Coccyx pain can feel stubborn, confusing, and disproportionately disruptive for something so small. And while many of us have been taught to focus primarily on the coccygeus muscles or direct coccyx mobility, there’s a bigger picture at play – one that may completely change how you assess and treat tailbone pain.

If you’ve ever worked with a postpartum client who says,

“Everything else is improving… but my tailbone still hurts,”

this one’s for you.

Let’s talk about the coccyx tug-of-war.

Why Coccyx Pain Is So Common After Birth

We know childbirth places enormous pressure on the tailbone. The coccyx can fracture, dislocate, or get pulled into dysfunctional positions as the baby moves through the pelvis. But even without structural injury, tension patterns can linger long after delivery.

And here’s the key insight:

The coccyx doesn’t exist in isolation.
It’s being pulled from multiple directions at once.

When pain persists, it’s often because we’re only addressing one of those forces.

The 3 Directions You Must Address for Coccyx Pain Relief

To truly help the coccyx settle, heal, and move comfortably again, we need to think laterally, posteriorly, and anteriorly.

1. Lateral Pull: The Coccygeus Muscles

The coccygeus muscles attach on either side of the coccyx and play a huge role in its side-to-side balance.

What to assess:

• Is tension bilateral and equal?
• Or is one side clearly more restricted?

Why it matters:

• Bilateral tension often suggests the sacrum is stuck in flexion.
• Unilateral tension commonly points to the classic postpartum pattern – sacral deviation (often to the right).

When lateral tension isn’t addressed, the coccyx can’t achieve even, comfortable mobility. Gentle tissue release (including techniques like the Schulte Hold) can help calm these tissues and reduce strain on the tailbone.

A “happy” coccyx needs balanced lateral forces.

2. Posterior Pull: Sacral Flexion

This is the piece that’s often underestimated.

If the sacrum is stuck in flexion, the tip of the coccyx is pulled posteriorly. That means constant tension at the base of the spine – even if the coccyx itself seems mobile.

Here’s where things get interesting.

At the tip of the coccyx lives the anococcygeal raphe, a connective tissue structure that links directly into the sphincter complex.

So when the sacrum stays flexed:

• The coccyx is pulled backward
• The coccygeal raphe tightens
• The sphincter complex gets dragged into the equation

Which brings us to the real “aha.”

3. Anterior Pull: The Sphincter Complex

Picture this – the coccyx is literally caught in a tug of war between:

• The sacrum pulling posteriorly
• The sphincter complex pulling anteriorly
• And the coccygeus muscles pulling side to side

No wonder it’s irritated.

After birth, the sphincter complex is dramatically stretched – sometimes many times its resting length. Knots and residual tension are incredibly common (and very under-addressed).

Why this matters clinically:

• Tension in the sphincter complex can prevent full closure
• Clients may report excessive wiping or incomplete evacuation
• Increased tone in the lower half of the sphincter often correlates with sacral flexion and coccygeal tension

A healthy sphincter should feel like a closed front door. You should have to “knock” before entering. If there’s no resistance at all, it’s often not weakness – it’s unresolved tension that needs to be released so the muscle can actually close again.

And yes – when you feel that reflexive closure return during treatment?
That’s a win!

Why Treating One Area Isn’t Enough

You can mobilize the coccyx all day long, but if:

• The sacrum remains stuck in flexion
• The sphincter complex stays knotted and reactive
• The coccygeus muscles keep pulling asymmetrically

…the tailbone will stay irritated.

True resolution comes from addressing all directions of force:

• Laterally: coccygeus balance
• Posteriorly: sacral flexion
• Anteriorly: sphincter complex release

Only then does the coccyx finally get out of the middle of the fight.

What This Means for Your Clinical Practice

If you’re working with clients who have:

• Persistent tailbone pain
• Postpartum bowel dysfunction
• A sense that “something still isn’t right” despite exercise and strengthening

This integrated approach can be a game changer.

When the bones are in better alignment:

• Muscles can release
• Nervous system tone can downregulate
• Function returns more naturally

And your clients feel the difference.

For the Week Ahead

As you head into clinic, keep this fact in mind:

The coccyx isn’t stubborn.
It’s just overstretched, over-pulled, and under-supported.

When you relieve tension anteriorly, posteriorly, and laterally, you give that tailbone, and your client, a real chance to heal.

Here’s to smoother births, faster recoveries, and far less tailbone pain. 💛

To learn more about working with the pelvic patterns, check out the Treating the Postpartum Pelvis course.

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com