Coccygectomy: Expected Recovery and Return to Work after surgery for coccyx pain, tailbone pain.

(See the video below if you prefer to watch this as a video.)

Let’s talk about what to expect for recovery after coccyx removal surgery which is called coccygectomy.

I’m Dr. Foye, the director of the Coccyx Pain Center or Tailbone Pain Center here in the United States at Rutgers New Jersey Medical School and I’ve been treating patients with coccyx pain for about 25 years, thousands of patients.

The good news is that the vast majority of patients do not require surgical amputation for treatment of tailbone pain.

Most people do respond well to non-surgical treatment.

However, there is a small percentage of patients who may require surgery.

And for those patients who do require surgery (or that I send for a surgical consult) they always ask what should I expect after surgery? what’s the recovery like?

So let’s just talk a couple of minutes about that.

It really varies of course from patient to patient.

And that’s dependent on a couple of important factors.

Number one is the skin and how well it heals at the surgical site.

For some patients the skin heals nicely smoothly without any difficulty.

Other patients unfortunately run into problems with skin breakdown at the surgical site, where it may get infected or the skin just may not heal well. or the scar may open up partly because it’s an area that we sit on.

So there’s a lot of restrictions in terms of how many weeks or months until you can sit on the tailbone area after you’ve had the coccyx or tailbone surgically amputated or removed.

Another issue then is the pain at the area.

Some patients are able to tolerate sitting earlier than others.

So for some people it’s hey I’m only a couple of weeks out from surgery and I can already tolerate sitting for short periods of time, such as 10 or 15 minutes.

For other patients it may be months and months out and they’re still having a lot of pain or discomfort while sitting. This can be either because of scar tissue or because of a retained bone fragment or just the skin not healing well or those kinds of things.

So again, it runs the spectrum in terms of outcomes.

Other factors are things like what kind of job is the person trying to get back to.

So for example some jobs require sitting a lot of the time, without a lot of ability to get up and stand during the work day.

So if you think about a job like an airline pilot or a bus driver where once they sit in that chair they need to be sitting in the chair for the bulk of the time that they’re doing their job.

They’re not able to just stand up at will throughout the workday like people in other occupations might be able to.

Another factor is how long is the commute to work.

If we’re talking about return to work expectations, if somebody is working from home and they’re able to do to stand up while they do a video meeting or something like that, then obviously the chances of them getting back to work soon is much better than for somebody who has an hour and a half drive for their commute each way and thus they may have a really difficult time tolerating the drive to and from work, let alone the sitting that they may need to do when they’re actually at work.

In general, it’s going to be important for you to work closely with the surgeon and their surgical office or team.

I’m not a surgeon, so I most I spend most of my time and professional career helping people avoid going for surgery when they can.

But if you do go for surgery, it’s important to work with your surgical team.

Make sure it’s clear to them if you’re having any difficulties or challenges.

Ask them what their specific advice is for how soon you should be able to sit, how long you should be able to sit, when you should be able to go back to work, and those kinds of things.

The biggest advice I could give you is to make sure that number one of course work with your surgeon.

But number two that you go gradually.

The biggest mistake I see people make is that they’re happy that they finally had the tailbone removed (if they’re getting a good initial outcome) but then they either go back to work too soon or they start doing prolonged sitting.

Or they think well the tailbone is gone maybe I can sit on an exercise bike and try it for 20 minutes.

And really my concern there is that it’s very easy to overdo it and have a big setback.

I would rather see people go more gradually and have a nice smooth recovery where they can sit for longer and longer periods of time.

So hopefully this video is helpful just for helping you to have some general expectations for things to take into consideration if you are having tailbone removal surgery (coccygectomy).

Now you have some idea about the variability and the factors that go into what recovery time frame is like and how long until you can sit again (we’re talking usually 6 weeks 8 weeks and then it’s going to be even a gradual progression after that).

And for return to work again that’s going to be very depending on the job and the commute and those kinds of things.

And coccygectomy is really known as a surgery that has a much longer recovery time than most surgeries.

So, it’s not the type of thing where hey I had this the tailbone removed that was yesterday today I’m totally fine and going about my full life’s activities.

That would be naive to go in thinking that’s going to be the outcome.

So hopefully this gives you some context for that.

Some people say it takes 6 to 12 months before fully assessing response to coccygectomy.

If you want more information you can find me online at you can grab a copy of my book on Amazon.

I hope this is helpful for you.

Here is the video:

Here is the link to the video:

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to:

– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.

Below, is the screen-capture image from the video:

PRP Platelet Rich Plasma or Prolotherapy for Tailbone Pain, Coccyx Pain

PRP is platelet rich plasma. PRP is a substance from a person’s own blood. PRP is injected to help with certain pain conditions. PRP and prolotherapy are sometimes considered part of “regenerative medicine.”

PRP and prolotherapy injections are mostly used in instances where someone has a condition like a tendon tear or a ligament tear. In those types of conditions, the hope is that the PRP or prolotherapy injection will promote inflammation at the site in order to help cause healing of the tendon or ligament.

There is not great research on PRP or prolotherapy injections to help with the coccyx pain.

Theoretically, PRP or prolotherapy injections might help with hypermobility of the coccyx. But most people with coccyx pain never have the proper sitting-versus-standing coccyx x-rays done to accurately or confidently confirm whether they do or do not have hypermobility.

Some folks with coccyx pain have hypOmobility (less joint movement than normal), and the PRP injections would potentially make that even worse.

Some folks have coccyx pain caused by a bone spur. A bone spur is additional bone, typically pointing down from the lower tip of the coccyx, pinching the patient’s skin into the chair that they are sitting on. I would not expect PRP or prolotherapy injections to help with pain from a coccyx bone spur.

Lastly, even if a person does have coccyx pain that is indeed due to hypermobility, it would be crucial to have the sitting-versus-standing coccyx x-rays to confirm which specific joint, and there is no guarantee that the PRP/Prolotherapy injection would get the joint to stay in the ideal position. After injection, at the coccyx you can not put the coccyx in a cast or a brace (like you could with a finger, for example), so there is the potential risk that the coccyx would get “stuck” in the dislocated or wrong position, rather than in the ideal position.

In summary, I find the topic VERY interesting and there is some potential for PRP or prolotherapy injections to help with some very specific, properly selected patients with coccyx pain. But so far there is not great research supporting this. Hopefully more research in the future will better answer which patients this may help versus those it may harm versus those for whom it would have no effect one way or the other.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to:

– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.

Reasons for Normal X-rays and MRI Despite Tailbone Pain, Coccyx Pain

There are many reasons why radiology imaging studies are reportedly “NORMAL” in patients with tailbone pain (coccyx pain, coccydynia).  This applies to x-rays, MRI, and CT scans. The video below explains 11 reasons WHY imaging studies FAIL to reveal the cause of the tailbone pain.

The video link is at the bottom of this post. Here is an edited transcript from the video:

Let’s talk about coccyx pain, or tailbone pain, when the patient has been told that all of their imaging studies were reportedly “NORMAL”.

I’m Dr. Patrick Foye, the director of the Coccyx Pain Center or Tailbone Pain Center, here at Rutgers New Jersey Medical School.

And lots of patients travel in to see us from around the country around the world and they’ve been told that their previous imaging studies were totally normal.

But the person still has lots of pain at their coccyx or tailbone.

Here are several reasons why that could happen.

# 1: Very common is that the imaging studies never even included the coccyx at all most commonly they were of the lumbar or lumbosacral spine and did not go low enough to see the coccyx in the imaging studies that’s reason number one.

# 2: If the test was an MRI or a CT scan, often it failed to include a sagittal view which is a view that goes right down the midline.

# 3: If the MRI or CT scan did include a sagittal view on the MRI, then they might have failed to include the T1 and T2 filter settings for the sagittal views. T1 shows the bony structures and T2 can show inflammation. BOTH views are helpful.

# 4: On the MRI or CT scan, if they did a sagittal view, they might not have done THIN enough sections. The tailbone at the midline is very thin, so if they do one slice at one side and the images slices are THICK then the images may SKIP right over the coccyx. There could be one slice (one image) just to the RIGHT of the coccyx, and the next slice (the next image) is to the LEFT of the coccyx. The images may MISS the coccyx entirely or may miss most of the coccyx.

# 5: On x-rays, they might not have done a LATERAL view, which is a side view. On x-rays, the lateral view is the best view for showing problems and pathology at the coccyx.

# 6: The x-rays might not have included a CONED-DOWN VIEW, which is almost like a zoom lens that focuses in specifically on the tailbone. (This is also called collimation.)

# 7: The x-rays might not have included SITTING-VERSUS-STANDING VIEWS. With coccyx pain, SITTING is typically the most painful position. So, it makes sense to do the x-rays while the person is SITTING and compare that with while the person is standing. This is to see if there is HYPERMOBILITY WHILE SITTING, which is the number one most common cause of tailbone pain.

# 8: Even if the imaging studies included the coccyx, it’s very common that the RADIOLOGIST FAILS to even comment on or MENTION that coccyx or tailbone in the report at all.

# 9: The RADIOLOGIST might LOOK at the coccyx but just NOT be familiar with the common causes of tailbone pain. This is because tailbone pain is relatively uncommon, as compared to low back pain in the lumbar spine.

# 10: The TREATING PHYSICIAN maybe NEVER LOOKS at the actual imaging studies themselves and therefore they can’t put it into the clinical context. For example, the patient might feel a bony tenderness at the lower tip of the tailbone, so then you would want to LOOK at THAT SPECIFIC AREA to see if there’s a bone spur, or a fracture, or something else that may be causing the pain there.

# 11: The physician might LOOK at the tailbone, but often they JUST DON’T KNOW ENOUGH about the causes of coccyx pain to really be able to accurately assess the imaging studies. Again, this is because tailbone pain is uncommon, compared to low back pain for example. Just like if I was to look at an MRI of the brain, it would not be surprising if I was to miss something there, just because that’s not a common part of my own practice.

SUMMARY: This explains 11 different reasons why people can be suffering from tailbone pain and be told that their imaging studies are totally “NORMAL”.

For more information about tailbone pain, you can get my book on Amazon “Tailbone Pain Relief Now!”

Or to come and see me in person, or find more information on my website, just go to

I hope that’s helpful. All right. Bye-bye.

Here is the VIDEO on this topic:

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to:

– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.

Bicycle Tips with Tailbone Pain. Cycling, Biking and Coccyx Pain.

If you have tailbone pain (or coccyx pain) while you are riding a bike or cycling the video below outlines here are six modifications that you can make to help to decrease the pain.

I’m Dr. Patrick Foye, Director of the Coccyx Pain Center at Rutgers New Jersey Medical School, online at

Bicycling with tailbone pain is often quite problematic and painful for a number of reasons.

Number one is that the coccyx or tailbone typically sits right on the narrow seat of the bicycle, so it’s quite painful.

So here are six things you can do:

Number one: you can ride less or ride less often or less far, or stop riding if riding is not that important to you.

But if it is important to you, here’s five other things you can do.

Number one is that you can change the seat so that it has a wider seat. If it’s a wider seat, it’ll be putting more of the body weight onto the other sit bones down here at the ischium and therefore not putting as much pain or pressure at the midline of the coccyx.

The other thing you can do is get a seat with a coccyx cut out so that the coccyx sort of hovers over that empty area so it’s not making as much direct content.

The fourth thing you can do is to lower the handlebars. If the handlebars are lower, then while you’re riding you’ll tend to flex forward more and therefore when you do that you’re lifting you’re tilting the pelvis forward and you’re taking the coccyx a little bit away from the seat giving you a little bit more clearance. You do have to be careful though because the further you go forward with your handlebars it does put additional stress or strain on the neck and shoulder area.

The other thing you can do is to ride kind of standing up on your pedals, so basically standing up, so that you’re not sitting flat on the seat. You can do that at least intermittently. And another thing you can do is to get a standing bike, which almost looks like an elliptical machine, where you’re more doing this gliding motion back and forth rather than sitting on a seat.

Bonus tip: consider padded cycling shorts, or Ass Armor.

So I hope that’s helpful. If you have tailbone pain and are still interested in cycling those are some tips that you may find useful. Of course discuss them with your in-person treating physician.

And if you need more information on tailbone pain you can find me on my website which is

Or you can get my book on tailbone pain on Amazon.

Okay, I hope that helps. Bye-bye.

Here is the YouTube video:

Rowing causing Tailbone Pain: Coccyx Pain from Canoeing, Kayaking, Rowing Machines

In the video below, we’ll talk for one minute about causing increased tailbone pain (coccyx pain) while rowing, or using a rowing machine, or being on a kayak or canoe.

I’m Dr. Patrick Foye, the Director of the Coccyx Pain Center or Tailbone Pain Center, at Rutgers New Jersey Medical School.

The tailbone is located right at the lower tip of the spine and there are a couple of things about rowing that typically make it painful for people who have tailbone problems.

Number one is that while rowing part of the time is leaning partway backwards and in that leaning partway backwards position we’re putting more of our body weight onto the tailbone. So if the tailbone is painful (whether that’s from a bone spur or arthritis or a hypermobile joint) it’s going to be increased pain while leaning partway back.

And the other thing is that while rowing there’s typically this back and forth motion. So you’re essentially rocking back and forth on that painful tailbone. So that also will tend to exacerbate or worsen the pain.

If you want more information about tailbone pain I’m online at

Here is the YouTube video:

Sacroiliac Joint Pain versus Tailbone Pain: SI Joint Pain versus Coccyx Pain

The video below will summarize in less than one minute the difference between coccyx pain (tailbone pain) versus sacroiliac joint pain.

The biggest thing is that the coccyx is right at the midline versus the sacroiliac joint which is off to either side right or left.

Also, the coccyx is significantly lower than the sacroiliac joint.

The tailbone or coccyx is just slightly above the anus, whereas the sacroiliac joints are higher up.

So, if you’re looking along the skin landmarks on the back, the tailbone is way down here, just above the anus.

Sacroiliac joint pain tends to be in the mid to upper buttocks, to the right or left.

On physical exam the best thing you can do is directly pressing over the tailbone to see if that reproduces the pain. If so then the pain is NOT the sacroiliac joint.

There are also physical exam maneuvers you can do for sacroiliac joint pain.

If you want more information about tailbone pain you can grab my book on Amazon or come to see me through

Here is the video on YouTube:

Does Your Radiology Report Even Mention Your Coccyx, for Your Tailbone Pain X-rays, MRI?

It is unfortunately VERY common that patients suffering from coccyx pain (tailbone pain, coccydynia) end up having the wrong imaging studies done or they end up with a radiology report that fails to even mention the coccyx!

There are multiple reasons why this problem happens:

  1. The ordering physician: If your doctor ordered imaging studies of the LUMBAR spine, or the LUMBOSACRAL spine, then those images usually will NOT actually show the coccyx! The ordering doctors needs to EXPLICITLY request that the imaging studies INCLUDE the COCCYX.
  2. The radiology technician: If your treating physician DID order the radiology test properly, it is still common that the Radiology center might not do them properly. This is because they may not be very experienced with doing imaging studies specifically for the tailbone pain.
  3. The Radiologist who reads the images: Even if the technician at the Radiology center maybe DID the test properly, it is still common that the Radiologist fails to actually even mention or comment upon the appearance of the coccyx! It is crazy, but this happen VERY commonly!

What can a patient do?

  1. When your doctor orders imaging studies for your coccyx pain, make sure to ask them if it EXPLICITLY requests that the imaging studies INCLUDE THE COCCYX!
  2. Remind the radiology technician that you really need the imaging studies to INCLUDE THE COCCYX.
  3. LOOK at the radiology report. Use a yellow highlighter to highlight every time you see the word coccyx or coccygeal. Unfortunately, in many cases you will be disappointed to discover that the Radiology never even mentioned the coccyx.
  4. If your radiology report failed to mention the coccyx, you can ask the ordering physician to request an “Addendum” to the radiology report, specifically requesting that the radiologist specifically comment on the appearance of the coccyx.
  5. If the imaging studies failed to include the coccyx, you can ask your treating physician to start over with a new set of orders, this time specifically requesting imaging of the coccyx.
  6. You can search for another doctor with more expertise in evaluating and treating tailbone pain.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to:

– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.

Tailbone Specialists, at International Coccyx Pain Symposium, July 2023

Tailbone Pain Specialists attended the International Coccyx Pain Symposium, July 2023, in Paris, France. Three of the lecturers made this video in Paris after one of the conference days.

Here is the text from what they said, and then the video is below.

Okay, we are here in Paris, France, for the International Coccyx Pain Symposium. It’s the fourth one ever. Here’s the Arc de Triumph behind us.

I’m going to have a few of my colleagues from around the world introduce themselves. Hi this is Dr. Elif Gurkan from Istanbul, Turkey. We are having our fourth Symposium altogether.

Yes, and I’m Sytske Lohof, pelvic floor physical therapist from the Netherlands and we are so happy we are here for the fourth time and the second time in Paris. The first time was also in Paris and it’s so nice to be here. The weather is fine. The people are fine. And it’s a good Congress.

And I’m Dr. Patrick Foye from Rutgers New Jersey Medical School, Coccyx Pain Center. And basically, this is a conference where we have clinicians from around the world talking about the latest in the diagnosis and treatment of coccyx pain. We had the first day of the conference today. We have the second day tomorrow. And I’ve been learning a lot from the lectures, even though I’ve been treating patients with coccyx pain for years, as I know you have as well for many years. There’s always new things to learn from our colleagues around the world.

It’s a relatively uncommon condition so there’s not a lot of physicians who really specialize in this or have a lot of expertise.

So it’s wonderful to have my colleagues from other countries around the world to get together and talk about this topic.

Anything else? Thank you. And we will help those people with coccyx pain that’s our intention. And share our experience. Exactly. Bye-bye. “Au revoir.”

Here is the VIDEO:

You can also watch the video on YouTube:

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to:

– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.

Tailbone Pain Conference 2023: Dr Foye after Day 1 of International Coccyx Pain Symposium, Paris

International Coccyx Pain Symposium, July 2023, in Paris, France. I made this video after Day #1.

Here is the text from what I said, and then the video is below.

I’m currently in Paris, France, for the International Coccyx Pain Symposium. I’m Dr. Patrick Foye from the Coccyx Pain Center at Rutgers New Jersey Medical School online at

Every couple of years (every two or three years) we have an International Coccyx Pain Symposium where physicians from around the world who have a particular special interest and expertise in coccyx pain get together. We give lectures . We talk to each other. And really about understanding what are the latest thoughts as far as diagnosis and treatment of coccyx pain or tailbone pain.

So there are lecturers from France and Norway and Germany and Turkey and New Zealand and I’ll be lecturing from the United States. So really it’s a terrific opportunity to for physicians in this very specialized area to get together learn from each other, teach each other, and teach others who come to the conference to learn more about tailbone pain.

And I’ll be posting more information about things or topics that have come up at the conference things that we’ve talked about. I’ll post those on my website and my YouTube channel and Facebook page which is So you can find the information there or post your comments down below or comments or questions and I can try to answer them there.

So okay I’ve gotta go to bed because day one is over of the conference it’s roughly midnight in Paris right now and there’s more lectures… I’m actually giving the first lecture tomorrow. So I’ll call it a night all right. Bye-bye.

Here is the VIDEO:


COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to:

– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.

2023 International Coccyx Pain Symposium, Speakers and Topics

The 4th INTERNATIONAL SYMPOSIUM ON COCCYX DISORDERS was held on July 6 & 7, 2023, in Paris, France, at the Cochin Hospital. This medical conference is held every 2 to 3 years. Experts from around the world give lectures regarding coccyx pain, tailbone pain, coccydynia.

Below is the list of topics and speakers:

Thursday, July 6 2023

Bony anatomy of the coccyx

Anatomical basis of sacrococcygeal pain

Dynamic films. The different lesions of the coccyx. Pitfalls in interpretation

Clinical examination of the painful coccyx

Pelvic floor, perineum and coccyx. A 3D reconstruction

Contribution of ultrasound to the understanding and treatment of coccydynia

Role of the sacrococcygeal junction in the damping of abdominal hyper pressure. A 3D reconstruction

Sacrococcygeal morphologic and morphometric risk factors for idiopathic coccydynia: an MRI study
MESREGAH Mohamed Kamal (EGYPT)

Can a sacrococcygeal or coccygeal lordosis predict instability?

A novel radiological classification for displaced os coccyx: the Benditz–König classification

Classification of coccygeal fractures

Friday, July 7 2023

Conservative treatment for chronic coccydynia: a 36-month prospective observational study of 115 patients

Fluoroscopic injections and ganglion impar sympathetic nerve blocks for coccyx pain
FOYE Patrick (USA)

Patch of Capsaïcin 8% and coccygodynia: a case series of 80 patients

Interdisciplinary multimodal pain therapy for pelvic pain

The efficacy of extracorporeal shock wave therapy for chronic coccydynia
AYDIN Canan Gonen (TURKEY)

Ultrasound-guided, pulsed radiofrequency treatment of painful coccygeal spicules. About 20 cases

Why do manual treatments for coccydynia differ between practitioners?

First scientific results of conservative treatment of coccygodynia with the non-invasive mobilization of the os coccyx (NIMOC) technique in the Netherlands (n=439)

Rectal and/or vaginal therapeutic mobilization of the coccyx. Comparative study on 30 patients

Development of the Dutch diagnostics and treatment protocol of coccydogynia, also in relation to pelvic pain and posture

What is coccygectomy?

The extent of resection in coccygectomy: a decision guide

Fascial ruptures after coccygectomy: diagnosis, treatment and results

Prevention of post-coccygectomy infection

MRI aspects at 3 and 6 months after coccygectomy in cured and failed patients

Persistent pain after coccygectomy

The treatment of coccydynia in adolescents – an update

Crazy images of the coccyx

The good timing for surgery

For more details about this conference, go to:

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to:

– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.

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