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.

Patrick Foye, M.D.
Follow Me

Comments are closed.

Book Now Available! Click on the book to get it now:

Get the Book at