Many people with tailbone pain are taken to a local "bone setter" for an external massage or a quick push to put it back. Dr Rajveer Singh sees patients every month whose pain became worse afterwards. Here is why.
Key points
- A displaced coccyx can shift inward into the pelvis or outward. From the outside, you can't tell which.
- If it has shifted inward, pressing on it from outside pushes it deeper into the pelvis: a small displacement becomes a bigger injury.
- Treating a displaced coccyx without first checking the direction on a dynamic X-ray is unsafe, and in Dr Rajveer's view unethical.
- A specialist realigns the coccyx with internal manipulation, aimed in the right direction.
How a quick push can go wrong
The coccyx sits at the very bottom of the spine, partly hidden inside the pelvis. When it has been pushed inward (an anterior subluxation), the part you can feel from outside is already further in than it should be. Pressing on it from behind adds to the same force that displaced it. The muscles around it go into spasm, and sitting becomes even more painful.
| Before any treatment | What it shows |
|---|---|
| A careful history | How it started: a fall, childbirth, long sitting, a sudden jolt |
| An examination | Where it hurts, how the coccyx and the pelvic floor muscles respond |
| A dynamic X-ray (sitting and standing) | Which way the coccyx has moved, and how much it moves when you sit |
What safe treatment looks like
Once the direction is known, the coccyx is realigned by internal manipulation, gently and from the right side, in a short series of sessions. Exercises chosen for your type of shift then help keep it in place. See tailbone subluxation: why the direction decides the treatment.
If you've already had bone setting
Don't worry, and don't repeat it. If the pain is the same or worse, book an assessment. Many patients still recover well once the direction of the shift is known and treated properly.
