Cracking the Coccyx Code: A State-of-the-Art Review on Physical Therapy for Coccydynia

Background:Coccydynia, or tailbone pain, is a debilitating musculoskeletal condition affecting the coccygeal region, limiting daily activities like sitting and transitional movements. Despite its significant impact, it is often underdiagnosed or mismanaged, progressing to chronic symptoms. Common causes include trauma, prolonged sitting, childbirth-induced pelvic floor dysfunction, microtrauma, and idiopathic factors. In recent years, conservative approaches—particularly physiotherapy—have gained prominence for symptom relief and functional restoration. Objective:To review and synthesize current evidence on the efficacy of physiotherapy interventions in the conservative management of coccydynia and identify research gaps to inform future clinical guidelines. Methods:A comprehensive search of relevant randomized controlled trials (RCTs) was conducted in PubMed/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) using terms like “Coccydynia,” “Manual Therapy,” and “Pelvic Floor Rehabilitation. Outcomes of interest included pain, function, mobility, and patient satisfaction. Due to the heterogeneity of the included studies, a narrative synthesis was performed. ” Studies from 1990 to 2025 evaluating non-invasive physiotherapy in adults with acute or chronic coccydynia were included. Exclusions were studies focusing solely on surgical or pharmacological treatments. Results:Manual therapy techniques, especially internal and external coccygeal mobilizations, improved mobility and reduced pain. Pelvic floor re-education, biofeedback, McKenzie approach and muscle energy techniques (METs) were effective in addressing dysfunction. Postural retraining, ergonomic correction, and core stabilization exercises offered sustained relief. Electrotherapy, including TENS and ultrasound, provided adjunctive benefits. Limitations included lack of standardized protocols and long-term data. Conclusion:Physiotherapy plays a critical role in conservative coccydynia management. Multimodal, individualized plans integrating manual therapy, pelvic floor rehab, and education are most effective. However, further high-quality trials and standardized protocols are essential for improving care quality.