Tailbone pain can make an ordinary chair uncomfortable and turn a car ride or workday into a struggle. For someone whose pain began after a fall, the frustration may be especially difficult when an initial X-ray did not reveal a fracture.
At Caring Medical, we emphasize the possible role of the structures that support a painful joint. With chronic tailbone pain, that includes the ligaments and nearby muscles. However, pain in this area does not automatically establish ligament injury, and different causes require different explanations.
What is coccydynia?
Coccydynia, also called coccygodynia, means pain around the coccyx—the small bone at the bottom of the spine. It typically worsens with sitting or rising from a chair. The coccyx usually consists of three to five segments and provides attachment points for ligaments and pelvic floor muscles. A fall, childbirth, repeated pressure, abnormal joint movement, or local degeneration may contribute. Occasionally, infection or a tumor is responsible. (1)
When can tailbone pain be a ligament problem?
The sacrococcygeal ligaments help support the connection between the sacrum and coccyx. A traumatic injury may affect these supporting tissues even without a visible fracture. Excessive movement or partial displacement during sitting can be associated with pain.
However, the coccyx can also be painful when it moves too little. Selected patients may benefit from standing and seated radiographs that compare movement under different loads. A normal static X-ray neither excludes all painful conditions nor proves that ligaments are the cause. (1)
Our clinical perspective is that supporting tissues deserve consideration when pain persists after an injury. That is a possible explanation, rather than a conclusion that all coccydynia reflects instability.
For related anatomy, see our discussion of sacroiliac joint dysfunction. Sacroiliac pain and coccyx pain are different conditions; a diagnosis involving one does not establish the other.
Video discussion: Why the painful area may extend beyond the coccyx
In the accompanying Caring Medical video, we explain that the coccyx connects to the sacrum through ligaments. When someone has been told that the tailbone is rotated or displaced, injury to its supporting structures is one possibility to consider. The appearance of rotation alone, however, does not establish the source of pain or prove ligament laxity.
The video uses a pelvic model to show the relationship between the coccyx, sacrum, sacroiliac region, sacrotuberous ligaments, and ischial tuberosities. The ischial tuberosities are the bony prominences commonly called the sit bones. These landmarks help explain why a person may describe several different painful areas as “tailbone pain.”
Our point is that a diagnostic label can describe where someone hurts without identifying every tissue involved. Pain centered on the coccyx may differ from pain directly over a sit bone, and either may coexist with pain elsewhere in the pelvis. Related anatomy is discussed in our article on iliolumbar ligament injury and pelvic stability.
Pain with sitting: Coccyx pain or sit-bone pain?
The video highlights that some people have discomfort both at the coccyx and over the sit bones. This distinction matters because the patient’s description may cover more than one pain location. It does not mean that every painful attachment requires an injection, or that all sitting pain has the same cause.
The speaker presents prolotherapy as a preferred treatment for suspected problems involving these supporting structures. We retain that clinical perspective while separating it from the research question: which patients benefit, from which injection approach, and for how long? The studies below address parts of that question rather than establishing a universally best treatment.
Rectal pain needs its own explanation
The video also connects rectal pain with pelvic floor dysfunction. Pelvic floor muscle problems can contribute, but rectal pain should not automatically be labeled as pelvic floor dysfunction or ligament injury. The location of pain alone cannot distinguish musculoskeletal pain from an anorectal condition.
The pelvic floor can also contribute
The pelvic floor is a group of muscles that supports the pelvic organs. Painful tension in these muscles can coexist with tailbone pain, making a purely bone-centered explanation incomplete.
A retrospective study examined pelvic floor physical therapy aimed mainly at muscle relaxation. Of 124 patients reviewed, 93 participated in therapy and 79 completed treatment. Among completers, average pain decreased from 5.08 to 1.91 after a mean of nine sessions. Some patients also received medication or injections. Because there was no randomized comparison group, the results support this approach as a potentially helpful option without proving that therapy alone produced every improvement. (2)
The original article also cited two physical therapy cases. Both women had restricted coccyx movement, but their outcomes differed. One experienced almost complete symptom resolution after manual therapy. The other had temporary relief and ultimately underwent surgical removal of the coccyx. These cases illustrate why similar symptoms do not guarantee similar treatment responses. (3)
What newer physical therapy research shows
A 2025 systematic review included 10 studies involving 515 adults. Several physical therapy interventions showed short-term improvements in pain or function. The studies examined different techniques, however, and the evidence does not identify one universally successful treatment. (4)
This is relevant to our ligament-focused discussion: improvement with muscle or movement treatment does not prove that ligament laxity was present. Likewise, incomplete improvement does not establish that prolotherapy is the necessary next step.
Prolotherapy for persistent tailbone pain
Dextrose prolotherapy involves injecting a dextrose solution with the aim of promoting a therapeutic response in painful musculoskeletal tissues.
Our published systematic review examined dextrose prolotherapy across several musculoskeletal conditions, including spinal and pelvic pain. It included randomized trials and observational studies. Although the review reported supportive findings for several conditions, its broader conclusions cannot be treated as proof of effectiveness for every patient with coccydynia. (5)
Foundational tailbone-specific research
A 2008 case series studied 37 patients with persistent coccydynia that had not responded to conservative treatment for more than six months. Average pain decreased from 8.5 before treatment to 3.4 after the first injection and 2.5 after the second. Thirty patients were reported to have good relief, while seven had minimal or no improvement.
There was no randomized comparison group. These results suggest potential benefit, but they do not establish superiority over other treatments or demonstrate that pain relief resulted from measurable ligament strengthening. (6)
New 2026 comparative research
A retrospective comparative study examined 56 patients with chronic coccydynia. Twenty-nine received ultrasound-guided 10% dextrose injections together with exercises and education; 27 received exercises and education alone.
At three months, the injection group had a reported 73% pain reduction compared with 26% in the comparison group. Complete pain resolution was reported in 37.9% of the injection group.
This is encouraging tailbone-specific evidence, but the study was not randomized and follow-up was short. Differences between groups, expectations, and other factors could influence the results. The findings do not establish a permanent cure or prove restoration of ligament stability. (7)
Dextrose treatment for nerve-related pain is a separate question
A 2026 double-blind, randomized placebo-controlled trial studied 32 women with chronic coccydynia. It investigated ultrasound-guided 5% dextrose neural injections targeting a proposed perforating cutaneous nerve entrapment mechanism. The researchers reported improvements in the dextrose group. (8)
This small trial concerns a nerve-targeted approach. It should not be presented as proof that hypertonic ligament prolotherapy repairs coccygeal instability. Dextrose concentration, injection location, and the intended target matter when interpreting treatment studies.
Other treatments and reasons for further evaluation
Published treatment options include cushions that reduce coccyx pressure, activity adjustments, physical therapy, medications, local injections, and—in selected persistent cases—coccygectomy, or surgical removal of the coccyx. Their usefulness depends on the underlying problem. The older literature describes uncertainty about the best injection target and limited evidence for some procedures. It does not support dismissing every conventional treatment as ineffective. (9)
Likewise, the evidence reviewed here does not justify stating that anti-inflammatory medication or a corticosteroid injection inevitably causes long-term loss of function. Symptom relief, tissue repair, and lasting functional improvement are distinct outcomes.
Rectal pain can have a separate anorectal cause. Fever, drainage, a new mass, unexplained weight loss, or progressive pain require medical assessment rather than an assumption of ligament weakness. New loss of bowel or bladder control, numbness around the groin, or significant leg weakness warrants urgent evaluation.
What this means for persistent pain
We believe the useful question is which structures may be contributing to the pain. Ligaments, joints, muscles, and nerves can all be relevant, and one explanation should not be assumed from symptoms alone.
The available studies support discussing several treatment options while acknowledging uncertainty. Pain improvement is a meaningful outcome, but it does not by itself reveal the biological mechanism or guarantee lasting relief.
Video accompanying this article
The accompanying video discusses our ligament-focused perspective on tailbone pain, including the sacrococcygeal connection, neighboring pelvic ligaments, and pain around the sit bones. The discussion above expands these points and distinguishes our clinical perspective from the findings and limitations of published studies.
References
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This article provides general education and does not establish a diagnosis or predict an individual treatment outcome.