Tailbone Pain: How Long to Heal? (+ Physio’Tips)

What type of coccyx pain am I referring to here?

In this article, I discuss coccyx pain regardless of its cause, whether it’s after a fall, childbirth, significant weight loss, or with no identified cause. These events could have led to:

1. Contusion: This is the most common occurrence.

It happens when small blood vessels under the skin, called capillaries, are damaged due to impact or a fall on the coccyx. This leads to blood leakage into the surrounding tissues, often causing swelling and pain. This is commonly referred to as a “bruise” or “contusion”.

Even with a simple contusion, coccyx pain can last a long time in some individuals.

2. Coccyx fractures,
3. Dislocations and ligament instability,
4. Rarely: infection (osteomyelitis),
5. Even rarer: malignant tumors like chordoma.

In medical terminology, coccydynia is used to refer to coccyx pain, regardless of its cause.

It is often difficult (and frustrating) to identify a precise cause of coccyx pain. Here’s what a British research team, synthesizing knowledge on coccyx pain, has to say:

Patients often report difficulty in obtaining a specific diagnosis for the cause of their coccyx pain and note that their treating clinicians seem to disregard this condition.

Mabrouk 2023

How long do coccyx pains generally last?

Although there are dozens of studies on coccyx pain, few aim to precisely identify how long the pain generally lasts.

Probably because many people do not consult their doctor for this type of pain. Or only after a certain time.

Here are some elements on the possible prognosis of these pains, although I’m sorry I can’t provide more precise information.

The prognosis for patients with coccydynia is variable. While the symptoms of most patients improve or disappear with conservative (non-surgical) care, other patients suffer from notoriously persistent coccyx pain, sometimes for life.

Mabrouk 2023

And also:

Many coccydynia patients see their symptoms disappear in the weeks or months following their onset, whether they receive medical treatment or not.

Mabrouk 2023

A French research team 🇫🇷 followed 115 people suffering from coccyx pain [Charrière 2021] for 3 years without receiving treatment or with conservative treatment (no surgery).

These were individuals who had been experiencing coccyx pain for at least 2 months (chronic pain).

Here are their conclusions:

• on average, the pain decreased over the months. It was 6.5/10 at the beginning, then 5.5/10 at 6 months, and 3.2 out of 10 at 3 years;
• people without posterior dislocation of the coccyx are more likely to have less pain more quickly;
• 1 person out of 2 had no pain at the 3-year follow-up.

Here are some numerical data drawn from my own experience, with patients experiencing coccyx pain after a fracture or childbirth. In the absence of other data from a larger sample of individuals.

Source of Coccyx Pain	Minimum Duration of Pain	Maximum Duration of Pain
Coccyx fractures after a fall	Several weeks	Several months. More rarely, pain “for life”, though fluctuating (may come and go)
Childbirth	Several days	Several months. More rarely, pain “for life”, though fluctuating (may come and go)

Why do coccyx pains sometimes last long?

Here are possible hypotheses to explain why coccyx pains can sometimes persist longer than those in other parts of the body.

1. Lack of blood supply

The coccyx has relatively low blood circulation compared to other parts of the body. Reduced blood flow can slow down the healing process by providing fewer nutrients and oxygen needed for tissue regeneration.

2. Constant pressure

The coccyx is subjected to constant pressure when we sit. If an injury, bruising, or inflammation affects this area, continued sitting can prolong healing due to this pressure.

3. Lack of rest

It can be difficult to give the coccyx enough rest as it is often involved in daily life activities, even during simple activities like sitting, standing up, or walking.

4. Nerve sensitivity

The coccyx is surrounded by many nerve endings, and irritation of these nerves can prolong the sensation of pain. Nerve sensitivity can slow down recovery and make the pain more persistent.

The fact that coccyx pains last a long time does not necessarily mean that there is a serious underlying problem, although this may seem counterintuitive.

What treatments are available to relieve coccyx pain?

There are around a hundred studies on the causes and treatments of coccyx pain:

Here is a summary of one of these recent publications that compiles these various studies on coccyx pain treatments:

The overall treatment involves avoiding exacerbating factors (sitting position), using cushions, taking oral or topical medications, and performing pain-relieving injections under fluoroscopic guidance.

Only a small percentage of patients with coccydynia require surgical treatment, namely coccygectomy (removal of the coccyx).

Mabrouk 2023

Also, remember this quote that I’ve already mentioned:

Many coccydynia patients see their symptoms disappear in the weeks or months following their onset, whether they receive medical treatment or not.

Mabrouk 2023

In other words: whatever you do (even without any treatment or medication), it’s possible that your pain may decrease or even disappear within a few weeks.

Here are the results of a study that attempts to compare how people’s pain evolves before/after certain coccydynia treatments.

These studies are of low quality because they often do not compare the effectiveness of the treatment to a placebo or natural progression (without intervention):

In this compilation of studies, the most relieved individuals were those who underwent:

• radiofrequency therapy;
• extracorporeal shockwave therapy;
• injections into the coccyx.

Should you have your coccyx removed? Coccygectomy

Feel free to let me know in the comments under this article if you would like me to create a full article on the pros and cons of having your coccyx removed.

While awaiting a possibly more comprehensive article, here’s a summary of what we know about this coccyx operation:

Coccygectomy has a relatively high postoperative infection rate, and even after the coccyx is removed, many patients experience some degree of persistent pain.

Mabrouk 2023

What to do about YOUR coccyx pain?

I haven’t delved much into the treatments for coccyx pain.

Why? Because we don’t have any good quality data on them, on their benefit-risk ratio, and the chances of success.

One option is therefore to “pick and choose” among the treatments and tips that appeal to you the most. For example, some people may prefer things that can be done independently and without purchasing anything. Others may opt for treatments provided by a professional, such as a physical therapist.

Here they are listed.

In the absence of quality data on the effectiveness of these treatments and tips, some people may decide not to implement anything and let things take their course.

Treatment or Tip for Pain	Comment
Modified cushions (coccyx cushions: see on Amazon)	Can relieve pressure on the coccyx when sitting. Available over the counter.
Circular cushions, Donut pillow (ring-shaped cushions like a donut: see on Amazon)	Suggested for coccydynia treatment, but may exert pressure on the coccyx. More useful for treating rectal pain.
Correction of sitting posture	Reviewing how to sit to try to find a less painful position
Application of heat and cold	Can be beneficial, but neither has been shown to be superior to the other: try both
Non-steroidal anti-inflammatory drugs (NSAIDs)	Most commonly prescribed for coccygeal pain. Opioids like morphine are generally not recommended, reserved for severe pain unresponsive to other measures.
Pelvic floor rehabilitation	May be useful in cases of pelvic floor muscle spasms associated with coccydynia.
Manual manipulation and physical therapy massage	Can be both diagnostic and therapeutic for muscle spasms or ligament pain associated.
Transcutaneous electrical nerve stimulation (TENS)	Can be beneficial, using either external or internal technique.
Psychotherapy	Indicated if a non-organic cause is suspected.
Shockwave therapy
Interventional procedures (injections, see below)	Although literary evidence is lacking, these procedures are recommended in cases of chronic coccydynia without consensus on the best injection site. Guided imagery is recommended.
Radiofrequency therapy	Performed by a doctor using electrodes emitting mild heat. This heat destroys or temporarily damages specific nerves that transmit pain signals.
Corticosteroid and local anesthetic injections	Diagnostic and therapeutic, especially at the sacrococcygeal junction.
Caudal epidural steroid injection	Used to treat coccygeal pain resulting from Tarlov cysts and for lower sacral radicular pain.
Ganglion impar block	Useful in refractory cases and those associated with pelvic pain or malignancies. Radiofrequency ablation of the ganglion impar is also described for severe pain due to carcinoma.
Spinal cord stimulation	Data is limited.
Coccygectomy: coccyx removal

Others may want to try different things.

I believe it’s up to you to decide what seems most appropriate in your case. For example, by discussing it with your primary care physician or trusted physical therapist, to get an external opinion.