What is chronic coccyx pain?

Chronic coccyx pain – medically referred to as coccydynia – is persistent discomfort or pain in the tailbone area. This condition can significantly affect your ability to sit, drive, bend, or carry out normal day to day tasks. Coccyx pain is often caused by a specific trauma or injury, however in some cases, it can develop gradually, without a clear trigger.

At Complete, we understand how debilitating long-term tailbone pain can be. Our team, led by Sports Medicine specialist, Dr Matteo Bernardotto, offers expert diagnosis and advanced injection treatments that will target the source of your pain and help improve your quality of life.

Common Causes of Coccyx Pain (Coccydynia)

Chronic coccyx pain is more common in females than males, and affects adults more than children. can arise from a variety of causes,

• Trauma: This is one of the most common causes – falling directly onto the tailbone (e.g. slipping on ice or falling backwards or down the stairs) can cause soft tissue and bone bruising, dislocation, or even fracture of the coccyx.
• Childbirth: Vaginal delivery, particularly if prolonged or complicated, can strain the joints or ligaments around the coccyx.
• Repetitive Strain: Sitting for long periods, especially on hard, narrow, or uneven surfaces, can irritate the coccyx over time.
• Poor Posture: When we slouch or lean backwards while sitting, it can increase the pressure going through the tailbone and cause pain and irritation.
• Degenerative Conditions: Age-related wear and tear or joint inflammation can also be a common cause of chronic coccydynia.
• Weight gain or weight loss: With added bodyweight, the coccyx is put under more pressure while sitting. With rapid weight loss, the cushioning around the coccyx may be lost, also causing more pressure on the area.
• Idiopathic Pain: In some cases, no specific cause is found, which can be particularly frustrating for patients.

Typical Symptoms

Symptoms can vary between patients, however below are some of the most common symptoms that patients describe:

• Pain or tenderness at the base of the spine, especially when sitting. This can be a dull ache or sharp pain.
• Discomfort that worsens with prolonged sitting or when rising from a seated position.
• Not being able to sit in a comfortable position – patients often sit with weight on one buttock.
• Pain when leaning back in a chair or bending forwards.
• Localised pain over the tailbone, that may spread into the lower back or buttocks.
• In some cases, pain during bowel movements or sexual activity.

What else could be causing chronic coccyx pain?

Not all pain felt around the tailbone originates from the coccyx itself.

A thorough assessment is essential to rule out other conditions that can mimic coccyx pain. One of the most common alternative sources is the sacroiliac joint (SIJ). Inflammation or dysfunction in this joint can refer pain down to the coccyx or buttock area.

Other possible causes include lumbar spine pathology (such as degenerative disc disease, or facet joint dysfunction), piriformis syndrome or pelvic floor dysfunction.

Referred gynaecological, urological, or gastrointestinal pain can also present in this area.

In rare cases, bone tumours, cysts, or infections may be responsible, which is why at Complete Injections, we ensure any serious or alternative diagnoses are considered and excluded before moving forward with targeted coccyx treatments.

How do we diagnose chronic coccyx pain?

At Complete, diagnosis begins with a thorough clinical consultation. We’ll ask about your symptoms, medical history, lifestyle, and any previous injuries.

Your specialist will then carry out a clinical examination, looking and palpating carefully around the area of discomfort.

Our team may recommend imaging to support your diagnosis or to rule out any other causes.

• X-rays – can be used to detect abnormal positioning of the coccyx, dislocation or fractures.
• MRI scans – are useful for assessing soft tissue inflammation, cysts, or tumours.
• Diagnostic injections – A steroid injection into the coccyx can be used to confirm the exact cause of your pain.

What are the best treatments for chronic coccyx pain?

Treatment options include:

• Home treatments: NSAIDs and painkillers, hot/cold therapy, and specialised cushions to reduce pressure when sitting.
• Physiotherapy: Stretching, core strengthening exercises, Specialist pelvic floor physiotherapy, manual therapy and massage, acupuncture for pain relief, advice on activity modification and posture.
• Injections: Corticosteroids or nerve blocks.

Injection Treatments for Coccyx Pain

Ultrasound guided injection therapy is a highly effective option for patients whose symptoms haven’t improved with conservative measures like rest, cushions, or physiotherapy.

At Complete, all coccyx injection procedures are carried out by Dr Matteo Bernardotto, a Consultant in Sports and Exercise Medicine with specialist expertise in ultrasound guided injections.

Coccygeal Joint Injection

This involves injecting a mixture of local anaesthetic and corticosteroid into the coccyx joints (sacrococcygeal or intercoccygeal joints).

It’s ideal for cases where pain is suspected to come from joint inflammation or arthritic changes.

• Purpose: It reduces local inflammation and provides diagnostic clarity.
• Effectiveness: Relief often begins within a few days and can last several months.
• Imaging: All injections are guided by ultrasound for precision.

When are injections appropriate?

At Complete, we always advocate for a stepwise approach to managing coccyx pain, with physiotherapy as the first-line treatment.

In many cases, hands-on therapy, postural retraining, and pelvic floor rehabilitation can lead to long-term improvement. However, when symptoms are particularly acute or severe, patients often find it too painful to engage fully in their rehabilitation, making progress difficult or impossible.

In these situations, a targeted injection can be an effective short-term solution to break the pain cycle. While injections can provide excellent relief, it’s important to understand they are not a standalone or long-term fix.

Instead, we use them to create a “window of opportunity” – a period where pain is significantly reduced, allowing patients to fully participate in a physiotherapy programme aimed at addressing the underlying causes and preventing recurrence.

What happens during the procedure?

All coccyx injections at Complete, are performed in a clean, controlled outpatient setting. The process usually involves:

1. Lying face down on a treatment couch/ table.
2. The skin is thoroughly cleaned and numbed with a local anaesthetic.
3. Using ultrasound guidance, a small needle is directed precisely to the affected area.
4. The injection is administered, and patients are kept in the clinic for observation before being allowed home.

Most procedures take around 15–30 minutes and cause minimal discomfort

Aftercare and Results

• You may feel some local soreness at the injection site for approximately 24 – 48 hours.
• Pain relief often begins within a few days but may take up to a week to take full effect.
• Some patients need one injection; others may benefit from a short series over several months.

We’ll provide a full aftercare plan, including a review appointment and onward referral to physiotherapy; which is a vital part of your treatment, to ensure long term recovery.

Can injections be repeated?

Yes, repeat injections can be an option in the management of chronic coccyx pain, particularly if the initial injection was effective but only provided temporary relief.

If a patient experiences significant improvement following the first injection, typically lasting several weeks or months, it’s reasonable to consider a repeat injection if symptoms return and continue to interfere with daily activities.

In some cases, a series of two to three injections spaced over several months may be used as part of a broader treatment strategy, particularly when used with ongoing physiotherapy intervention.

However, injections are not intended to be given indefinitely. If multiple injections provide only short-term benefit or minimal relief, it may be a sign that the pain is stemming from another structure or that a different approach is needed.

At Complete, Dr Matteo Bernardotto will assess your response to each injection and work with you to develop a long-term plan, ensuring that any further injections are used with caution, and always in combination with rehabilitation to address the root cause of your symptoms.

What if injections don’t work?

While many patients experience excellent relief with injection therapy, a small number may require further intervention. If injections are ineffective, we may refer you for:

• Further imaging or diagnostic review
• Surgical opinion (e.g. for coccygectomy) – though this is very rare and only considered when all other options are exhausted.

At Complete we work with a multidisciplinary team of musculoskeletal physiotherapists, strength and conditioning coaches, pilates instructors and women’s health physiotherapists. We can also refer to trusted orthopaedic and rheumatology consultants if a second option is required.

Why choose Complete?

• All coccyx injections are consultant-led and performed by Dr Matteo Bernardotto, a specialist in musculoskeletal and spinal pain with extensive experience in coccyx-related conditions.
• Access to evidence based, ultrasound-guided techniques which ensures a more precise and effective treatment.
• We work closely with physiotherapists and other specialists for a joined-up holistic approach to your care.

Book a Consultation

If you’ve been struggling with tailbone pain that’s affecting your quality of life, help is available.

Book a consultation with Dr Matteo Bernardotto at Complete to explore your options for diagnosis and targeted treatment.

To book an appointment or make an enquiry, please email info@complete-physio.co.uk or call 020 7482 3875.