Why Your Tailbone Hurts When You Sit (And What Actually Helps)

When you're dealing with tailbone pain, it can be a real pain in the butt. Pun intended. But moving on from my bad puns, let's discuss.

If you're finding that sitting at work, driving, leaning back on the couch, or even getting up from a chair is painful, you may be experiencing tailbone pain. This may feel sharp, aching, or pressure.

If this sounds familiar, you’re not alone. Tailbone pain, also called coccyx pain, is more common than most people realize.

What the Tailbone Actually Does

The tailbone, or coccyx, sits at the very bottom of the spine. It's a tiny, slightly movable bone, and it serves as an important point of attachment for several structures, including ligaments and pelvic floor muscles.

Because of these connections, the tailbone is not just an isolated bone. It’s part of a larger system that contributes to how you move, sit, lift, play, give birth, and more.

Why Tailbone Pain Happens

Tailbone pain usually isn’t caused by just one thing. It’s often a combination of factors.

Direct irritation or injury: A fall onto the tailbone or even prolonged pressure from sitting can irritate the area. Sometimes the pain shows up immediately, but in other cases it lingers or develops over time.

Prolonged sitting: Spending long periods sitting, especially on firm surfaces or in a slouched position, can place repeated pressure on the coccyx.

Pelvic floor muscle tension: The pelvic floor muscles attach directly to the tailbone. If these muscles are overactive or tight, they can pull on the coccyx and contribute to discomfort, especially when sitting.

Postpartum changes: During childbirth, the tailbone can shift or experience increased stress. Even after recovery, lingering sensitivity or muscle tension can contribute to ongoing pain.

Why Sitting Feels So Uncomfortable

Our pelvis has a thickening of bone at the bottom of each side that we call the ischial tuberosity, but colloquially, we call them the "sits bones." But these are only really supporting our weight in upright sitting, and let's be honest, how often are any of us sitting at a perfect 90 degree angle. When you sit, your body weight is distributed through the pelvis.

Positions and certain activities (i.e., driving) can impact this position and the amount of tension/pressure distributed through the pelvis. If the tailbone is irritated or the surrounding muscles are not coordinating well, more pressure can be placed directly on the coccyx.

This is why positions like leaning back or sitting on hard surfaces often feel worse. That's not to say these positions are bad, but when our body is already grumpy, they certainly aren't tolerated as well.

What Actually Helps

Tailbone pain often improves when we address both the local irritation and the surrounding system.

Some helpful starting points include:

Adjusting sitting position: Leaning slightly forward or sitting on a supportive cushion can reduce direct pressure on the tailbone. Changing positions frequently can also help.

Breaking up sitting time: Standing and moving regularly can decrease prolonged stress on the coccyx.

Addressing pelvic floor tension: Improving how the pelvic floor muscles relax and coordinate can reduce pulling on the tailbone.

Improving movement patterns: How you sit down, stand up, and move throughout the day can influence symptoms more than most people realize.

How Pelvic Floor Physical Therapy Helps

Pelvic floor physical therapy looks at more than just the tailbone itself.

Treatment may include:

• Assessing pelvic floor muscle tension and coordination

• Improving movement and pressure strategies

• Addressing mobility of the coccyx and surrounding tissues

• Guiding gradual return to sitting and daily activities without pain

• Improving strength through pelvic floor, core, and hips to increase overall capacity.

The Bottom Line

Tailbone pain can make daily life frustrating, but it is often very treatable.

Because the tailbone is connected to the pelvic floor and surrounding structures, addressing the whole system is key to improving symptoms. If sitting, driving, or daily activities have become uncomfortable due to tailbone pain, pelvic floor physical therapy can help you make sense of these symptoms and navigate the best path forward for you.

You can schedule a complimentary discovery call to see if care at Fortis Physical Therapy & Pelvic Health is the right next step for you.