Pelvic Floor Physical Therapy and Tailbone Pain

  • As a rehab medicine physician, let me start by saying that in general… I am a big fan and a big advocate for physical therapy as a non-surgical approach to many musculoskeletal/pain disorders.
    • For pelvic floor pain and dysfunction, there are a growing number of physical therapists who specialize in treating pelvic floor pain.
    • A pelvic floor P.T. can often be extremely helpful with a variety of conditions including some forms of:
      • urinary incontinence,
      • pelvic floor sagging/prolapse,
      • vaginal muscle pain during sexual intercourse,
      • various pelvic floor muscle spasms, tightness, etc. (including pelvic floor muscle spasms that may occur as a guarding/reactive response because of tailbone pain),
      • and much more!
  • Having said that, when it comes to focal tailbone pain the benefit (or lack thereof) of any given treatment probably depends most on the underlying cause or condition. There are some tailbone conditions that I would NOT expect P.T. (or other attempts to do mobilization of the coccyx) to be particularly helpful for:
    • Bone Spurs:
      • If the tailbone pain is being caused by a focal bone spur (which commonly occurs at the lowest tip of the tailbone) and if it is NOT associated with any muscle/tendon pain within the pelvic floor, then P.T. would probably NOT be likely to provide substantial relief.
    • Recent bone fractures:
      • if the bones of the coccyx have recently been broken (fractured), then those bones may need relative rest and a chance for the fractures to heal. As with other body regions, aggressive physical therapy too soon after fracture would have the potential to delay fracture healing.
    • Unstable or excessively mobile tailbone joints:
      • If “coccyx mobilization” is the proposed treatment, then it makes sense to wonder when that might be helpful and when that might be harmful.
      • Mobilization (or “manipulation”) is done to increase the movement of a joint or body region that is felt to be “stuck” or “too stiff”.
      • At the tailbone, mobilization is done by the clinician inserting one or two of their fingers into the anus and rectum (in front of the coccyx) while the thumb is placed in back of the coccyx. Then the clinician attempts to move (mobilize) the tailbone.
      • However, if the tailbone is already moving too much (due to unstable joints causing excessive mobility) then mobilizing the tailbone might actually WORSEN the problem.
        • This is important since probably the MAJORITY of patients with tailbone pain have undiagnosed joint instability at the coccyx.
        • So this MAJORITY of patients would have a condition for which we would typically recommend AGAINST attempting additional mobilization.


In the comments section below, I would love to hear from:

  • Any pelvic floor physical therapists who have input on pelvic floor PT specifically for patients with tailbone pain. Feel free to agree, disagree, or just add additional perspectives and dialogue regarding this challenging area.
  • Any people with tailbone pain who have tried pelvic floor PT. What were the biggest benefits? What were the biggest limitations? Any other thoughts… ?


Patrick Foye, M.D.
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9 comments to Pelvic Floor Physical Therapy and Tailbone Pain

  • Roni

    Patient here. I have been going to pelvic floor physical therapy for about two months now and almost immediately my pain increased more and more. Just saw a new doctor who did sit/stand x-ray and lo and behold I have a hyper mobile coccyx!! THANK YOU for all you do for us Dr. Foye!! Without you and your site Im not sure I would ever known where to even start!

    • THANK YOU for the feedback. Often I put up info. on the website and I don’t know for sure whether people find it helpful.

      I really appreciate your feedback and it helped you guide your treating physician to the right testing for your tailbone pain.

      THANKS. You comment made my day!

  • T

    Pelvic floor PT for a dislocated coccyx posterior segment was horrific. I had one helpful session with another therapist with myofascial release clothes on. The other one insisted I be butt naked. There was no need for that. Even the doctor who administered a corticosteroid injection did not do that. Pelvic floor PT also insisted I lay flat on my back legs suspended in a Pilates traction device. I was on my couch in misery the next day. I find Voltaren gel helpful. It is painful transitioning to lying down and still have tingling. I am post op coccygectomy. I tried a little regular PT too and a sacral adjustment was painful. I heard in recovery my coccyx was arthritic. Acupressure cupping helped a bit especially this white tiger balm they gave me. Ganglion impar blocks are un heard of.

    • I am sorry to hear that you had such a bad experience with pelvic floor physical therapy. As a physician specializing in Physical Medicine and Rehabilitation, I frequently refer patients for PT. For those patients with pelvic floor problems, many of them do respond well to pelvic floor PC.

      However, if there is a dislocated coccyx then manual medicine and internal manipulation of the coccyx does unfortunately have the potential to worsen the pain, which sounds like that may be what you are describing.

      I am very sorry to hear about your pain. My heart goes out to you for what you are suffering with.

  • W

    Dear Dr. Foye,
    Coccyx was angulated and fractured (non-displaced) due to a bad fall. The PT I went to see did an external manipulation and told me the coccyx was not only angulated but pointed to the right side and that she moved it to the center. However, by next day, I felt the coccyx moved back to the right side – I can feel something touching the right side of the rectum, while sitting, standing, walking and lying down. I don’t think I should go for more manual manipulation since the area is more painful and the anal/rectum has burning pain now and I have pain in rectal area while going to the bathroom. Thank you very much.

    • I am very sorry to hear about your coccyx pain. Are you saying that you had an apparent exacerbation in response to the pelvic floor physical therapy? That can happen, unfortunately. You mentioned that the tailbone was injured by a non-displaced fracture, so I’m wondering how soon after the fracture did you start undergoing physical therapy. In general, we expect that a fracture will take some time to heal before it is subjected to any substantial physical stresses. All of this may be worth discussing with your treating clinicians.

  • Bernadette

    Unfortunately pelvic floor exercises severely aggravate my coccyx pain. I don’t know whether that points to some sort of clue as to what is causing the pain but without fail any pelvic floor exercises heighten the pain dramatically. Un ultrasound check by a physiotherapist indicated my pelvic floor muscles are working ok. I had another physiotherapist specialising in this issue but as soon as she heard my issues were accident related, not from giving birth she declined to examine me and sent me on my way.

    I have not been able to find a physiotherapist in Melbourne Australia who works with a doctor specialising in coccyx issues other than those focussed on post natal issues.

    I have not been able to find anyone here who will do a sit stand X-ray. Maybe I just need to print out the information and then see if a radiologist will follow the recommended method.

    • I am sorry to hear about your tailbone pain. I understand your frustration with how difficult it can be to find a doctor with expertise in treating tailbone pain or coccyx injuries. If you don’t already have it, you would probably be interested in the book: Tailbone Pain Relief Now!
      It is on Amazon at: Link:

  • T

    Thank you for your reply. I never had an internal manipulation however I found
    Pelvic floor PT to be horrible. And traumatizing . I quit after I had to lie flat on my back with my legs in traction,
    I am post op coccygectomy almost a year. I still get a lot of pain when I go to
    Lie down. I have no idea why, It is excrutiating at first. Tingling too. My surgeon has not heard of ganglion impar injections. I may give him
    Your book. I don’t know whether to request imaging. He is happy how well I healed and he is a nice surgeon. it was from another
    Car hitting my child,who was driving,head on and I was a few weeks post op a hysterectomy/ liter of staph aureus infection,

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