"My back hurts" can mean a lot of different things — and one of the most commonly confused (and mistreated) pain patterns is tailbone pain that gets lumped in with general low back pain. They're not the same condition, and treating one like the other usually means treatment that doesn't work.
## Where the Pain Actually Is
**Tailbone pain (coccydynia)** is felt at the very base of the spine — the small, pointed bone you can feel if you press just above where your glutes meet. It's typically:
- Sharp or localized directly at the tailbone
- Worse with direct sitting pressure, especially on hard surfaces
- Aggravated by leaning back while seated
- Often painful when standing up from sitting
- Sometimes worse during bowel movements
**Lower back pain** is felt higher up, across the lumbar spine and often into the hips or buttocks. It's typically:
- Broader and less localized
- Worse with bending, lifting, or twisting
- Often accompanied by stiffness in the morning
- Sometimes radiating down one or both legs (which tailbone pain rarely does)
## Why the Distinction Matters
Lower back pain is frequently addressed with core strengthening, spinal mobility work, and general postural correction. While that approach can be part of a coccydynia treatment plan too, it misses the piece that actually resolves most tailbone pain: the pelvic floor.
The muscles and ligaments that attach to the coccyx are part of the pelvic floor, not the lumbar spine. If those muscles are tight, guarded, or imbalanced — from an old injury, childbirth, prolonged sitting, or postural habits — general back exercises won't touch the source of the pain, and can sometimes aggravate it.
## Can You Have Both at Once?
Yes, and it's fairly common. Pelvic floor tension and lumbar spine dysfunction often develop together, especially after pregnancy, prolonged sitting jobs, or a fall. This is exactly why a thorough evaluation matters — treating only the back when the tailbone is the real driver (or vice versa) leaves you stuck in a cycle of partial relief.
## How to Know Which One You're Dealing With
A few quick self-check questions:
- Does pressing directly on your tailbone reproduce the pain? → Points toward coccydynia
- Is the pain worse with bending or lifting rather than sitting? → Points toward lumbar back pain
- Does pain radiate down your leg? → More typical of lumbar spine involvement
- Is standing up from a chair the worst part of your day? → Common with coccydynia
These are starting points, not a diagnosis — an in-person evaluation is the most reliable way to know for sure.
## Getting the Right Evaluation
A pelvic floor physical therapist is trained to assess both the coccyx and the surrounding pelvic floor musculature — something general orthopedic back treatment typically doesn't include. If your "back pain" isn't responding to standard treatment, it may be worth asking whether the tailbone, not the lumbar spine, is the actual source.
*Learn more about tailbone pain and coccydynia treatment at Sharp Ortho & Pelvic Physical Therapy, or call 205-515-0258 to schedule an evaluation.*
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**Sharp Ortho & Pelvic Physical Therapy**
Kaye Sharp, MPT, WHC | 2481 Valleydale Rd, Hoover, AL 35244 | 205-515-0258 | sharpphysicaltherapy.com
