their weight again.
That includes your pelvic floor and deep core. They help support the pelvis and contribute to how you manage load when you move.
Your glutes are part of the picture, too. They are working when you sit down, stand up and walk, helping your body deal with those everyday loads.
Then there is hip mobility. The way your hip flexors and hamstrings move can influence the position of your pelvis, particularly when you spend a lot of your day sitting.
Eventually, rehabilitation comes back to tolerance. Can you sit upright for a little longer? Can you move through your normal day without constantly thinking about your tailbone? Can you gradually return to the activities you enjoy?
That is the direction you want to be heading.
What other considerations contribute to contusion of coccyx?
Sometimes your routine is part of the problem. Take a look at the chair you spend eight hours sitting in. Then think about your car seat, your posture at your desk, and how much time you spend sitting each day. A combination of poor support, firm surfaces and prolonged sitting can keep pressure on an already irritated coccyx.
Pregnancy and childbirth can also leave the area more sensitive because of the changes that occur through the ligaments around the pelvis.
And if you have injured your tailbone before, that history matters. A previous injury can leave the area more reactive when it takes another knock, so it is worth mentioning during an assessment.
What treatments can help relieve some pain or fast track my coccyx rehabilitation?
There is more to assessing tailbone pain than poking the sore spot and calling it a day. Your physiotherapist will want to understand what happens when you sit, stand and move. They can then look at how the surrounding muscles and joints are contributing to the way the area is being loaded.
From there, treatment might look quite different depending on what you find. It could include hands-on treatment for tension around the area, changing the way you sit, finding the right cushion, or building strength through the pelvic floor, glutes, and core.
If the pain is hanging around despite giving it reasonable time and care, your physiotherapist may also recommend speaking with your GP about whether further investigation, imaging or other pain-management options are appropriate.
The aim is not simply to make sitting hurt less for a few days. It is to understand why the area is struggling and work towards tolerating normal life again.
What are the expected timeframes of rehabilitating coccyx?
There is no single countdown clock for a bruised tailbone. A milder contusion may settle within two to four weeks. A more significant injury can take six to twelve weeks, particularly if your normal day involves a lot of sitting, driving or commuting.
When pain refuses to follow the expected timeline, it is worth stepping back and looking at the whole picture. How much pressure is the area getting each day? What happens when you sit? Have you been able to gradually reload it, or have you been stuck bouncing between doing too much and backing right off?
Those details matter. If your tailbone is still making work, driving, exercise or simply sitting comfortably difficult, there is no prize for putting up with it indefinitely.
Book an assessment with our Melbourne physiotherapy team so we can help you make sense of what is going on, identify what may be keeping the area irritated, and map out the next steps for getting back to the things you need and want to do.
This article is for general education only and is not a substitute for personalised medical advice.