Kegel exercises are good for many people, especially after childbirth. But if your tailbone has been pushed inward, or it is fractured, squeezing exercises can do harm. Dr Rajveer Singh asks his patients to stop them until the direction of the problem is known.
Key points
- The pelvic floor muscles are attached to the coccyx.
- If the coccyx has shifted inward (an anterior subluxation) or is fractured, contracting these muscles pulls it further inside.
- So Kegels and "butt-squeezing" exercises should not be done until a specialist has checked which way the coccyx has moved.
- The right exercises depend on the direction of the shift, and are taught after the coccyx has been realigned.
Why squeezing can make it worse
Several of the pelvic floor muscles, including the coccygeus and parts of the levator ani, attach to the coccyx. When they contract, they pull on it. With a normally placed coccyx that's fine. But if it has already been pushed into the pelvis, each squeeze tugs it further the wrong way. The displacement increases, the pain lasts longer, and treatment becomes harder.
| Exercise | Coccyx in normal position | Coccyx shifted inward or fractured |
|---|---|---|
| Kegel / squeezing exercises | Usually fine | Avoid: they pull the coccyx further in |
| What helps | Exercises a physiotherapist teaches you | Diagnosis first, internal manipulation, then direction-specific exercises |
What to do instead
- Stop squeezing exercises if you have tailbone pain and haven't been examined yet.
- Take the pressure off with a cut-out cushion and regular breaks from sitting (see sitting with tailbone pain).
- Find out the direction. An examination and a dynamic X-ray show whether the coccyx has moved inward or outward (see tailbone subluxation).
- Follow a plan made for you. Once the coccyx is back in line, your exercises are chosen for your particular shift.
After childbirth
New mothers are often told to start Kegels straight away. If you have tailbone pain after delivery, check with a specialist first: childbirth is one of the commonest causes of an inward-shifted coccyx (see tailbone pain after pregnancy).
