Best Coccyx X-ray Views: Side-View versus Front-View for Tailbone Pain

Which Xray Views are Best for Evaluating Tailbone Pain, Coccyx Pain?
  • I recently did a video explaining which views are best when doing x-rays (radiographs) for coccyx pain (tailbone pain).
  • Here is the text from that video, and the actual video itself is down below.
  • (The actual video is at the bottom of this page.)
  • Hi. I’m Dr. Patrick Foye.
  • I’m an M.D., or Medical Doctor, and I am the Director of the Coccyx Pain Center or a Tailbone Pain Center here in the United States, online at
  • And here I’m going to explain the difference for x-rays of the front view and the side view and why that’s important if you have tailbone pain.
  • So just to sort of orient you… For starters here this is a plastic model of the pelvis and  this is looking at the pelvis from the front.
  • Here you’re looking at it from the side.
  • And now you’re looking at it from the back.
  • And the tailbone is right down here.
  • And the larger bone above that is the sacrum and the easiest way to show this is without showing the entire pelvis, but just showing here the sacrum and then down below that is the coccyx or tailbone.
  • So now you’re looking from the back and this is from the side and that’s from the front.
  • So I’m going to draw these here just to give you a sense of what you’re looking at when you look at the sacrum and coccyx.
  • So the sacrum (and I’m no great artist) but the sacrum is sort of like that and then the tailbone is down below it.
  • The sacrum has five segments (one two three four five) and the sacrum is essentially fused together into one solid bone.
  • And then the tailbone is more variable.
  • It’s much smaller than the sacrum as you can see  here.
  • The **TAILBONE** is much smaller and it’s usually anywhere from three to five bones they may or may not be fused.
  • Now if you look at it  so that’s basically looking at it sort of from the front  we’re back in that particular plane.
  • How about if we look at it from the side well that’ll look something a little more like this: it has a curve to it and it’s bigger at the top and gets more narrow down at the bottom.
  • And then we’ll draw coccyx down here  roughly continuing that  curve.
  • I’m going to move this camera because there may be a little glare there okay.
  • (I think it made it worse!) Alright, there we go.
  • Alright, so basically that and again the sacrum (with its  five segments) and the tailbone  (with anywhere from three to five segments).
  • Again the tailbone being much smaller.
  • So how is this relevant when it comes to getting the proper x-rays?
  • Well, if you get x-rays that are done in the in the “front” view…
  • So basically in medicine they call that a “frontal” view, or they may call it an “A-P” view for “Anterior to Posterior”.
  • Then there’s some things that can come in the way of getting a good view of the tailbone.
  • So let’s take a look at those.
  • So basically if we look at our front view here, well in that view because we’re  taking the x-ray like this, number one you can see here how the pubic bones up in the front of the pelvis can block the view of the coccyx.
  • So right now from your vantage point of the camera or your eye you can’t see the tailbone at all.
  • So, the first thing that the radiology technician needs to do is to tilt the camera angle so that now you can see the coccyx back here whereas without that tilt if they do a straight AP view or front view they can see most or all of the sacrum but would not be able to see the coccyx.
  • So that tilt becomes very important.
  • Even if they do the tilt, there’s still problems with the front view and I’ll show you that here.
  • Well, what’s up in the front of the pelvis that’s going to be in front of the coccyx? Well, there’s the urinary bladder (the bladder where we collect urine before we  pee).
  • So that’s going to be up here and you’ve got some urine in there so that’s going to sort of block the view.
  • The other thing that’s in front of the tailbone is the uterus in women and in men and women there’s the rectum or colon (the part of the large intestine where stool collects, feces collects before having a bowel movement).
  • So basically now you’ve got your stool collecting in that area and now you can see why you’re going to have a tough time on that front view really getting any decent detail in your imaging of the coccyx.
  • So now let’s take a look…
  • [I’m going to change this camera angle to avoid the glare a little bit] So now let’s take a look from our side view.
  • Well on our side view (which is  over here this is behind you and this is in inside of your pelvis)…
  • Well the bladder would be all the way up front of you here and then your colon would be here with its stool and you can see now with that unlike the view here from the FRONT where it’s BLOCKING the view of the tailbone, here at the view from the SIDE this is NOT blocking the view of the tailbone.
  • The tailbone is still nice and clear.
  • So I would say probably 99 times out of 100 (maybe more) the SIDE view is going to be much more helpful and much more important when it comes to showing the coccyx.
  • So again this is our front view, where in medicine we call that a frontal view some which is sometimes referred to as a AP view which stands for anterior to posterior view.
  • So that’s there.
  • As opposed to over here where we have our side view, which in medicine, medically we call that a “lateral” view.
  • Now this is different  now I’m talking about x-rays.
  • It’s different if we are looking at MRIs and CT scans because those take images and slices.
  • There are some corollaries for those but I’ll probably go into that in another video because it’ll just get too long to say it all on this one.
  • So the take-home message really is that unfortunately there’s lots and lots of times where people have tailbone pain and the only view that they order in the emergency room or when they see their primary care doc or even their musculoskeletal doctor (if the doctor is not experienced in treating tailbone pain) is that they’ll get this  front view which doesn’t really show the tailbone very well at all, either because they didn’t tilt to have the tailbone included so then it’s blocked, or they did the tilt but even so you’re looking through the bladder or the uterus the stool within the colon or rectum all of that and you really can’t see the tailbone very well.
  • And then unfortunately people are told we didn’t see anything abnormal so your tailbone must be fine, which is sort of misleading…
  • it may be true that they didn’t see anything abnormal but they didn’t see anything abnormal because they didn’t get a good view of the tailbone in the first place!
  • So really then what becomes much more important is to get this side view or lateral view for people who have tailbone pain, because that will typically show a lot more detail.
  • Now beyond this there’s also having that lateral view done sitting versus standing which we can talk about in another in another video, because that’s really important as well, because there’s lots of times where people may look normal while they’re standing up but when they sit and put their body weight onto the tailbone (which is usually when they’re most painful) then they may have an abnormality or dislocation that only shows up on the sitting x-rays.
  • But that’s for another video.
  • So on this one just simple things first: frontal view can help with some things but really what’s most important for people with tailbone pain usually is that SIDE view or LATERAL view.
  • And I see this very very commonly: patients fly in to see me from around the country and sometimes internationally and there’s unfortunately lots and lots of times where people bring with them their CDs (which I appreciate) and we look at the imaging that were done that’s on the CDs of their x-rays, that they were told was were normal years ago when they first started having tailbone pain when the imaging were done.
  • And we realize there’s not a decent view of the tailbone to begin with.
  • And that can be very frustrating of course for patients.
  • So, anyway, I hope this information is helpful for you.
  • If you want more information you can find me online at
  • Bye bye.
Here is the actual VIDEO:

Here is a screenshot photo from the video:
Tailbone X-rays, Side-View versus Front View, for Tailbone Pain, Coccyx Pain,

Tailbone X-rays, Side-View versus Front View, for Tailbone Pain, Coccyx Pain,

Sitting x-rays:
  • Note: This video, above, does not address the SITTING x-rays, which is even better. Most of local radiology centers will never have even heard of sitting-versus-standing x-rays, and will not be able to do those. But they should at least be able to do the front views and side views that I describe in this video above.
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Patrick Foye, M.D.
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Patrick Foye, M.D.

Founder and Director at Tailbone Pain Center
Dr. Foye is an expert at treating tailbone pain (coccyx pain).

His personable, private-practice office is located on a modern, renowned, academic medical school campus, at Rutgers New Jersey Medical School.

For an appointment, call 973-972-2802.
Patrick Foye, M.D.
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