What Muscles Cause Tailbone Pain? Complete Anatomy Guide

Tailbone pain (coccydynia) is one of the most frustrating conditions—it makes sitting unbearable and can persist for months or years. While the coccyx itself can be injured, many cases of tailbone pain are actually muscular in origin, arising from muscles that attach to or near this small but important bone.

This guide maps the muscular anatomy of tailbone pain and explains why it's so often misdiagnosed.

Understanding the Coccyx

The coccyx (tailbone) is a small triangular bone at the very bottom of your spine, consisting of 3-5 fused vertebrae. Despite its small size, multiple muscles attach to it, making it a intersection point for pelvic floor and hip mechanics.

Key functions:

• Attachment point for muscles and ligaments
• Support for pelvic floor
• Weight-bearing during sitting
• Stabilization for sitting and standing transitions

Muscles That Attach to the Coccyx

1. Gluteus Maximus — The Direct Attacher

Impact: VERY HIGH

The largest muscle in your body attaches directly to the coccyx and sacrum.

Why it causes tailbone pain:

• Direct attachment to coccyx creates pull
• Trigger points refer to sacrum and coccyx area
• Tightness can pull on the tailbone
• Sitting compresses glute max against coccyx

The sitting mechanism: When sitting, especially on hard surfaces, the coccyx bears weight AND glute max is compressed against it. Trigger points in glute max near the coccyx attachment create direct tailbone area pain.

2. Levator Ani — The Pelvic Floor Foundation

Impact: VERY HIGH

The levator ani is a group of muscles forming the main part of the pelvic floor:

• Pubococcygeus
• Puborectalis
• Iliococcygeus

Several portions attach to the coccyx.

Why it causes tailbone pain:

• Direct coccyx attachments
• Tension pulls on the tailbone
• Trigger points create deep pelvic/tailbone pain
• Often involved in chronic coccydynia

The pelvic floor connection: Hypertonic (overly tight) pelvic floor muscles are a major cause of persistent tailbone pain. The muscles pull constantly on the coccyx, creating pain that doesn't resolve with typical treatments.

3. Coccygeus (Ischiococcygeus) — The Direct Coccyx Muscle

Impact: HIGH

This muscle runs from the ischial spine to the sacrum and coccyx. It's literally named for its coccyx attachment.

Why it causes tailbone pain:

• Primary attachment is the coccyx
• Supports the coccyx position
• Tension or trigger points create direct tailbone pain
• Often tight alongside other pelvic floor muscles

4. Piriformis — The Deep Rotator Neighbor

Impact: MODERATE-HIGH

While piriformis doesn't attach to the coccyx, it attaches to the nearby sacrum and its dysfunction affects the entire sacrococcygeal region.

Why it causes tailbone pain:

• Close proximity to coccyx
• Trigger points refer to sacrococcygeal area
• Tightness affects overall pelvic mechanics
• Often involved in complex pelvic pain

5. External Anal Sphincter — The Overlooked Muscle

Impact: MODERATE

This muscle surrounds the anus and attaches to the coccyx via the anococcygeal ligament.

Why it causes tailbone pain:

• Direct coccyx connection via ligament
• Tension can pull on tailbone
• Often involved with other pelvic floor tension
• May be tender with internal examination

6. Gluteus Medius and Minimus — The Neighbors

Impact: MODERATE

While not attaching to the coccyx, trigger points in these muscles can refer pain to the sacrococcygeal region.

Why they contribute:

• Trigger points refer toward midline/sacrum
• Part of overall gluteal dysfunction pattern
• Often involved with glute max problems

7. Obturator Internus — The Deep Pelvic Muscle

Impact: MODERATE

A deep hip rotator that's part of the pelvic floor complex.

Why it causes tailbone pain:

• Part of pelvic floor muscle system
• Trigger points create deep pelvic pain
• Often tight alongside coccygeus and levator ani
• Can refer pain toward tailbone region

Non-Muscular Causes to Consider

Before assuming muscular cause, consider:

Coccyx itself:

• Fracture (from fall or childbirth)
• Dislocation or hypermobility
• Bone bruise
• Degenerative changes

Other structures:

• Sacrococcygeal joint dysfunction
• Pilonidal cyst
• Tumors (rare)
• Referred pain from lumbar spine

The evaluation: Imaging can rule out fracture or dislocation. If imaging is negative and the tailbone isn't unstable, muscular causes become more likely.

Why Tailbone Pain Becomes Chronic

The cycle:

1. Initial injury or strain (fall, childbirth, prolonged sitting)
2. Pelvic floor muscles tighten protectively
3. Muscle tension pulls on coccyx
4. Pain continues even after initial injury heals
5. More guarding, more tension, more pain
6. Chronic pain develops

The pelvic floor factor: Many people with chronic coccydynia have hypertonic pelvic floors—muscles that are constantly contracted. Even after the original injury heals, the muscle tension perpetuates the pain.

Coccydynia Patterns

Pattern 1: Post-Traumatic (Fall)

Cause: Direct impact to tailbone Initial: Possible fracture or bruise Chronic: Muscle guarding persists, pelvic floor tightens Treatment: Address muscle tension once fracture heals

Pattern 2: Post-Partum

Cause: Childbirth trauma (baby passing over coccyx) Initial: Possible dislocation, ligament strain Chronic: Pelvic floor dysfunction persists Treatment: Pelvic floor PT essential

Pattern 3: Insidious/Sitting-Related

Cause: Prolonged sitting, poor sitting posture Initial: No specific injury Development: Gradual muscle tension accumulation Treatment: Ergonomics + muscle treatment

Pattern 4: Tension/Stress-Related

Cause: Chronic stress, anxiety, tension holding Mechanism: Pelvic floor "clenches" with stress (like jaw) Associated: Often have jaw clenching, shoulder tension Treatment: Stress management + pelvic floor relaxation

The Treatment Framework

Step 1: Rule Out Structural Issues

X-ray (seated and standing) can assess:

• Fracture
• Dislocation
• Hypermobility
• Bony abnormalities

If structural issues ruled out, proceed with muscular treatment.

Step 2: External Muscle Release

Gluteus maximus:

• Lacrosse ball, targeting area near coccyx
• Be gentle—may be very tender
• Sustained pressure, not aggressive

Piriformis:

• Standard piriformis release techniques
• Ball work, stretching

Glute medius/minimus:

• If tender and referring toward midline
• Standard release techniques

Step 3: Pelvic Floor Assessment and Treatment

This is often the key to resolution.

Signs of pelvic floor involvement:

• Pain with sitting that persists despite other treatment
• Pain that varies with stress
• Associated symptoms (urinary, bowel, sexual dysfunction)
• History of trauma, surgery, or childbirth

Pelvic floor treatment:

• Internal manual therapy (by specialized PT)
• Pelvic floor relaxation techniques
• Reverse Kegels (learning to release, not just contract)
• Breathing coordination

Why pelvic floor PT is often needed: The coccygeus and levator ani can't be effectively treated externally. Internal release (through rectum) is often necessary for complete treatment.

Step 4: Stretching and Relaxation

Deep squat stretch:

• Feet wide, full squat position
• Relaxes pelvic floor muscles
• Hold 30-60 seconds

Happy baby pose:

• On back, knees to armpits, hold feet
• Gentle pelvic floor stretch
• Breathe and relax

Child's pose:

• Wide knee child's pose
• Relaxes gluteals and pelvic floor
• Breathe into the pelvis

Step 5: Address Sitting

Cushion support:

• Coccyx cutout cushion (wedge with hole)
• Reduces direct pressure on tailbone
• Essential for healing

Sitting posture:

• Weight on sit bones, not tailbone
• Avoid slumping back
• Regular position changes

Reduce sitting duration:

• Standing desk options
• Frequent breaks
• Alternative positions

Step 6: Breathing and Relaxation

Diaphragmatic breathing:

• Pelvic floor relaxes with proper breathing
• Belly expands on inhale, pelvic floor descends
• Practice daily

Stress management:

• If tension-related, address underlying stress
• Body-wide relaxation practices
• May need mental health support

Advanced Treatment Options

If conservative treatment fails:

Injections:

• Trigger point injections to pelvic floor (internal)
• Coccygeal nerve blocks
• May provide relief and confirm muscular cause

Manipulation:

• Internal coccyx manipulation
• Can help if joint is malpositioned
• Should be done by specialist

Surgery (last resort):

• Coccygectomy (removal of coccyx)
• Only after extensive conservative treatment fails
• Success rates vary (60-90%)

Prevention and Long-Term Management

Sitting habits:

• Use cushion support
• Avoid prolonged sitting
• Regular movement breaks

Pelvic floor awareness:

• Learn to relax (not just strengthen)
• Regular stretching
• Stress management

Overall health:

• Core stability
• Hip mobility
• Stress management

The Bottom Line

Tailbone pain is often muscular:

Primary muscles:

1. Gluteus maximus — direct coccyx attachment
2. Levator ani/pelvic floor — often the key to chronic cases
3. Coccygeus — the coccyx muscle
4. Piriformis — nearby contributor

Key insights:

• Chronic coccydynia often involves hypertonic pelvic floor
• External treatment alone may not be enough
• Pelvic floor PT is often essential for resolution
• Sitting modifications are necessary during healing

The treatment approach:

1. Rule out structural issues (imaging)
2. External muscle release (glutes, piriformis)
3. Pelvic floor evaluation and treatment (often internal)
4. Sitting modifications (cushion, posture, duration)
5. Relaxation and breathing work

Many people suffer with tailbone pain for years before getting proper pelvic floor assessment. If your tailbone pain isn't resolving, consider seeing a pelvic floor physical therapist—the pelvic floor muscles are often the missing piece.

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Ready to address your tailbone pain? Explore our pelvic health programs designed to release the muscles that attach to and affect your coccyx.