A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

You sit down at your desk, get into the car, or settle onto the couch, and a sharp or aching discomfort appears near the very bottom of your spine. You shift your weight to one side to find a comfortable position. Then, when you stand up, the pain briefly becomes more noticeable.

Maybe it started after a fall. Perhaps it developed during pregnancy or after childbirth. Or maybe there was no obvious injury at all. You might wonder whether your tailbone is bruised, broken, out of alignment, or simply irritated by sitting too long.

Pain centered around the tailbone is sometimes called coccydynia (or coccygodynia). But pain with sitting does not automatically mean the coccyx is the source. Symptoms in this region can also relate to the lumbar spine, pelvic structures, skin or soft-tissue conditions, and other medical concerns. A careful evaluation matters. 1

At Nova Physical Therapy in North Hollywood, California, we evaluate movement, muscle performance, sitting and functional tolerance, and other physical impairments relevant to outpatient orthopedic and musculoskeletal rehabilitation. We serve North Hollywood and nearby communities, including Toluca Lake, Burbank, Studio City, and Valley Village. Learn more about Nova Physical Therapy services.

Patient Question

“My tailbone hurts when I sit for a while, especially in the car or on a hard chair. Sometimes it hurts even more when I stand up. Does this mean my tailbone is damaged, and can physical therapy help?”

The Short Answer

Tailbone-region pain that is aggravated by sitting or rising from a chair can occur with coccydynia. The coccyx is a small structure at the bottom of the spine, and pressure or movement around this region may reproduce symptoms in some people.

However, the symptom pattern alone cannot establish the cause. A fall, childbirth, prolonged pressure, or other factors may be relevant, but not everyone with tailbone pain has a fracture or a displaced coccyx. Other conditions sometimes need to be considered.

For appropriately evaluated patients, initial management often involves education, reducing direct pressure during sitting, activity adjustments, and selected rehabilitation strategies. A 2026 review of 42 studies supports a stepwise approach beginning with conservative care; a 2025 review of 10 randomized studies involving 515 adults found short-term improvements with several physical therapy-related interventions, while emphasizing the need for stronger long-term evidence. 1 2

What Is the Tailbone, and Where Is It Located?

The tailbone, or coccyx, is the small bony structure at the lower end of the spine, below the sacrum. It is close to the area that bears pressure when you sit, and it provides attachment sites for muscles, ligaments, and other tissues.

Patients often point to the center of the lower buttock crease or just above it when describing tailbone pain. That is different from pain located primarily on one sitting bone, along the upper hamstring, or farther up the lower back.

The location can help guide an examination, but it does not provide a diagnosis by itself.

Why Does My Tailbone Hurt When I Sit?

Sitting can increase pressure around the coccyx, particularly on firm surfaces or in positions that load the back of the pelvis. Some people notice that leaning backward makes the discomfort worse, while a small change in position makes it more tolerable.

The clinical literature describes sitting-related pain as a characteristic complaint in coccydynia. The important question is whether the pain is truly centered over the coccyx and whether the rest of the history and examination fit that presentation. 3

It is also worth distinguishing pain that begins immediately upon sitting from discomfort that develops only after a prolonged period. Both patterns can be important when planning activity modifications.

Why Does It Hurt More When I Stand Up From a Chair?

Some people experience a brief increase in pain during the transition from sitting to standing. Changing position shifts pressure and movement around the lower pelvis and coccyx.

A 2026 clinical review specifically notes that pain may briefly intensify during this transition in people with coccyx-related pain. 3

During a physical therapy evaluation, we may look at how the person rises from different seat heights, whether they shift weight to one side, and whether the symptoms change with a more controlled movement strategy. These observations are used to understand function, not to assume the coccyx is mechanically “out of place.”

Why Does Driving Make My Tailbone Hurt?

Driving can combine sustained sitting, limited opportunities to move, and pressure against the lower pelvis. The seat shape and the person's preferred position may also influence symptoms.

For someone commuting through North Hollywood, Burbank, or other parts of Los Angeles, this can become a significant daily limitation. A patient may be comfortable walking around the house but struggle during a longer drive.

Potential temporary adjustments include trying a pressure-relieving cushion, modifying the seat position, and taking safe movement breaks when practical. The best setup is the one that reduces unnecessary symptom provocation without creating new discomfort elsewhere.

Can a Fall Cause Tailbone Pain?

Yes. Landing directly on the buttocks can irritate tissues around the coccyx and, in some cases, cause a fracture or other injury.

But not every painful tailbone after a fall is fractured, and not every fracture can be identified from symptoms alone. A medical provider determines whether imaging or additional assessment is warranted, particularly after significant trauma or when pain and function are markedly affected.

If you have severe pain after a fall, difficulty walking, significant bruising, or other concerning findings, seek appropriate medical evaluation rather than assuming it is a routine bruise.

Can Tailbone Pain Start During Pregnancy or After Childbirth?

Yes. Tailbone-region pain may occur during pregnancy or following delivery, although the exact cause can vary. Changes in physical demands, pressure, and pelvic structures may be relevant for some patients.

A 2026 medical review describes childbirth among the potential contexts in which coccydynia may arise. 4

However, postpartum tailbone pain does not automatically mean the pelvic floor is weak or that childbirth displaced the coccyx. Symptoms should be evaluated individually, and patients with new or severe postpartum pain should discuss it with their obstetric or medical provider.

When rehabilitation is appropriate, treatment may focus on movement tolerance, positioning, functional strength, and education. More specialized pelvic-health assessment may be indicated in selected cases and should be performed by an appropriately trained clinician with informed consent.

Is Tailbone Pain the Same as Lower-Back Pain or Sciatica?

Not necessarily. Coccyx-region pain is generally more localized near the bottom of the spine and may be especially sensitive to sitting pressure. Lumbar-related conditions can sometimes cause pain into the buttocks or legs, while nerve-related presentations may involve tingling, numbness, burning, or radiating symptoms.

The distinction matters because treating every painful sitting position as “sciatica” or “tailbone inflammation” can overlook other causes.

A physical therapist may assess lumbar movement, hip movement, neurological findings when indicated, and the relationship between symptoms and different functional tasks. Concerning findings should prompt appropriate medical referral.

Could Pain Near My Tailbone Actually Be Something Else?

Yes. The lower pelvic and buttock region contains multiple structures. Possible alternative explanations include pain from the lumbar or sacral region, proximal hamstring structures, pelvic conditions, or a skin or soft-tissue problem near the gluteal cleft.

A painful lump, redness, drainage, fever, or a rapidly worsening tender area near the tailbone may suggest an issue requiring medical assessment rather than a routine rehabilitation approach.

This is one reason it is important not to diagnose coccydynia based solely on the phrase “my tailbone hurts.”

Is There a Best Sitting Position for Tailbone Pain?

There is no single posture that is correct for every person. Some patients tolerate a slight forward lean or a different distribution of weight better than leaning backward. Others benefit from a higher seat or a chair with a different cushion.

The goal is not to force an artificially rigid posture all day. It is to identify comfortable, practical options and reduce prolonged exposure to positions that consistently aggravate symptoms.

Changing positions regularly may be more useful than trying to maintain one “perfect” posture.

Should I Use a Donut Cushion or a Coccyx Cushion?

Pressure-relieving cushions are commonly recommended as an early conservative strategy. A wedge-shaped or U-shaped cushion with a rear cutout may help reduce direct pressure on the coccyx. 1 5

A round donut cushion is not automatically the best option for everyone. Cushion shape, firmness, chair height, and individual comfort can all matter. If a cushion shifts pressure to another painful region or makes sitting less stable, it may not be a good fit.

The cushion is a symptom-management tool, not a guarantee of healing or a substitute for evaluation when symptoms persist.

Should I Avoid Sitting Completely?

Usually, the goal is not to avoid all sitting indefinitely. Many people need to sit for work, driving, meals, or family activities.

Shorter sitting periods, movement breaks, and pressure modification may make daily activities more manageable while symptoms are assessed. A gradual return to more normal sitting tolerance may be appropriate as symptoms improve.

If sitting pain is severe, rapidly worsening, or accompanied by concerning medical symptoms, seek medical evaluation before attempting to push through it.

What Exercises May Help Tailbone-Related Pain?

There is no universal exercise that corrects every cause of tailbone pain. Depending on the evaluation, a physical therapist may consider gentle mobility, graded functional movement, hip and trunk strengthening, breathing and relaxation strategies, or other exercises that address documented impairments.

For example, a patient who has become less active because sitting and rising are painful may need a gradual program to restore confidence with daily movement. Another may have specific hip or trunk limitations that can be addressed without directly provoking the coccyx.

Exercises should be individualized. Aggressive stretching, repeated painful sit-to-stand testing, or intense strengthening are not automatically appropriate simply because the tailbone hurts.

Does Tailbone Pain Mean I Need Pelvic Floor Physical Therapy?

Not always. Some people with tailbone-region pain may have relevant pelvic-floor or pelvic-muscle findings, while others do not.

A 2025 systematic review included trials involving pelvic-region manual approaches among several interventions studied for coccydynia. However, those findings do not mean every patient needs internal treatment or that pelvic-floor dysfunction is always the source. 2

If a specialized pelvic-health evaluation is clinically indicated, the patient should be informed about the purpose, alternatives, clinician qualifications, and consent requirements. No internal examination or treatment should be assumed or performed as a routine step.

Can Shockwave Therapy Help Tailbone Pain?

Extracorporeal shockwave therapy (ESWT) has been investigated for persistent coccydynia. Some trials and systematic reviews have reported improvements in pain and function, and a 2026 review of 42 studies identified shockwave among the better-supported conservative or noninvasive interventions in the available literature. 1

A 2025 systematic review of nine randomized trials involving 532 participants also reported promising findings for shockwave therapy, while highlighting important limitations such as small samples, differences in protocols, and limited long-term follow-up. 6

That does not establish shockwave as a guaranteed cure, a necessary first step, or the best option for every patient. Treatment decisions should consider the individual presentation, the specific device and protocol, contraindications, clinician qualifications, and the quality of the evidence.

Patients should not assume that results from shockwave studies involving heel pain or tendons apply automatically to the coccyx. The body region and clinical indication matter.

Do I Need an X-Ray or MRI?

Not everyone with tailbone-region pain needs immediate imaging. Medical decisions about imaging depend on the history, trauma, examination findings, duration, and whether concerning symptoms are present.

A 2026 review discusses standard radiographs primarily to assess for important alternative pathology, with sitting-versus-standing images sometimes considered in selected persistent cases. MRI or CT may be appropriate when trauma, infection, a tumor, or other concerning findings are suspected. 1

Physical therapists can evaluate movement and function, but decisions about medical imaging and interpretation should be coordinated with the appropriate medical provider.

Can Physical Therapy Help?

For appropriately evaluated musculoskeletal presentations, physical therapy may help address limitations that accompany tailbone-region pain. The program should reflect what is found during the examination and what the patient needs to do in daily life.

Depending on the presentation, rehabilitation may address:

• Sitting and driving tolerance, including pressure-relief strategies.
• Sit-to-stand movements, walking, and other daily activities.
• Hip and trunk mobility or muscle-performance limitations when relevant.
• Gradual return to exercise and functional activity.
• Education about symptom monitoring and practical activity modifications.
• Referral or coordination with medical or pelvic-health professionals when indicated.

The goal is not simply to perform a series of exercises. For one patient, meaningful improvement may be sitting through a work meeting; for another, driving comfortably enough to commute or returning to exercise after childbirth.

What Does Research Say?

2026: Contemporary Management Review

A review published in Neurospine in April 2026 synthesized 42 studies on the evaluation and treatment of coccydynia. It proposed a stepwise approach that begins with history and examination, conservative strategies such as education and pressure relief, and physiotherapy when appropriate. The authors also reviewed evidence for shockwave therapy and medical interventions in persistent cases. Because the underlying studies differ in design and quality, the review should not be interpreted as proof that one treatment works for every patient. 1

2025: Review of Physical Therapy Interventions

A systematic review in Archives of Physiotherapy included 10 studies and 515 adults. The authors reported short-term improvements in pain and function with several studied interventions, including shockwave therapy and certain manual or exercise-related approaches. However, treatment protocols were heterogeneous, and stronger trials with longer follow-up were needed. 2

2025: Review of Nine Randomized Trials

A separate review in BMC Musculoskeletal Disorders included nine randomized controlled trials and 532 participants. It reported promising results for shockwave therapy and some manual approaches, but also identified moderate-to-high risk of bias in several domains, small study samples, and limited follow-up. Those limitations matter when discussing expected benefits with patients. 6

2022: Broader Review of Treatment Options

A systematic review involving 64 studies and 1,980 patients examined conservative, interventional, and surgical approaches. Many studies were observational, so differences in average pain improvement across treatment categories should not be treated as proof that one option is superior. The review supported a progressive approach that begins with less invasive care and considers more invasive options for carefully selected persistent cases. 5

What Does the Evidence Mean for Patients?

Conservative care is a reasonable starting point for many appropriately evaluated cases, and physical therapy-related interventions may help some patients. But the research does not establish a single exercise, manual technique, cushion, or device that reliably resolves every case of tailbone pain.

Clinical decisions should be individualized, and patients with persistent, atypical, or worsening symptoms may need medical evaluation beyond physical therapy.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy in North Hollywood, an evaluation for pain around the tailbone may include a detailed history and assessment of the movements and activities that matter most to the patient.

Depending on the presentation, the physical therapist may evaluate:

• How symptoms began, including any fall, injury, pregnancy, or childbirth history.
• Exact pain location, symptom behavior, and sitting tolerance.
• Functional transitions such as sitting down and standing up.
• Lumbar and hip movement when relevant.
• Muscle performance, walking, and other functional limitations.
• Neurological or other screening findings that warrant referral.

We may ask whether pain is worse on hard chairs, whether leaning forward changes it, how long driving is tolerated, and whether there are symptoms such as numbness, fever, drainage, or unexplained worsening pain.

An evaluation does not automatically require an internal examination. When findings suggest a need for specialized pelvic-health assessment or medical investigation, the appropriate next step can be discussed and referral arranged.

When Should You Seek Medical Attention?

Tailbone pain is not always a routine musculoskeletal problem. Seek prompt medical assessment after a significant fall or injury, especially if there is severe pain, marked bruising, difficulty walking, or concern for fracture.

Other findings that warrant timely medical evaluation include:

• Fever, redness, drainage, or a painful lump near the tailbone.
• Unexplained severe pain, persistent night pain, or symptoms that progressively worsen.
• New or progressive numbness or weakness.
• Unexplained weight loss or other concerning systemic symptoms.
• Pain associated with significant bowel, bladder, or pelvic symptoms.

New loss of bladder or bowel control, urinary retention with concerning neurological symptoms, or numbness in the saddle region requires emergency medical evaluation.

An examination may reveal that a medical, neurological, dermatological, or pelvic condition needs to be considered rather than routine physical therapy alone.

Why Patients Choose Nova Physical Therapy

We Care.

Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, serving patients with appropriate orthopedic, musculoskeletal, sports, balance, post-surgical, and other movement-related rehabilitation needs.

Our clinic serves North Hollywood and nearby Toluca Lake, Burbank, Studio City, Valley Village, and surrounding Los Angeles communities. You can learn more about our approach on the Nova Physical Therapy About Us page.

We do not assume that every person with pain while sitting has the same condition. One patient may have symptoms after a fall, another after childbirth, and another only during a long commute. A different patient may have skin changes, neurological symptoms, or another finding that requires medical attention.

Our approach emphasizes listening carefully, evaluating physical and functional limitations, explaining the findings within the physical therapist's scope, developing an individualized plan when appropriate, and coordinating referral when needed.

We Care means understanding what the pain is preventing you from doing—working, driving, caring for family, exercising, or simply sitting comfortably—and making those goals part of the rehabilitation conversation.

Frequently Asked Questions

Why does my tailbone hurt when I sit?

Sitting may increase pressure around the coccyx. Coccydynia is one possible explanation, but the location and symptom pattern alone cannot determine the cause.

Why does my tailbone hurt when I stand up from sitting?

Changing position can briefly aggravate coccyx-region symptoms in some people. A physical and functional evaluation can help clarify the pattern and identify appropriate next steps.

Can driving cause tailbone pain?

Prolonged driving can aggravate existing tailbone-region pain because of sustained sitting and pressure. That does not prove driving caused an underlying condition.

Does tailbone pain mean I broke my coccyx?

No. Pain can occur without a fracture. A medical provider determines whether imaging is appropriate, particularly after trauma.

Can tailbone pain happen after childbirth?

Yes. Tailbone-region pain may occur during pregnancy or after delivery, but the underlying explanation varies and should not be assumed from the timing alone.

Is a coccyx cushion better than a donut cushion?

A U-shaped or wedge-style cushion with a rear cutout may reduce direct pressure for some people. The best option depends on fit, comfort, and symptom response.

Should I avoid sitting until the pain is gone?

Not necessarily. Shorter sitting periods, movement breaks, and pressure modification may help people remain functional while symptoms are evaluated.

Is tailbone pain the same as sciatica?

No. The symptom patterns can overlap with lumbar or nerve-related conditions, but they are not interchangeable.

Can physical therapy help coccydynia?

Some studies report improvements in pain and function with physical therapy-related approaches, although evidence quality and long-term outcomes vary. Rehabilitation should be individualized.

Do I need pelvic floor physical therapy for tailbone pain?

Not everyone does. Specialized pelvic-health assessment may be relevant for selected patients, but it is not automatically required.

Does shockwave therapy help tailbone pain?

Some studies report benefits for coccydynia, but protocols and study quality vary. Shockwave is not a guaranteed cure or a required first-line treatment for everyone.

When should I worry about tailbone pain?

Significant trauma, fever, drainage, a painful lump, progressive neurological symptoms, or unexplained worsening pain warrant medical evaluation. New bladder or bowel dysfunction with concerning neurological findings requires emergency assessment.

Schedule an Evaluation

If pain around your tailbone is limiting sitting, driving, standing up from a chair, work, exercise, or daily activities, a physical therapy evaluation may help identify relevant movement and functional limitations and determine whether rehabilitation is appropriate.

Nova Physical Therapy is located at 4795 Vineland Avenue, Suite E, North Hollywood, CA 91602, serving North Hollywood and nearby Toluca Lake, Burbank, Studio City, Valley Village, and surrounding Los Angeles communities.

Explore our physical therapy services or call 818-639-3402 to ask about scheduling an evaluation.

Disclaimer

This article is provided by Nova Physical Therapy in North Hollywood, California, for general education only. It does not constitute medical advice, a medical diagnosis, an imaging interpretation, an individualized treatment plan, or clearance to exercise.

Tailbone-region pain, sitting pain, tenderness, or pain when standing up cannot independently establish coccydynia, a coccyx fracture, pelvic-floor dysfunction, lumbar radiculopathy, infection, or another condition. Physical therapists in California evaluate and treat physical impairments and functional limitations within the California Physical Therapy Practice Act; a physical therapy license does not authorize the diagnosis of disease. Medical referral is appropriate when findings fall outside the physical therapist's scope or require additional evaluation. 7

No cushion, exercise program, manual treatment, shockwave therapy, injection, or other intervention guarantees symptom relief, tissue healing, or avoidance of additional medical care. Individual results vary.

References

1. Staartjes VE, De Wilde D, Alakmeh A, et al. Contemporary Management of Coccydynia. Neurospine.2026;23(2):365–379. DOI: 10.14245/ns.2551726.863.
2. 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.
3. Coccyx pain. Tidsskrift for Den norske legeforening. Clinical review, February 2026. Read the clinical review.
4. Coccygodynia. BMJ Best Practice. Evidence reviewed September 11, 2026. Read the clinical summary.
5. Andersen GØ, Milosevic S, Jensen MM, et al. Coccydynia—The Efficacy of Available Treatment Options: A Systematic Review. Global Spine Journal. DOI: 10.1177/21925682211065389.
6. Blanco-Diaz M, Ruiz Palacios L, Martínez-Cerón MR, et al. Physiotherapy approaches for coccydynia: evaluating effectiveness and clinical outcomes. BMC Musculoskeletal Disorders. 2025;26:514. DOI: 10.1186/s12891-025-08744-3.
7. Physical Therapy Board of California. Physical Therapy Practice Act. California PTBC.
8. American Physical Therapy Association. Clinical Practice Guidelines Library. APTA evidence-based practice resources.

SEO Keywords

Tailbone Pain, Coccyx Pain, Coccydynia, Coccygodynia, Tailbone Pain When Sitting, Tailbone Pain When Standing Up, Tailbone Pain Driving, Coccyx Pain After a Fall, Postpartum Tailbone Pain, Tailbone Pain After Childbirth, Coccyx Cushion, Tailbone Pain Physical Therapy, Coccydynia Physical Therapy, Pelvic and Lower Back Pain, Shockwave Therapy Coccydynia, Orthopedic Physical Therapy, Outpatient Physical Therapy, Nova Physical Therapy, Nova Physical Therapy North Hollywood, Tailbone Pain North Hollywood, Physical Therapy Burbank, Physical Therapy Toluca Lake, Physical Therapy Studio City, Physical Therapy Valley Village, Physical Therapy Los Angeles.

AI Search Phrases

Why does my tailbone hurt when I sit?; Why does my tailbone hurt when I stand up?; Why does my tailbone hurt in the car?; Can prolonged sitting cause coccyx pain?; Is tailbone pain the same as coccydynia?; How can I tell tailbone pain from lower-back pain?; Does tailbone pain mean my coccyx is broken?; Can a fall cause tailbone pain without a fracture?; Why does my tailbone hurt after pregnancy?; Is tailbone pain common after childbirth?; Do I need a pelvic floor physical therapist for tailbone pain?; What is the best cushion for coccyx pain?; Is a donut cushion good for tailbone pain?; Should I avoid sitting with coccydynia?; What exercises help tailbone pain?; Can physical therapy help coccydynia?; Does shockwave therapy help coccyx pain?; Do I need an X-ray for tailbone pain?; When should I worry about tailbone pain?; Where can I get physical therapy for tailbone pain in North Hollywood?; Tailbone pain physical therapy near Burbank; Coccyx pain rehabilitation near Toluca Lake; Physical therapy for sitting pain near Studio City; Orthopedic physical therapy near Valley Village.