Whether you’ve tripped on a stair or had a run-in with a patch of black ice, most of us have fallen on our bottom at one point or another. While there is natural padding in the area, enough of an impact can cause damage to the bottom of the spine (the tailbone). It may be difficult to know if this pain is caused by something like a bruise that will dissipate or a more severe issue like a fractured tailbone. An orthopedic doctor will ultimately help you to diagnose the exact cause of your pain, but it can be important to know the signs of each injury.
About the Tailbone
While the common term for the bottom of the spine is tailbone, the medical term is the coccyx. The coccyx is the lowest portion of the spine, sitting below the sacrum, and is a triangular arrangement of bone that makes up this area. An individual’s development can change the makeup of the tailbone, which can have anywhere from three to five different bones connected by fused joints and/or ligaments. The level of fusion can determine how much movement is available in the coccyx, which allows more for some people than others.
When the coccyx does move, it is usually a limited amount in the space between the bones and the sacrum. The tailbone will move slightly forward or backward as the pelvis, hips, and legs move. When a person sits or stands, the bones in the pelvis rotate outward and inward slightly to offer better support and balance. When sitting, a part of your weight is supported by the coccyx.
The tailbone has technically been designated as vestigial, or no longer necessary in the human body, but this support to the pelvis does have a purpose. It is one part of the three-part support needed for a person in the seated position, taking some of the weight off of the hips and providing balance and stability. Additionally, many pelvic floor muscles are connected to the tailbone, and they help support the anus, vagina, and movement of the legs.
Because women have a broader pelvis structure and use the muscles in different ways, they are more prone to injuries in the tailbone. A lack of pelvic rotation, additional weight on the tailbone, and potential childbirth complications all make women much more likely to suffer complications in the coccyx.
Common Causes of a Bruised vs. Fractured Tailbone
Although both bruised and fractured tailbones are typically caused by trauma, the severity and circumstances of these types of injuries can help explain what happened. A bruised tailbone most commonly happens because of a backward fall onto a hard surface, like slipping on a wet floor or on ice. These injuries frequently occur during everyday activities but are also common among athletes like gymnasts, skaters, and cyclists who place repeated pressure on the coccyx. Prolonged sitting on hard or narrow surfaces, such as bicycle seats, rowing machines, or wooden benches, can also cause enough repetitive stress to bruise the bone. Childbirth is another potential cause, especially during long or difficult labor, when the coccyx may be strained or compressed.
On the other hand, a fractured tailbone usually occurs after higher-impact trauma. Falling down the stairs, landing forcefully from a height, or being involved in a car accident can generate enough force to crack or break the coccyx. Direct blows during contact sports may also cause fractures of the coccyx. Older adults are at increased risk due to bone density loss from osteoporosis, which can make bones more fragile and susceptible to breaking even after relatively minor falls. While both types of injuries can be painful, coccyx fractures are more commonly associated with intense, persistent pain that does not improve quickly with rest.
Bruised Tailbones
Just like our skin can bruise, so can a bone. Enough impact on the bone can cause damage to the small blood vessels at the injury site, which can leak into nearby tissue. Rather than the telltale skin discoloration, a bone bruise is identified by pain, inflammation, and irritation. The tailbone is particularly susceptible to bruising due to the kind of impact it can suffer.
The most common cause of bruises to the tailbone is falling. This can include any normal person falling during their daily activities, though the risk is elevated in athletes, especially gymnasts and ice skaters. Childbirth can also lead to a bruised coccyx in certain conditions. Alongside sudden trauma, tailbones can be bruised due to sitting for too long on a hard and narrow surface, like a bicycle seat or a bench.
The first sign of a bruised tailbone will be pain that appears or worsens when you put pressure on the tailbone, especially when you sit. Leaning forward may reduce pressure on the area. In addition to this pain, you may also notice:
- * Numbness
- * Tingling
- * Swelling
- * Leg weakness
- * Worsening pain
- * Trouble controlling the bowels or bladder
A bruised tailbone will usually heal on its own with little intervention, though symptoms need to be managed.
Fractured Tailbones
While bruising your tailbone is fairly common, a true fracture to the tailbone is less likely to occur. Any of the bones that make up the tailbone can be a part of the break, though the type of break may vary. Broken tailbones can manifest in three ways:
- Displacement, when the separated bone fragments are identifiable on an X-ray
- Hairline fracture, where the broken pieces are still connected
- Communition, in which the bone breaks into multiple pieces
A fractured tailbone usually occurs in response to trauma or direct injury. For young people, this means a backward fall or a car accident is usually the cause of the injury. Older adults may also suffer a break due to bone deficiency like osteoporosis. It is rare for a tailbone to be broken during childbirth, but it can occur when certain instruments and maneuvers are used in emergencies.
The pain associated with this injury is typically very localized to the tailbone and lower back, but it may be aggravated by prolonged sitting, leaning back while sitting, prolonged standing, getting up from a seated position, using the restroom, or sexual intercourse. Pain may radiate into the legs, though that is not common. Other damaged coccyx symptoms may include:
- Swelling around the tailbone
- Pain during bowel movements
- Irregular bowel movements
- Numbness and tingling in the legs
Broken tailbones will require more proactive treatment and pain management.
When to Seek Medical Attention
A minor fall or injury may lead to a sore tailbone that resolves quickly on its own. If the pain is so severe that you can’t perform a normal activity, or it does not lessen within a few days, you should see a doctor. They can evaluate whether you have a more serious injury like a fracture or what treatment may be appropriate. In rare cases, tailbone pain can be a sign of cancer and other serious conditions that you will want to rule out as well.
Diagnosing Tailbone Injuries
It can be difficult to determine whether a tailbone has been broken vs. bruised tailbone based on symptoms alone. When you present with these symptoms, an orthopedic doctor will review your experience and medical history and may perform a physical examination. This exam will usually include the doctor feeling the soft tissue around your coccyx and sacrum to see if they can detect a pointy growth of new bone that could be causing the pain. They may also look for tumors, ingrown hairs, cysts, or pelvic muscle spasms.
Your doctor may also perform a rectal exam. During this, the doctor will grasp your coccyx between their forefinger and thumb to see how much motion is present. The normal range of motion is about 13 degrees, and more or less may indicate to them what is causing your symptoms.
If they cannot identify another problem causing your pain, you will likely be sent for an X-ray. You will usually be asked to take X-rays in both a standing and sitting position, allowing a comparison of the angle in both positions. These X-rays will also show if a fracture is present or if a bruise is the likely cause.
Treating a Bruised Tailbone
A bruised tailbone will repair itself with time, though you can take steps to prevent further injury and reduce pain. Your doctor may prescribe a short course of painkillers, or you can use over-the-counter medications for temporary management. If the pain is severe or causing issues in your daily activities, steroid injections can be used to reduce inflammation, pain, and swelling in the area.
Many people will use a doughnut pillow to relieve pain during the period of healing. These seat cushions have a hole in the middle to take pressure off the tailbone when sitting. Wedge-shaped and V-shaped pillows can also be useful. Physical therapists can help teach you exercises in order to stretch ligaments and strengthen muscles that support your back. This can promote faster bruised tailbone healing times and prevent future injuries to the tailbone for a high-risk population.
The expected recovery time for a bruised tailbone is about four weeks. In that time period, there are simple steps you can take at home to find relief.
- Get up and walk around more frequently to avoid pain from prolonged sitting. When you have to sit, be careful to lean forward to take pressure off the coccyx.
- Wear loose clothing to avoid putting pressure on your tailbone.
- Avoid activities that bring on additional pain, like riding a bicycle.
- If you’ve fallen or experienced an injury, icing your lower back can be helpful. Be sure to use a towel or light fabric between the ice pack and your skin, and don’t keep it on for more than 10 minutes every few hours. After a few days, begin alternating the ice with heating pads.
- Get a gentle massage on the sore area, or seek out ultrasound therapy for relief.
If you are suffering from related constipation, try a laxative or stool softener and drink plenty of fluids.
Treating a Broken Tailbone
Unlike other broken bones, a tailbone cannot be placed into a cast or a brace to allow healing. Instead, various therapies and pain management can be used to reduce pain and avoid further complications.
The primary treatment of a broken coccyx is physical therapy with a focus on exercises to stretch the ligaments and strengthen the muscles that support the lower spine. A therapist may also use massage, heat therapy, cold compresses, and other techniques to lessen your pain. Once immediate symptoms are managed, you may also focus on improving your sitting posture in the future to avoid putting too much pressure on the coccyx.
You may be sent home with a coccygeal cushion, specially designed to support the buttocks, but with a cutout for the tailbone. Doughnut cushions are not recommended for a broken tailbone, as they can place extra pressure on the coccyx.
In addition to both prescription and over-the-counter medication, other non-surgical treatments may involve:
- Pelvic floor rehabilitation
- Manual manipulation and massage by a chiropractor
- Electrical nerve stimulation
- Steroid injections
- Nerve blocks
- Spinal cord stimulations
Most cases of tailbone injury do not result in surgery, but people who don’t respond to therapy may require this type of intervention. Surgical methods can involve removing the entire tailbone in a coccygectomy or removing only some of the segments. These are most useful in those with hypermobility of the coccyx or new bone growth.
A fractured tailbone can take up to 12 weeks to heal. During this time, it can be helpful to change habits like your sleep to use a pillow between or under your knees and a firm mattress.
Stretches for Tailbone Injuries
If you suspect a tailbone injury, you should always consult with a doctor before performing any exercises to ensure that you do not worsen the problem. But if you are suffering only minor pain or have healed and want to continue addressing your tailbone, there are simple stretches you can do at home to encourage proper alignment and strength for the future.
- Single-leg knee hug: Lie down on your back and bend one knee toward your chest. Extend the foot straight out, holding the bent knee gently to the chest. Hold for 30 seconds, then repeat on the other side.
- Figure 4 stretch: Lie down on your back, raising your knees to the ceiling and keeping your feet flat on the floor. Bend one leg closer to the body, resting the ankle across your other knee. Loop your hands around the thigh, pulling it gently to your chest for 30 seconds. Repeat on the other side.
- Kneeling hip flexor stretch: Kneel on the floor, with one leg in front of you and the foot flat on the floor- your thigh should be at a 90-degree angle. Point your toes on the other foot backward. Rest your hands on your hips and lead forward very slightly to achieve a pelvic tilt. Hold for 30 seconds and repeat on the other side.
A physical therapist can also provide you with exercises designed for your specific injury. To work with an experienced physical therapist and a team of other specialists, you can visit AICA Snellville today. With diagnostic imaging on the premises and a team of experts, we will be able to diagnose your tailbone injury and develop a personalized treatment plan based on your needs.
Frequently Asked Questions
Who Is at Higher Risk for a Tailbone Fracture?
People with osteoporosis, postmenopausal women, and older adults are at greater risk for a tailbone fracture because decreased bone density can weaken the coccyx. Athletes who participate in high-impact sports and people who have previously injured their tailbone may also be more vulnerable to this type of injury. Obesity can increase pressure on the coccyx while sitting, which may contribute to the severity of this type of injury.
What Happens If a Tailbone Injury Is Left Untreated?
While many minor injuries heal on their own, any untreated tailbone trauma can lead to chronic pain, also known as coccydynia. Persistent inflammation can also interfere with discomfort while sitting, exercising, bowel movements, and even sexual activity. In rare cases, ongoing pain could indicate a more serious underlying condition that requires further medical attention.
Can You Tell the Difference Without an X-Ray?
It is difficult to definitively distinguish a bruise from a fracture without imaging. However, bruised tailbones often improve gradually within a few weeks, while fracture-related pain tends to remain sharp, severe, and persistent. If pain lasts longer than two weeks or significantly limits daily activity, a tailbone fracture X-ray may be recommended.
How Can You Prevent Tailbone Injuries?
Preventive measures include strengthening core and pelvic muscles, using proper cushioning during cycling or prolonged sitting, and addressing your bone health through regular screenings and adequate calcium and vitamin D intake. Practicing good posture and ergonomic seating can also help reduce long-term strain on the coccyx.
What Is Coccydynia?
Coccydynia is the medical term for persistent tailbone pain. It can develop after a bruise, fracture, or repeated irritation of the coccyx and may require targeted treatment such as physical therapy, injections, or other interventions if symptoms do not resolve on their own.