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Understanding the Causes of Tailbone Pain

The pain that occurs in the lowest part of the spine, the coccyx, is called the tailbone. The coccyx itself is made up of 3 to 5 vertebrae, some of which may be fused together. The ventral side of the coccyx is slightly concave whereas the dorsal aspect is slightly convex. Both of these sides have grooves that show where the vestigial coccygeal units had previously fused. The coccyx attaches the sacrum, from the dorsal grooves with the attachment being either a symphysis or as a true synovial joint, and also to the gluteus maximus muscle, the coccygeal muscle, and the anococcygeal ligament.

Possible Underlying Causes of Coccydynia

Generally, a diagnosis of the cause of coccydynia will identify one of the following underlying causes of pain:

  • Local trauma. A fall on the tailbone can inflame the ligaments or injure the coccyx or the coccygeal attachment to the sacrum. This is probably the most common cause of coccydynia.
  • Childbirth. During delivery, the baby’s head passes over the top of the coccyx, and the pressure created against the coccyx can sometimes result in injury to the coccyx structures (the disc, ligaments and bones). While uncommon, the pressure can also cause a fracture in the coccyx.
  • Pressure. Certain activities that put prolonged pressure on the tailbone, such as horseback riding and sitting on hard surface for long periods of time, may cause the onset of coccyx pain. Tailbone pain due to these causes usually is not permanent, but if the inflammation and symptoms are not managed, the pain may become chronic.
  • Tumor or infectionScreen Shot 2016-03-25 at 2.35.17 AM. Rarely, coccydynia is due to a tumor or infection in the coccyx area that puts pressure on the coccyx.

Physical Examination for Coccydynia (Tailbone Pain)

A thorough physical examination for coccyx pain should include:

  • Pelvic and rectal exam to check for a mass or tumor that could be a cause of the pain
  • Palpation to check for local tenderness.

The most striking finding on examination is usually the local tenderness upon palpation of the coccyx. If the coccyx is not tender to palpation, then the pain in the region is referred from another structure, such as a lumbosacral disc herniation or degenerative disc disease.

If you are struggling with tailbone pain, call Dr. Kushwaha. He’s a board certified Orthopedic Surgeon specializing in Spine Surgery. To learn more about his procedures or to schedule an appointment please call, (713) 587-6263 or visit

About Vivek Kushwaha

Vivek P. Kushwaha attended the University of Texas at Austin where he earned his B.A. from the College of Natural Sciences. He then earned his medical degree from the University of Texas Medical School at San Antonio, Texas.

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