After a fall, a jolt or childbirth, the coccyx rarely breaks cleanly. More often it is pushed slightly out of line with the rest of the spine. This is called a subluxation, and it is one of the commonest reasons tailbone pain doesn't go away on its own.
Key points
- A subluxed coccyx shifts in one of two directions: inward into the pelvis (anterior) or outward (posterior).
- The direction matters more than anything else, because the right treatment for one can make the other worse.
- Dr Rajveer checks the direction on a dynamic X-ray (taken sitting and standing) before any manipulation or exercise programme.
- Treatment then follows three steps: an exact diagnosis, internal manipulation to realign the coccyx, and exercises chosen for that direction.
Inward or outward: what's the difference?
| What | Inward shift (anterior) | Outward shift (posterior) |
|---|---|---|
| Where the coccyx goes | Into the pelvis | Backwards, towards the skin |
| What makes it worse | Pressure from outside, and squeezing the pelvic floor | Direct pressure when sitting |
| Never do | Kegel or "butt-squeezing" exercises; external "bone setting" | Long sitting on flat, hard seats |
| Treatment | Internal manipulation, then exercises for an inward shift | Internal manipulation, then exercises for an outward shift |
Why the X-ray comes first
From the outside, both kinds of subluxation can feel the same: pain on sitting, pain getting up, pain at the base of the spine. But they need opposite handling. A dynamic X-ray, taken sitting and standing, shows how the coccyx actually moves under your body weight. Dr Rajveer's rule is simple: no manipulation, no exercise programme and no physical therapy should begin without knowing the direction of the shift.
The three steps of treatment
- Diagnose exactly. The examination and a dynamic X-ray show whether the coccyx has shifted inward or outward, and by how much.
- Realign. Internal manipulation gently moves the coccyx back into line. It is done in a short series of sessions, usually within about a week, spaced at the right intervals.
- Keep it there. Exercises chosen for your direction of shift strengthen and relax the right muscles, so the coccyx stays in place. Doing them faithfully at home is what makes the result last.
A patient's recovery
| When | What happened |
|---|---|
| Day 1 | An IT professional from Pune, badly affected by tailbone pain, was diagnosed with an outward (posterior) subluxation on a dynamic X-ray |
| Week 1 | A short series of internal manipulation sessions corrected the outward shift |
| Month 4 | Marked recovery, after following the home exercise programme very closely |
| Months 5 to 8 | He continued the exercises for another 3 to 4 months to keep the coccyx stable |
Not everyone recovers at the same pace, but the pattern is typical: the manipulation corrects the position, and the exercises keep it.
What to avoid while it heals
- Cycling and riding motorbikes, which put your weight on a narrow saddle right under the coccyx (see two-wheelers and tailbone pain).
- Sitting flat on hard chairs without a cut-out cushion (see sitting with tailbone pain).
- Bending forward without support.
- Squeezing exercises if your coccyx has shifted inward (see Kegel exercises and tailbone pain).
- External "bone setting" (see why bone setting can be dangerous).
Treat it early
Tailbone pain is often brushed off as soreness that will pass. When the coccyx is out of line, it usually doesn't. Left alone, sitting at work, driving and even sleeping can become harder over months. Early assessment and the right treatment are much easier than undoing years of strain.
Sources
- Dr Rajveer Singh's videos on tailbone pain (YouTube)
- Maigne JY et al. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine. 2000;25(23):3072–3079
- Garg B, Ahuja K. Coccydynia: a comprehensive review on etiology, radiological features and management options. J Clin Orthop Trauma. 2021;12(1):123–129
