Coccygeal Fracture

The commonest mechanism is a direct fall onto the buttocks — for example slipping on ice or stairs and landing on the tailbone. The coccyx can also be injured during childbirth, particularly a difficult delivery, and, less often, by a direct blow or by repeated pressure from prolonged sitting on hard surfaces. Because the coccyx sits right at the base of the spine and takes the impact of a backward fall, it is well placed to be injured in this way.

The dominant symptom is pain and tenderness right at the base of the spine, over the tailbone. Very characteristically, the pain is worse when sitting — especially on a hard surface or leaning back — and when rising from a seated position, and it is often eased by standing or by sitting leaning slightly forward. There may be bruising, and passing a bowel motion can be uncomfortable. The pain can be significant and can make everyday sitting difficult during the healing period.

The diagnosis is often made clinically, from the history of a fall onto the buttocks and the characteristic tenderness over the coccyx. Plain X-rays of the coccyx are frequently taken but are of limited value, as fractures and normal variation can be hard to distinguish and the findings do not always change the management. Where pain is severe or persistent, specialised "sit-and-stand" X-rays taken while sitting, or an MRI scan, can be used to look more closely at the coccyx and to exclude other causes of tailbone pain.

The great majority of coccygeal fractures are managed without surgery, and most heal over a period of weeks. The mainstays are simple: pain relief with anti-inflammatory and analgesic medication, and measures to take pressure off the tailbone when sitting — most usefully a specially shaped cushion (a wedge or "doughnut" cushion) and avoiding prolonged sitting on hard surfaces. Softening the stool to make bowel motions more comfortable can help in the early stages. Activity is modified as needed while the bone heals.

In a minority of people, pain at the tailbone persists for months (chronic coccydynia). For these cases, additional treatments can be considered before any thought of surgery, including targeted injections of local anaesthetic and steroid around the coccyx, physiotherapy, and other pain-management measures. Surgical removal of the coccyx (coccygectomy) is rarely needed and is reserved for carefully selected people with severe, persistent pain that has not responded to a thorough course of non-surgical treatment over many months.

The outlook is generally very good. Most coccygeal fractures heal with conservative care, with the pain gradually settling over several weeks, though full resolution can occasionally take longer. A small proportion of people develop persistent tailbone pain that requires the additional measures described above. Even in these cases, most improve with non-surgical treatment, and surgery is needed only rarely.

Myth: "A broken tailbone needs to be put in a cast." Fact: The coccyx cannot be cast; treatment is pain relief and taking pressure off the area while it heals.

Myth: "You need an X-ray to diagnose it." Fact: The diagnosis is often clinical; X-rays are of limited value and are not always necessary.

Myth: "A broken tailbone usually means surgery." Fact: The great majority heal without surgery; coccygectomy is rarely needed and only for refractory pain.

This page is for general education and does not replace an individual assessment. Treatment depends on a person's specific symptoms, examination findings, imaging findings and overall health, and should always be discussed with a suitably qualified healthcare professional.

The coccyx, commonly called the tailbone, is the small, triangular group of fused bones at the very bottom of the spine, below the sacrum. A coccygeal fracture is a break of this bone. The usual cause is a fall onto the buttocks, and it can also occur during childbirth. The main problem it causes is pain at the base of the spine — known as coccydynia — which is characteristically worse when sitting and when moving from sitting to standing. It is a painful but rarely serious injury, and the overwhelming majority heal well with straightforward measures. This page explains how a coccygeal fracture happens, how it is diagnosed, and how it is managed.

• —Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84-87. (PMID: 24688338)
• —Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br. 2010;92(12):1622-1627. doi:10.1302/0301-620X.92B12.25486
• —Foye PM. Coccydynia: Tailbone Pain. Phys Med Rehabil Clin N Am. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006
• —Patel R, Appannagari A, Whang PG. Coccydynia. Curr Rev Musculoskelet Med. 2008;1(3-4):223-226. doi:10.1007/s12178-008-9028-1
• —Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976). 2000;25(23):3072-3079. doi:10.1097/00007632-200012010-00015
• —Fogel GR, Cunningham PY 3rd, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12(1):49-54. doi:10.5435/00124635-200401000-00007
• —Trollegaard AM, Aarby NS, Hellberg S. Coccygectomy: an effective treatment option for chronic coccydynia: retrospective results in 41 consecutive patients. J Bone Joint Surg Br. 2010;92(2):242-245. doi:10.1302/0301-620X.92B2.23030
• —Karadimas EJ, Trypsiannis G, Giannoudis PV. Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J. 2011;20(5):698-705. doi:10.1007/s00586-010-1617-1
• —Antoniadis A, Ulrich NH, Senyurt H. Coccygectomy as a surgical option in the treatment of chronic traumatic coccygodynia: a single-center experience and literature review. Asian Spine J. 2014;8(6):705-710. doi:10.4184/asj.2014.8.6.705
• —Marinko LN, Pecci M. Clinical decision making for the evaluation and management of coccydynia: 2 case reports. J Orthop Sports Phys Ther. 2014;44(8):615-621. doi:10.2519/jospt.2014.4850
• —Guideline note (place near references): No dedicated NICE or AAOS clinical practice guideline specific to coccygeal fracture or coccydynia was identified at the time of writing; management follows peer-reviewed evidence and specialist consensus.

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.