Conditions We Treat
Tailbone Pain
At a glance
Tailbone pain, known clinically as coccydynia, is pain at the very base of the spine that is typically worse when you sit and when you stand up from sitting. It most often follows a backward fall, childbirth or long periods sitting on hard surfaces, and women are five times more likely to develop it than men. Conservative treatment is successful in around 90% of cases, and our care combines sitting and offloading advice, hands-on treatment of the surrounding muscles and joints, rehabilitation and shockwave therapy.
You perch on the edge of the chair or lean onto one hip, because sitting squarely is too sore. The worst moment is standing up: a sharp catch right at the bottom of the spine as you rise. Long drives, hours at a desk and soft couches that let you sink back all make it worse.
The coccyx is the small, triangular bone at the very base of the spine. When you sit, it forms one leg of a tripod with your two sitting bones, and it is an attachment point for several muscles, ligaments and tendons (Lirette et al., 2014). Tailbone pain is typically worse with sitting and with the move from sitting to standing (Staartjes et al., 2026), and leaning back in a chair or standing for a long time can aggravate it too (Lirette et al., 2014).
The most common trigger is injury. A backward fall onto the bottom can bruise, dislocate or break the coccyx, and childbirth can strain it from the inside, particularly a difficult or instrumental delivery. Smaller, repeated strain from long or frequent sitting on hard, narrow or uncomfortable surfaces can also set it off. Women are five times more likely to develop coccydynia than men, and obesity is a recognised risk factor (Lirette et al., 2014).
After birth, the pain often shows up the first time you sit down. In a series of 57 women with postpartum coccydynia, the pain appeared as soon as they sat after delivery, and just over half of the deliveries (50.8%) had used forceps (Maigne et al., 2012). If that sounds familiar, it can be assessed as part of your wider recovery, and our pregnancy and postpartum care covers the pelvis and lower back through pregnancy and after birth.
At our Sandton practice, assessment starts with a detailed history and a focused examination, checking for localised tenderness over the coccyx and reproducing the pain that bothers you, which matches current recommendations (Staartjes et al., 2026). We also check the lower back, pelvis and hips so that nothing nearby is missed. X-rays are mainly used to rule out more serious problems, and we can refer you directly when imaging is needed. Serious causes are uncommon, and further scans are kept for significant injuries, warning signs or when a more serious cause needs to be ruled out (Staartjes et al., 2026). If your pain followed a hard fall, keeps getting worse or comes with feeling generally unwell, see your GP promptly, and we will refer you on whenever the picture calls for it.
The outlook is encouraging: conservative treatment is successful in around 90% of cases (Lirette et al., 2014). Current recommendations put education, ergonomic advice, offloading strategies and physical therapy first (Staartjes et al., 2026), and a 2025 systematic review of 10 trials found that physical therapy approaches, including shockwave therapy, muscle energy technique and kinesiotaping with exercise, improved pain and function in the short term (Sidiq et al., 2025). In practice that means changing how you sit, using a wedge-shaped coccygeal cushion to take pressure off the tailbone, soft tissue work and muscle energy techniques for the gluteal and hip muscles, mobilisation of the lower back and pelvis where they are stiff and a graded rehabilitation programme.
Shockwave therapy is one of the better supported conservative options for tailbone pain (Staartjes et al., 2026). In a randomised trial of 41 patients whose pain followed a fall or slip, four weekly sessions of radial shockwave reduced pain significantly more than a course of heat and electrotherapy, and patients reported higher satisfaction (Lin et al., 2015). A 2025 review of nine randomised trials found that shockwave reduced pain and improved function, with benefits lasting up to six months in some studies (Blanco-Diaz et al., 2025).
In pain now? Same-day appointments available at our Sandton rooms.
Book OnlineCommon symptoms of tailbone pain
- Pain at the very bottom of the spine when you sit
- A sharp catch as you stand up from a chair
- Pain that is worse when you lean back while seated
- Sitting tilted onto one buttock to avoid pressure
- Tenderness when the tailbone is pressed
- Pain that began after a fall onto your bottom
- Tailbone pain that started after giving birth
- Aching after long drives or hours at a desk
- Discomfort when standing for long periods
Tailbone pain that keeps catching you every time you sit is worth having assessed early, so you can start offloading it properly and get the right treatment in place.
Located on Rivonia Road in Morningside, we treat patients from Sandton, Bryanston, Rivonia, Fourways and across Johannesburg.
Book an appointment at our Sandton practice and let us help you sit comfortably again.
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Same-day appointments available at our Sandton rooms.
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Frequently Asked Questions
It depends on the cause and how long it has been there. Many cases settle without medical treatment, and conservative care is successful in around 90% of cases. If your tailbone has been sore for more than a few weeks, or flares every time you sit, an assessment helps work out what is keeping it irritated and what will help it settle.
Yes. Current recommendations put education, ergonomic advice, offloading and physical therapy first. Our care covers each of those: advice on how to sit and what to sit on, soft tissue work and muscle energy techniques for the surrounding hip and gluteal muscles, mobilisation of the lower back and pelvis, a graded rehabilitation programme and shockwave therapy where it suits you.
It is a recognised problem after childbirth, but it is not something you simply have to put up with. In a study of 57 women with postpartum tailbone pain, the pain appeared as soon as they sat down after delivery, and just over half of the deliveries had used forceps. It can be assessed and treated alongside the rest of your postpartum recovery.
Trials support it. In a randomised trial of 41 patients whose tailbone pain followed a fall or slip, four weekly sessions of radial shockwave reduced pain significantly more than the comparison treatment, and patients were more satisfied. A 2025 review of nine randomised trials found shockwave reduced pain and improved function, with benefits lasting up to six months in some studies.
Not always. Diagnosis starts with a detailed history and examination, including checking for localised tenderness over the coccyx. X-rays are mainly used to rule out more serious problems, and further imaging is kept for injuries, warning signs or cases that are not settling. As primary contact practitioners, we can refer you directly for imaging if you need it.
A wedge-shaped coccygeal cushion relieves pressure on the tailbone while you sit, and these are available over the counter. We pair it with advice on how and for how long you sit, which we go through with you at your first visit.
References
- Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. The Ochsner Journal. 2014;14(1):84-87.
- Staartjes VE, De Wilde D, Alakmeh A, Alsaleh O, Elmi-Terander A, Edström E, Nilsson G. Contemporary management of coccydynia. Neurospine. 2026;23(2):365-379.
- Maigne JY, Rusakiewicz F, Diouf M. Postpartum coccydynia: a case series study of 57 women. European Journal of Physical and Rehabilitation Medicine. 2012;48(3):387-392.
- Sidiq M, Ravichandran H, Janakiraman B, et al. Effectiveness of physical therapy interventions for coccydynia: a systematic review with a narrative synthesis. Archives of Physiotherapy. 2025;15:77-89.
- Lin SF, Chen YJ, Tu HP, et al. The effects of extracorporeal shock wave therapy in patients with coccydynia: a randomized controlled trial. PLoS One. 2015;10(11):e0142475.
- Blanco-Diaz M, Palacios LR, Martinez-Cerón MDR, Perez-Dominguez B, Diaz-Mohedo E. Physiotherapy approaches for coccydynia: evaluating effectiveness and clinical outcomes. BMC Musculoskeletal Disorders. 2025;26(1):514.