Tailbone Hurts After Falling on Your Backside? Rule Out a Fracture First

You miss a few stairs, or slip on the bathroom floor or an icy patch, and your body reflexively drops straight down onto your backside. A sharp jolt shoots through the tip of your tailbone the instant you land, and within a few minutes it's throbbing badly enough that just sitting feels unbearable. Getting up and walking around is more or less fine, but the moment you try to sit in a chair, that same sharp pain comes rushing back.

Searching for this usually turns up articles on chronic tailbone pain (coccydynia) that builds up from long hours of sitting, but pain right after landing hard on your backside is a different animal. Because it came from a single sudden impact, it could be a simple bruise, a partial dislocation where the joint shifted slightly out of place from stretched ligaments, or, less commonly, an actual fracture of the tailbone itself. The tailbone sits deep within the pelvis, so visible bruising or swelling alone isn't enough to tell the three apart with confidence — and even a standard X-ray can miss it, which is exactly why even doctors sometimes find this a tricky call.

This guide walks through, in order, what to do in the first few minutes after the fall, how to check yourself for signs that lean toward a fracture, the line between needing the ER immediately versus watching it for a few days, and — importantly — a staged approach to posture and cushioning that eases the pain that flares up every time you sit, followed by what rehab looks like once the pain has settled. NIR care shows up in this sequence only as a supportive step for easing muscle and ligament tension once the acute phase has passed — to be upfront, it is not a way to judge whether a bone is broken, nor a way to treat a fracture or dislocation itself.

What Happens to the Tailbone the Instant You Land on It

The tailbone (coccyx) is made of 3 to 5 small bone segments strung together at the very end of the spine, and unlike the rest of the spine, its position actually shifts a little depending on whether you're standing or sitting. The instant you sit down, the pelvis tilts backward and the tip of the tailbone flexes slightly forward — and that last joint, the sacrococcygeal joint, is what absorbs that motion. When you land hard on your backside, the force in that instant exceeds what that joint can cushion, and the result falls into one of three categories of injury.

A Bruise: The Bone Is Fine, But the Surrounding Tissue Got Compressed

This is the most common outcome — the bone itself stays intact, but the periosteum covering it and the surrounding ligaments and muscle bruise and swell from the sudden compression. Sitting hurts a lot at first, but the pain typically eases gradually over time.

A Partial Dislocation: The Joint Shifts Slightly Out of Place

If the ligaments supporting the sacrococcygeal joint or the joints between the coccygeal segments stretch, the bone segments can end up shifted out of their normal position and stay that way. It's not as severe as a fracture, but because that shifted position gets compressed again every time you sit, the pain here tends to linger longer.

A Fracture: An Actual Crack or Break in the Bone

With a harder impact, or in someone with a leaner build and less cushioning fat over the area, the coccyx segments themselves can crack or break. Unlike fractures elsewhere, a standard X-ray taken in a standing position often doesn't show the fracture line clearly here, which is exactly what makes the tailbone notoriously difficult to diagnose.

How Often Does a Fall Lead to Chronic Pain?

A study by Maigne, Doursounian, and Chatellier at Cochin Hospital in Paris, published in the journal Spine in 2000, analyzed how more than 200 patients seeking care for chronic tailbone pain (coccydynia) first developed their symptoms. A traumatic onset — falling into a seated position and landing on the tailbone — accounted for a substantial share of cases, and patients whose pain developed gradually with no clear trauma tended to have a significantly higher body mass index (BMI) than those with a traumatic onset. This is a retrospective study of patients who had already sought care at a specialty pain clinic for chronic symptoms, so it comes with a real limitation — it doesn't mean everyone who lands hard on their tailbone ends up with chronic pain. Even so, it's cited often because it backs up why a fall-related injury shouldn't be brushed off.

Your Natural Coccyx Shape Also Affects How Pain Plays Out

A study by Postacchini and Massobrio, a research team in Rome, Italy, published in the Journal of Bone and Joint Surgery (American volume) in 1983, analyzed side-view X-rays of the coccyx and classified its shape into four types, ranging from a gently forward-curved form to one where the joint itself is subluxated. The clinical significance of this classification is that pressure distribution while sitting differs by type — someone whose coccyx is naturally curved at a sharper angle, or whose joint is looser to begin with, may end up with longer-lasting pain from the same-intensity fall than someone else. This was a radiographic study analyzing both a surgical patient group and an asymptomatic control group, and it comes with the limitation that the classification alone doesn't explain every cause of pain — but it's a useful reference for understanding why recovery speed can vary from person to person even after an identical fall.

Either Way, the First Response Is the Same

Right now, there's no way to know for certain whether it's a bruise, a partial dislocation, or a fracture. The first-aid steps in the next section apply the same way regardless of which one it turns out to be, so the exact diagnosis can wait for a doctor — what matters right now is working through what needs to happen immediately, in order.

Right After the Fall: What to Do This Instant

Whether it turns out to be a fracture or a simple bruise, what you do in the first few minutes after the fall is identical. Work through these in order.

1. Don't Sit Back Down Right Away — Lie on Your Side

If you sit straight back down on the floor or a chair just to check how it feels, the injured area takes your full weight again immediately and the pain gets worse. Instead, lie on your side or lie face-down for a bit and see whether the pain settles.

2. Start Icing It

Wrap ice in a towel or a plastic bag and apply it to the tailbone area for 15-20 minutes, repeating every 2-3 hours. Never place ice directly on skin, since that risks frostbite — always wrap it in cloth. Lying face-down makes it easier to hold the ice pack in place.

3. Get a Wedge Cushion Ready Before a Donut Cushion

If you need to move around, a wedge-shaped cushion with a V-shaped cutout for the tailbone is a better choice than a ring-shaped donut cushion. Rehabilitation medicine literature has repeatedly noted that a donut cushion, by compressing the entire pelvis against the inside of the ring, can actually increase pressure on the surrounding tissue rather than relieving it.

Before Reaching for Pain Medication

If the pain is significant, an over-the-counter pain reliever is fine, but it's worth doing the self-check in the next section before taking anything. Once medication dulls the pain, it becomes much harder to accurately pinpoint tender spots or gauge how intense the pain really is.

Fracture vs. Simple Bruise: A Self-Check List

Working through the following items in order gives you a reasonable sense of how urgently you should get it looked at. That said, the tailbone is genuinely hard to palpate accurately given its location, so regardless of what you find, significant pain on its own is reason enough to see a doctor.

1. Location and Character of the Pain

Gently press with a finger at the very tip of the spine, just above where the buttocks separate. A broad, dull ache leans toward a simple bruise; sharp, intense pain concentrated at one specific spot you could point to with a single finger raises more suspicion for a fracture or partial dislocation.

2. How Pain Behaves When Sitting Down and Standing Up

Try sitting slowly in a chair (don't force it if the pain is severe). If sharp pain is reproduced both while sitting down and while standing back up, and shifting your weight to either side doesn't ease it at all, that suggests something more significant than a simple bruise.

3. How Much Bruising and Swelling Is Present

The tailbone has a layer of fat between the skin and the bone, so a fracture often produces little visible bruising. The reverse matters just as much: the absence of bruising doesn't rule out a fracture.

4. Whether Pain Changes During a Bowel Movement

Check whether straining during a bowel movement makes the tailbone pain worse. If pain is clearly triggered this way, the injury may extend into the pelvic floor muscles, and that calls for a medical evaluation.

Why Imaging Is Tricky Here

A study by Maigne, Lagauche, and Doursounian, published in the Journal of Bone and Joint Surgery (British volume) in 2000, took side-view X-rays of chronic coccydynia patients both standing and sitting and compared them. A substantial number of patients showed either hypermobility — the coccyx flexing beyond its normal range when sitting — or a posterior subluxation. A standard X-ray taken only lying down or standing, however, doesn't reveal these changes, which is exactly why fractures and dislocations here get missed. This study comes with real limits — it was a small, single-center imaging study, and it requires a specialized seated-position X-ray that isn't available at every facility. Beyond imaging, doctors sometimes perform a rectal exam to palpate the coccyx directly through the anus, but that's something for a clinician to assess, not something to attempt on your own.

What Not to Do While Checking Yourself

Trying to self-diagnose a fracture can sometimes make the injury worse. Avoid the following.

Pressing Hard to See How Much It Hurts

A gentle press with a finger is all that's needed to locate tenderness. Pressing or tapping harder to gauge the pain more precisely only adds extra stimulation to tissue that's already injured, and pain intensity alone can't tell you whether something is broken anyway.

Trying to Push It Back Into Place Yourself

Some people, based on something they read online, try to push the pelvis or tailbone back into place themselves. If there's actually a fracture or a partial dislocation, this kind of attempt can shift the bone further out of position or cause additional damage to nearby nerves and the rectal wall.

Gritting Your Teeth and Sitting Through the Pain for Long Stretches

It's common to push through the pain and sit on a hard chair for long periods because of work or a schedule, but repeated compression right after an injury can slow healing and let a partial dislocation set in place.

Trying Heat or a Massage to Loosen It Up

It's tempting to think warmth or rubbing it out will help, but applying heat during the early acute phase of an injury increases blood flow and can make swelling and inflammation worse. Cold, not heat, is the rule in the acute phase.

Putting Off the Doctor for Days Because the Pain Feels Manageable

A fracture can be present even when visible bruising and swelling look minor. Left unaddressed, the bone can heal in a shifted position and lead to chronic coccydynia — so if even one item on the checklist above raised suspicion, don't delay care just because the pain itself feels tolerable.

Signs That Mean Go to the ER Right Now

If any of the following apply, skip the management steps in the next section and head straight to the emergency room instead.

• Weakness, numbness, or tingling that radiates down into the legs (possible nerve damage).
• New difficulty controlling bowel movements, or trouble urinating (possible cauda equina syndrome — needs immediate emergency evaluation).
• Noticeably reduced sensation around the anus (possible saddle anesthesia).
• Pain so severe it isn't controlled by pain medication, even lying or standing still.
• Active bleeding right after the fall, or tissue exposed through a wound.
• You hit your head during the fall, or you're experiencing dizziness or confusion (needs evaluation for a concurrent injury).

Not an Emergency, But See a Doctor Today or Tomorrow

If none of the above apply but you have even one suspicious finding from the checklist earlier — sharp, pinpoint tenderness at one spot, for instance — it's safest to get evaluated at an orthopedic or rehabilitation medicine clinic that same day or by the next day at the latest, even without going to the ER.

When It's Reasonable to Call It a Simple Bruise

If none of the red flags above apply, the pain is a broad, dull ache rather than a sharp pinpoint pain, and it has been gradually easing over time, it's reasonable to lean toward a simple bruise and move on to the management steps in the next section. Keep in mind, though, that this isn't a substitute for a doctor's visit if something changes.

Easing Sitting Pain in Stages: Posture and Cushions

The biggest challenge after landing hard on your backside is that, unlike most injuries, you can't fully rest the area — work and daily life still require sitting. Changing how you sit in stages, based on where you are in the healing timeline, lets you manage the pain while still getting through what you need to do.

Stage 1 (Days 0-3): Avoid Sitting Where Possible, and Shift Weight Forward When You Do

During this period, stay standing or lying on your side as much as possible. When sitting is unavoidable, tilt the pelvis forward so your weight rests on the sit bones (ischial tuberosities) and the tailbone hangs free over the cutout at the back of a cushion. Observations from Maigne's research group found that the more you lean back into a backrest, the more the coccyx flexes and the more pressure builds up on it — so during this stage, leaning the upper body slightly forward works better than sinking fully back into a chair.

Stage 2 (Days 4-10): Break Sitting Time Into 15-20 Minute Blocks

As the pain gradually eases, sit for 15-20 minutes at a stretch, then get up and take a few steps or stand for a bit before sitting again. If your schedule includes meetings or travel that require sitting for longer, it's safer to always have a wedge cushion on hand.

Stage 3 (Day 11 Onward): Gradually Increase Time Sitting Without a Cushion

Once sitting in a regular chair without a cushion doesn't cause much pain, gradually increase your total daily sitting time. That said, keep using a cushion during this stage on surfaces that concentrate pressure, like a hard wooden chair or a car seat, since that reduces the chance of a flare-up.

A Note on Driving

Car seats tend to be shallower and firmer than seating at home, which puts more pressure on the tailbone. Hold off on long drives until the pain has settled enough, and if a drive is unavoidable, sit the seat as upright as possible and make sure to use a wedge cushion. If you don't have one on hand, rolling a thin towel into a ring shape and leaving the center hollow where the tailbone rests can work as a temporary substitute.

Once the Pain Settles: Tailbone Rehab Exercises

Once the pain while sitting has noticeably eased and everyday movement is possible, the two exercises below release tension in the tissue around the tailbone and rebuild pelvic stability. If you've been diagnosed with a fracture, follow the timeline and intensity your treating clinician sets, and treat these exercises as something to reference once that clearance has been given.

Exercise 1: Lying Knee-to-Chest Stretch

Starting Position

Lie on your back on the floor or a mat with both knees bent.

Movement Sequence

Step 1: wrap both hands around one knee and slowly pull it toward your chest. Step 2: pull only to the point where you feel a comfortable stretch in the buttock and lower back, stopping just short of where pain would begin. Step 3: hold that position. Step 4: slowly lower the leg back to the starting position. Step 5: repeat the same sequence with the other leg.

Breathing

Exhale slowly as you pull the knee in, and take 3-4 short breaths while holding the position to let the whole body relax.

Sets and Frequency

Hold each leg for 20-30 seconds, 3 sets, twice a day (morning and evening).

Common Mistakes and Fixes

A common mistake is rocking the lower back off the floor to generate momentum for the pull. Keep the lower back pressed against the floor and check on every rep that you're pulling slowly using only arm strength.

When to Stop (Red Flags)

If sharp pain is reproduced in the tailbone area while pulling the knee in, or tingling radiates down the leg, stop immediately and go back to the previous stage (ice and rest).

Exercise 2: Pelvic Tilt

Starting Position

Lie on your back with knees bent and feet flat on the floor. Let your arms rest naturally at your sides.

Movement Sequence

Step 1: engage your lower abdomen and tilt the pelvis slightly backward, pressing the lower back gently into the floor. Step 2: hold for 2-3 seconds. Step 3: slowly release and return to the starting position. Step 4: then move slightly in the opposite direction, gently lifting the lower back (only within a pain-free range). Step 5: alternate between the two directions and repeat.

Breathing

Exhale as you press the pelvis down and engage the lower abdomen, and inhale as you release.

Sets and Frequency

10 reps per set, 2-3 sets a day. Once it's pain-free and comfortable, extend the hold time to 3-5 seconds rather than adding more sets.

Common Mistakes and Fixes

A common mistake is tensing the entire glute muscles and rocking the hips slightly instead of isolating the pelvis. Check that your hips stay on the floor and that the movement comes only from the lower abdomen and lower back.

When to Stop (Red Flags)

If the movement presses the tailbone into the floor and triggers pain, or if pain after the exercise is worse than before it, stop for the day and rest lying face-down or on your side.

Contraindications for These Exercises

Do not start either exercise, and talk to your treating clinician first, if any of the following apply: a fracture diagnosis with healing not yet confirmed, ongoing numbness or tingling in the legs, any prior issue controlling bowel or bladder function, or recent pelvic or spinal surgery without rehab clearance from your surgeon.

A 4-Week Recovery Table for Tailbone Injuries

Once a simple bruise has been confirmed, use the 4-week progression table below to guide how you ramp up activity. Don't advance to the next week just because time has passed if you haven't actually met the criteria.

If Pain Remains After 4 Weeks

If you've followed the 4-week program faithfully but pain keeps recurring every time you sit, or sharp, pinpoint tenderness persists, that can indicate a fracture line or partial dislocation that wasn't apparent at the initial assessment. At this point, rather than repeating self-management, it's reasonable to get a reevaluation at an orthopedic or rehabilitation medicine clinic. When you go in, bringing notes on the date of the original injury, how the pain has changed over time, and which positions make it worse can save time and help the clinician reach a more accurate assessment.

When to Avoid This and Other Precautions

NIR care can be used as a supportive step to ease muscle and connective tissue tension around rehab exercises, but it is not a treatment that reverses fracture healing or a partial dislocation itself. See a doctor first, rather than relying on self-management, in the following situations.

• A confirmed fracture, or one strongly suspected but not yet confirmed — imaging and a decision on management come first, and both rehab exercises and NIR exposure should wait until then.
• Any prior numbness, tingling in the legs, or difficulty controlling bowel or bladder function — a nerve damage evaluation takes priority.
• Over a surgical site with metal implants in the pelvis or spine, or a recent surgical site — check with your treating clinician before use.
• Taking photosensitizing medications (tetracycline-class antibiotics, amiodarone, etc.) — consult beforehand.
• During pregnancy, avoid exposure near the abdomen, pelvis, and tailbone.
• Do not apply directly over an area with active malignancy.

Signs to Pause the Rehab Program

If pain flares up again during or after exercise, or new numbness or tingling shows up in the legs, stop the program at that point and go back to the previous stage. If the same signs keep recurring, prioritize a medical evaluation over continued self-management.

When Fear of the Pain Leads to Just Standing or Lying Down All the Time

After a bad injury like this, it's common to start unconsciously avoiding sitting altogether. That feels manageable in the short term, but standing or lying down excessively for too long can weaken the muscles around the pelvis and shift strain onto other areas, like the lower back or knees. If you've met the criteria at each stage of the 4-week table above, sticking to the planned pace rather than delaying the next stage out of fear is the safer choice long-term.

Worth Checking Alongside This

Tailbone pain can flare up repeatedly not just after a fall but simply from the habit of sitting for long stretches. If your pain flares up specifically while sitting, our guide on why coccyx pain shows up specifically when sitting may help; if you want to change how you sit to reduce the pain itself, see our guide to sitting in ways that hurt the tailbone less; and if you want a closer look at applying NIR care to this area, our guide to NIR care for tailbone pain when sitting covers that. If you're curious about first aid for a similar fall injury elsewhere, our wrist sprain after a fall guide follows much the same logic.