This article is intended to overview my perspective on exercise for patients with coccydynia. Of course, you should always consult with your physician or physical therapist prior to engaging in any exercise program, whether specific to coccydynia or in general, to make sure that you are safe to participate!
I consider exercise and stretching important components in the vast majority of coccydynia treatment plans. However, every person's pain is different and it follows that every patient's exercise program must be tailored to their needs. Of course, the ideal is for every person with pain to be able to access a knowledgeable physician or physical therapist that can advise them on a safe and effective exercise regimen. However, that may not always be possible. If you are trying to choose exercises for yourself it may be helpful to consider the basic anatomy of the area:
The coccyx is affected by overall spine and pelvic alignment- therefore exercises that focus on posture, alignment, and core stability are usually helpful. If it's good for the rest of your pelvis/spine, it's probably good for your coccyx too! The same goes for any exercise that helps you to maintain good sitting and standing posture, such as exercises that target your core, stretch your hip flexors, or strengthen your upper back.
You also want to "zoom-in" and consider the structures that most directly affect the tailbone and it's stability/movement. The muscles that attach directly to the tailbone are the gluteus maximus (hip extensors) and pelvic floor (sacrococcygeal flexors and important core muscles). There are also important indirect connections to the hamstrings (hip extensors, knee flexors). I have found that strengthening the hips, especially into extension, is often helpful in cases of coccyx pain. Learning to contract, and sometimes more importantly, to Relax the pelvic floor is also very helpful. Good balance between the gluteals, pelvic floor, and deep core muscles, in combination with good posture and lumbopelvic alignment, will help to support the tailbone and reduce irritation.
However, not every exercise is right for every person. For example, some people with tailbone pain have their worst pain when they are moving from sitting into standing. This is because the gluteals contract to lift you off the chair, and for some people this pulling on the inflamed tailbone causes increased pain. For those people, gluteal exercises have to be undertaken carefully or not at all. Another example would be many common "core" exercises, such as sit-ups, which put mechanical pressure on the tailbone and can make pain worse. Even many excellent Pilates exercises rely on movements that can directly irritate the tailbone through pressure against the ground.
My general rule of thumb is that you want to do as much SAFE, COMFORTABLE movement as possible, but if it hurts, don't do it. There are many people who may need to have their inflammation/irritation managed before they can engage in exercise. This is where evaluation by a knowledgeable physician or physical therapist can be especially beneficial.
At Wellsprings Health we offer specialized Physical Therapy for treatment of coccydynia, as well as Yoga targeted to clients with tailbone pain.