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How Is the Tailbone Connected to the Pelvic Floor?
The coccyx is located at the very bottom of the sacrum.
Despite its small size, it has important anatomical relationships with muscles and ligaments throughout the pelvis.
Several pelvic floor muscles have attachments on or near the coccyx. The tailbone also has connections with ligaments and other soft tissues that help support the pelvis.
Because of these connections, the coccyx and pelvic floor don’t function completely independently of one another.
Changes in coccyx mobility or position can change the mechanical environment of the tissues attached around it.
What Happens When the Tailbone Is Flexed Forward?
The coccyx normally has some degree of curvature, and normal anatomy varies from person to person.
In some patients, however, the tailbone may be positioned farther forward or have limited mobility.
When evaluating someone with tailbone pain, a pelvic floor physical therapist may assess whether the coccyx moves appropriately and whether the muscles and connective tissues surrounding it are excessively tense or sensitive.
A more flexed coccyx doesn’t automatically mean something is wrong. But when coccyx position or mobility corresponds with a patient’s symptoms and examination findings, it may become an important part of treatment.
How Can Tailbone Position Affect Pelvic Floor Tension?
Think of the coccyx as one of several attachment points within the pelvic floor.
If its position changes, the relationship between the tailbone and the tissues attached to it changes as well.
When a restricted coccyx is able to move into a more comfortable position, the surrounding pelvic floor tissues may have more room to lengthen and move.
That’s particularly relevant when someone has an overactive or tight pelvic floor.
Rather than simply trying to stretch an individual pelvic floor muscle, treatment may need to address the structures influencing that muscle’s position and mobility.
What About the Bladder, Uterus, and Rectum?
The pelvic organs—including the bladder, uterus in people who have one, and rectum—are supported within a complex system of fascia, ligaments, and pelvic floor muscles.
However, it’s important not to think of these organs as being directly stretched simply because the tailbone moves.
Instead, changing coccyx position can alter tension and spatial relationships among the muscles and connective tissues within the pelvis.
That’s one reason pelvic health treatment considers the pelvis as an interconnected system rather than treating each structure in isolation.
Can a Physical Therapist Mobilize the Tailbone?
For certain patients, yes.
A pelvic floor physical therapist with appropriate training may assess coccyx position and mobility as part of a comprehensive examination.
If restrictions are found and appear relevant to the patient’s symptoms, treatment may include gentle manual techniques directed at the coccyx and surrounding tissues.
The goal isn’t simply to force the tailbone into a predetermined “correct” position.
Instead, treatment focuses on improving mobility, reducing sensitivity, and helping the surrounding pelvic floor tissues function more normally when coccyx dysfunction appears to be contributing to symptoms.
When Should the Tailbone Be Evaluated?
A coccyx assessment may be worth considering when someone experiences symptoms such as:
- Persistent tailbone pain
- Pain while sitting
- Pain when transitioning from sitting to standing
- Pelvic floor tightness
- Pain with bowel movements
- Pelvic pain following a fall or childbirth
- Symptoms that haven’t improved despite treating other areas
Not everyone with pelvic floor dysfunction has a tailbone problem, and not everyone with an unusually shaped or positioned coccyx needs treatment.
The important question is whether the coccyx appears to be contributing to the individual’s symptoms.
The Bottom Line
The tailbone is more than a small bone at the bottom of your spine.
Because pelvic floor muscles, ligaments, and connective tissues have important relationships with the coccyx, changes in its mobility or position can influence how the surrounding tissues function.
For some patients, improving coccyx mobility may help the pelvic floor tissues move and lengthen more comfortably.
If you’re experiencing persistent tailbone or pelvic pain, a pelvic floor physical therapy evaluation can help determine whether coccyx dysfunction is part of the problem and whether it should be addressed as part of your treatment plan.
