Most people with tailbone pain get better without surgery. Treatment works like a ladder: start with the simplest, safest steps, and climb only if they don't help enough. Reviews put the success rate of the non-surgical steps at about 9 in 10.
Key points
- About 90% of people with coccydynia improve with non-surgical care.
- The first step is changing how and how long you sit: a wedge or cut-out cushion, leaning forward, and regular breaks.
- Manipulation of the coccyx, usually combined with an injection, helped about 75–92% of patients in older clinical series. General physiotherapy (heat, ultrasound) helped little in the same studies, so the type of hands-on treatment matters.
- Injections are an option when pain persists; reported relief varies widely between studies.
- Surgery (coccygectomy) is kept for a small, carefully selected group, and has a real risk of wound infection.
The steps at a glance
| Step | What it involves | What studies report |
|---|---|---|
| 1. Sitting changes | Wedge or U-shaped (cut-out) cushion, leaning forward, breaks every 20–30 minutes | Recommended first-line in all reviews; a cut-out or wedge cushion is preferred over a doughnut ring (MSD Manual) |
| 2. Hands-on treatment | Internal or external manipulation of the coccyx, release of the pelvic floor muscles, stretching and exercises | Manipulation with injection cured about 85% in a 120-patient trial (Wray 1991); other series report 75–92% improvement (Perkins, Ramsey, summarised by Garg and Ahuja). The same trial found general physiotherapy of little help |
| 3. Medicines | Short courses of anti-inflammatory pain relief, sometimes medicines for nerve pain | Helpful for symptoms; not a cure on their own |
| 4. Injections | Local anaesthetic and steroid around the coccyx, or a ganglion impar block | About 60% responded to steroid and anaesthetic injections (Wray 1991); ganglion impar block helped 6 of 8 patients at 6 months in a small CT-guided study (Datir 2010) |
| 5. Ablation | Radiofrequency treatment of the nerves or the ganglion impar | Used for pain that keeps coming back after injections; evidence is from small studies |
| 6. Surgery | Removal of part or all of the coccyx (coccygectomy) | Needed by almost 20% in Wray's trial, with over 90% success; 85–100% improvement in carefully selected patients across studies; complication rates of 0–50% across studies, mostly wound infection |
These figures come from different studies with different patients and definitions of success, so they can't be compared directly. They do show a clear pattern: the simple steps help most people, and the risky steps are only for a few.
Step 1: sitting differently
Sitting puts weight on the coccyx, especially when you lean back. Small changes take that pressure off:
- Lean forward slightly so your weight rests on your thigh bones and sitting bones, not on the tailbone.
- Use a wedge or cut-out cushion with the gap at the back. A doughnut ring can still press on the coccyx.
- Stand up every 20–30 minutes, and avoid low, soft sofas.
See sitting with tailbone pain for more detail.
Step 2: hands-on treatment
This is the core of what we do at the clinic. After a careful examination, the clinician gently moves the coccyx back towards its normal position and range of movement, and releases the tight pelvic floor muscles that pull on it (see conditions linked to tailbone pain). Treatment is usually done from the inside, through the back passage, because that is the only way to reach the front of the coccyx and the muscles attached to it. It is explained fully before it starts, and you can stop at any time.
People whose coccyx is too mobile or slightly displaced when they sit often respond well. Those whose coccyx is very stiff may need more sessions or another step. This is one reason we assess the coccyx shape and movement first.
Step 3: medicines
Anti-inflammatory tablets or gels can ease pain while other treatment takes effect. They are not a long-term answer, and should be taken only as advised by your doctor.
Step 4: injections
If pain persists for several weeks despite the steps above, an injection of local anaesthetic and steroid around the painful joint can calm it down. Another option is a ganglion impar block, an injection at a small nerve cluster in front of the coccyx. Injections should be done by a specialist under X-ray or CT guidance.
Steps 5 and 6: ablation and surgery
For the few people whose pain continues despite everything else, radiofrequency treatment of the nerves or removal of the coccyx may be considered. Surgery gives good results in carefully chosen patients, usually those with an unstable or clearly abnormal coccyx on sitting and standing X-rays. Because the wound is close to the back passage, infection is the main risk.
Our approach
We start at the bottom of the ladder, with a thorough history and examination, sitting advice and hands-on treatment, and refer on only when it is genuinely needed. Most of our patients need only a few sessions. Book a consultation in Delhi or online.
Sources
- Garg B, Ahuja K. Coccydynia: a comprehensive review on etiology, radiological features and management options. J Clin Orthop Trauma. 2021;12(1):123–129
- Lirette LS et al. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–87
- Datir A, Connell D. CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol. 2010;65(1):21–25
- Wray CC et al. Coccydynia. Aetiology and treatment. J Bone Joint Surg Br. 1991;73(2):335–338
- MSD Manual Professional: Coccyx disorders (Foye PM, reviewed 2024)
