How Pelvic Floor Physical Therapy Can Help Tailbone Pain and Coccydynia
Tailbone pain can make some of the most ordinary activities—sitting at work, driving, exercising, getting up from a chair, or using the bathroom—surprisingly difficult. When pain in or around the tailbone persists, the condition is often called coccydynia or coccygodynia.
Many people with coccydynia are told to simply use a cushion, take anti-inflammatory medication, or wait for the pain to improve. While these strategies can be helpful, persistent tailbone pain may also involve the pelvic floor muscles, surrounding connective tissue, joint mobility, posture, and movement patterns. This is where pelvic floor physical therapy may play an important role.
A growing body of research supports physical therapy as a conservative treatment option for coccydynia. Recent systematic reviews have found that interventions including manual therapy, pelvic floor muscle techniques, stretching, exercise, and other physical therapy approaches can improve pain and function, although researchers emphasize that more high-quality long-term studies are still needed.
What Is Coccydynia?
Coccydynia refers to pain located in or around the coccyx, commonly known as the tailbone. The pain is often worse with:
Prolonged sitting
Leaning backward while sitting
Standing up after sitting
Driving
Bowel movements
Certain exercises
Sexual activity in some individuals
Coccydynia can develop after a direct fall onto the tailbone, childbirth, repetitive pressure from prolonged sitting, or other trauma. In some cases, however, no single cause can be identified. Tailbone pain can significantly interfere with daily activities and quality of life.
What Does the Pelvic Floor Have to Do With Tailbone Pain?
The coccyx is not an isolated bone. It serves as an attachment point for several muscles and ligaments, including structures associated with the pelvic floor.
The levator ani and other pelvic floor muscles have important anatomical and functional relationships with the coccyx. When these muscles become overactive, tight, painful, or poorly coordinated, they may contribute to increased tension around the tailbone. Conversely, persistent tailbone pain may cause a person to unconsciously guard or tighten their pelvic floor muscles, potentially creating an ongoing cycle of pain and muscle tension.
This is one reason that simply strengthening the pelvic floor is not always the appropriate treatment. For some people with coccydynia, the primary issue may be excessive muscle tension and difficulty relaxing, rather than weakness.
A pelvic floor physical therapist can evaluate how the pelvic floor, hips, low back, sacroiliac region, breathing mechanics, posture, and movement patterns may be contributing to symptoms.
How Pelvic Floor Physical Therapy Can Help Coccydynia
1. Identifying Pelvic Floor Muscle Tension
One of the most important components of pelvic floor physical therapy is determining whether the pelvic floor muscles are functioning appropriately.
Muscles can become:
Overactive or excessively tight
Tender or painful
Difficult to relax
Poorly coordinated
Weak after prolonged guarding or dysfunction
When appropriate and with the patient's consent, a pelvic floor physical therapist may perform an internal pelvic floor assessment to evaluate muscle tension, tenderness, coordination, and mobility. An internal examination is not required for every patient, and treatment plans should always be individualized.
For patients with pelvic floor overactivity, treatment may focus on improving relaxation and reducing unnecessary tension rather than immediately prescribing Kegel exercises.
2. Manual Therapy to the Pelvic Floor and Surrounding Structures
Manual therapy may be used to address muscle and connective tissue restrictions contributing to tailbone pain.
Depending on the individual's examination findings, treatment may include techniques directed toward:
The levator ani and other pelvic floor muscles
Muscles surrounding the hips
The gluteal muscles
The sacral and pelvic region
The low back
Connective tissue surrounding the coccyx
Research has specifically examined levator ani stretching and massage as treatments for coccydynia. A 2025 systematic review of randomized and quasi-randomized trials found that levator ani stretching or massage was associated with improvements in pain, including sustained pain improvement in one study with longer-term follow-up. The authors concluded that several physical therapy interventions show promise for improving pain and function, while also noting limitations in the quality and consistency of the available research.
3. Improving Coccyx and Pelvic Mobility
In some individuals, restrictions or abnormal movement around the sacrococcygeal region may contribute to symptoms.
A physical therapist can assess movement and mobility throughout the pelvis, sacrum, hips, and lower back. When clinically appropriate, manual techniques may be used to address mobility restrictions and improve how these structures move.
Manual therapy and manipulation have been studied as conservative treatments for coccydynia. Recent systematic reviews found evidence of short-term improvements in pain and function with several manual and physical therapy approaches. However, the evidence is heterogeneous, meaning that no single technique can currently be considered the best treatment for every person with tailbone pain.
4. Teaching the Pelvic Floor How to Relax and Coordinate
The pelvic floor needs to do more than contract. Healthy pelvic floor function also requires the ability to lengthen, relax, and coordinate with breathing and movement.
Pelvic floor physical therapy may include:
Diaphragmatic breathing
Pelvic floor relaxation training
Down-training for overactive muscles
Coordination of the pelvic floor with the diaphragm and abdominal muscles
Strategies to reduce habitual gripping or clenching
These techniques may be particularly important for people who notice that their tailbone pain increases during stress, bowel movements, sitting, or activities that cause them to tense their pelvic floor.
5. Addressing Posture and Sitting Mechanics
Because coccydynia is frequently aggravated by sitting, modifying how a person sits can be an important part of treatment.
A pelvic floor physical therapist may evaluate:
Sitting posture
Pelvic position
Workstation setup
Driving position
The way the patient transitions from sitting to standing
The type of chair or surface being used
Recommendations may include temporary use of a cushion that reduces direct pressure on the coccyx, as well as strategies for changing positions and gradually improving sitting tolerance.
The goal is not necessarily to avoid sitting forever. Instead, therapy can help patients reduce unnecessary pressure and irritation while progressively improving their ability to tolerate everyday activities.
6. Treating Related Hip, Back, and Pelvic Dysfunction
Tailbone pain does not always originate solely from the coccyx.
The hips, lumbar spine, sacroiliac joints, abdominal wall, and pelvic floor work together during movement. Limitations in one area may contribute to compensatory movement or increased stress elsewhere.
A comprehensive physical therapy evaluation may therefore include assessment of:
Hip strength and mobility
Gluteal muscle function
Lumbar spine movement
Core muscle coordination
Sacroiliac and pelvic mobility
Functional movements such as squatting, bending, and transferring from sitting to standing
Treatment may then include individualized mobility, strengthening, and motor-control exercises.
Importantly, exercise should be prescribed based on the patient's specific impairments. More exercise or more pelvic floor strengthening is not automatically better for someone with coccydynia.
What Does the Research Say?
Research on physical therapy for coccydynia has expanded in recent years.
A 2025 systematic review published in Archives of Physiotherapy evaluated 10 randomized or quasi-randomized studies involving 515 adults with coccydynia. The review found that several physical therapy interventions—including levator ani stretching or massage, manipulation, muscle energy techniques, kinesiotaping combined with exercise, and other interventions—were associated with improvements in pain and/or function in the short term. Levator ani stretching or massage also showed longer-term pain improvement in the available evidence. The authors cautioned, however, that additional high-quality research with longer follow-up is needed.
Another 2025 systematic review in BMC Musculoskeletal Disorders included nine randomized controlled trials involving 532 participants. The review concluded that physiotherapy interventions are promising conservative treatment options for coccydynia, while noting substantial variation among treatment protocols, study quality, and outcome measures.
A randomized controlled trial involving patients with post-colonoscopy coccydynia also examined the addition of pelvic floor exercise to conventional treatment. All groups demonstrated changes in pain and disability after four weeks, although kinesiotaping produced greater pain improvement than pelvic floor exercise in that specific study. This finding highlights an important principle of pelvic rehabilitation: pelvic floor treatment is not a one-size-fits-all approach, and the best intervention depends on the cause and contributing factors involved in each patient's pain.
Overall, the current evidence supports physical therapy as a reasonable conservative option for coccydynia, particularly when treatment is individualized. At the same time, patients should understand that the research base remains limited and that more high-quality studies are needed to establish the most effective treatment protocols.
What Should You Expect During Pelvic Floor Physical Therapy for Tailbone Pain?
Your first visit typically begins with a detailed discussion of your symptoms and medical history. Your physical therapist may ask about:
When the pain began
Previous falls or injuries
Pregnancy and childbirth history
Sitting tolerance
Bowel and bladder symptoms
Sexual pain
Exercise and activity limitations
Previous treatments
The physical examination may include assessment of the low back, hips, pelvis, posture, breathing, and movement patterns. A pelvic floor assessment may be recommended when appropriate, but it should only be performed with informed consent and can be modified according to the patient's comfort and preferences.
Your treatment plan may include a combination of:
Education about coccydynia and pain management
Manual therapy
Pelvic floor muscle relaxation or coordination training
Mobility exercises
Strengthening exercises
Breathing techniques
Postural modifications
Sitting strategies
A progressive home exercise program
When Should You Seek Medical Evaluation?
Although many cases of tailbone pain can be managed conservatively, persistent or severe pain should be appropriately evaluated.
Seek medical attention if tailbone pain is associated with concerning symptoms such as:
Fever or signs of infection
Unexplained weight loss
A history of cancer
Significant trauma
Progressive weakness or numbness
New bowel or bladder dysfunction
A healthcare provider may recommend imaging or additional evaluation when symptoms suggest another underlying condition or when pain does not improve with conservative treatment.
The Bottom Line
Tailbone pain can be frustrating, painful, and disruptive—but you do not necessarily have to simply live with it.
Because the coccyx has a close relationship with the pelvic floor and surrounding musculoskeletal structures, pelvic floor physical therapy can be an important part of a comprehensive treatment plan for coccydynia. Treatment may help address pelvic floor muscle tension, mobility restrictions, movement dysfunction, sitting intolerance, and other factors that may be contributing to persistent pain.
Current research suggests that physical therapy interventions can improve pain and function for many people with coccydynia, although the evidence is still evolving and more high-quality long-term studies are needed.
If you are experiencing persistent tailbone pain, an individualized evaluation can help identify potential contributing factors and determine whether pelvic floor physical therapy may be appropriate for you.
Looking for Pelvic Floor Physical Therapy for Tailbone Pain?
At Naples Pelvic Health, treatment is individualized to the whole person—not just the painful area. A comprehensive pelvic floor physical therapy evaluation can help identify contributing factors related to the pelvic floor, hips, pelvis, low back, posture, and movement.
If tailbone pain or coccydynia is interfering with your ability to sit, exercise, work, or enjoy everyday life, pelvic floor physical therapy may be able to help you move more comfortably and return to the activities that matter to you.
Contact Naples Pelvic Health to schedule a pelvic floor physical therapy evaluation in Naples, Florida.
References
Sidiq M, Ravichandran H, Janakiraman B, et al. Effectiveness of physical therapy interventions for coccydynia: a systematic review with a narrative synthesis. Archives of Physiotherapy. 2025;15:77–89. doi:10.33393/aop.2025.3233.
Blanco-Diaz M, Ruiz Palacios L, Martinez-Cerón MDR, Perez-Dominguez B, et al. Physiotherapy approaches for coccydynia: evaluating effectiveness and clinical outcomes. BMC Musculoskeletal Disorders. 2025;26:514. doi:10.1186/s12891-025-08744-3.
Mosaad EH, Mohamed AY, Fawzy AA, Mohamed HM. The effect of adding kinesiotaping versus pelvic floor exercise to conventional therapy in the management of post-colonoscopy coccydynia: a single-blind randomized controlled trial. African Health Sciences. 2023;23(1):575–583. doi:10.4314/ahs.v23i1.60.
Andersen GØ, et al. Coccydynia—the efficacy of available treatment options: a systematic review. Global Spine Journal. 2022.