Few things often perplex lifters as much as experiencing tailbone pain when performing squats. Oftentimes this is because there hasn’t been any particular trauma to the tailbone region that the lifter is aware of, yet the pain continually shows up during every squat session.
Fixing tailbone pain when squatting will require you to examine your low back health, your pelvic floor tension, and changing your squats until you get your pain under control and fully identify and eliminate the underlying issue.
The most common factors for tailbone pain when squatting include referred pain from pelvic floor disorders, low back disorders, and direct trauma or irritation to the tailbone itself. Fixing this issue should focus on a combination of interventions, however, you first need to identify what is causing the issue in the first place.
So, how do you go about fixing tailbone pain while squatting? Here’s how:
1. Avoid box squats for the time being
2. Check your low back and hip health
5. Start incorporating quadrant stretches
6. Use diaphragmatic breathing exercises
The good news is that identifying squat-related causes of tailbone pain can actually be rather straightforward if you know and understand some basics of hip and lower back anatomy.
So, before we look at how to take care of your tailbone pain, it will first be helpful to took at the most common reasons as to how and why it occurs. This will give you a much better understanding as to why the steps to take for correcting your tailbone pain (presented immediately thereafter) can be as incredibly effective as they are.
Read our full guide on How To Avoid A Powerlifting Injury.
Defining the tailbone & tailbone pain
It’s important to quickly discuss what exactly the tailbone is since many people often have different interpretations of what it comprises and/or what tailbone pain consists of and feels like.
The tailbone (anatomically known as the coccyx) is the very bottom section of the spine, sitting just beneath the sacrum. It’s essentially one solid segment of bone that is fused from three (but in some individuals can be more than this number) originally separate bones. This is the actual structure one refers to when they say they have tailbone pain. The medical term for tailbone pain is coccydynia, but we’ll just keep calling it “tailbone pain” for this article.
Now, for the sake of this article, I’m going to define “tailbone pain” as any form of pain arising in the general region of the tailbone, approximately a 3 or 4-inch radius from the center of the tailbone itself. It can be a general discomfort, mild annoyance, or any sort of painful disturbance within this region.
While pain can indeed arise from the actual tailbone itself, there are in fact certain structures within the body that can refer pain directly to the tailbone or extremely close to it.
Tailbone pain can feel different for each individual but it’s most often described as either a sharp, focal pain within a very small area or as a strong, achy feeling that is a bit more diffuse in the area that it’s felt. It may arise only when there is physical contact with the tailbone itself or may arise when performing physical movements (such as squats).
A common culprit to tailbone pain: the pelvic floor muscles
One of the most prominent causes of tailbone-region pain is due to dysfunction within a set of muscles known as the pelvic floor muscles.
Since the muscles of the pelvic floor are so commonly involved in the expression of tailbone pain when they’re dysfunctional (too tight, in this case), it would be prudent to quickly go over and understand what these muscles are along with their subsequent role in creating tailbone pain.
The pelvic floor muscles
The pelvic floor (sometimes referred to as the pelvic diaphragm) is a set of muscles and connective tissues that spans across our hips. It’s specific function is beyond the scope of this article, however going over the basics of this structure is highly warranted due to its prevalence in causing tailbone pain.
Clearing up misconceptions about the pelvic floor
A quick misconception to clear up is that the term “pelvic floor” and/or “pelvic floor dysfunction” only applies to women (female powerlifters, in the context of this article). Nothing could be further from the truth, so men, listen up here.
Men have a pelvic floor, just as women do. Whether you’re male or female, the pelvic floor muscles can become chronically tight, dysfunctional and will often refer their pain directly to the tailbone, regardless of one’s biological sex. Pudendal neuralgia, as an example, does not care whether you’re male or female, it just cares about giving you excruciating pain in your perineal area and sometimes into your tailbone region.
The soup can analogy: why pelvic floor muscles take a beating in lifters
The pelvic floor muscles can take an absolute thrashing in powerlifters – which can lead to tailbone pain. In order to understand why these particular muscles can take such a beating, it’s helpful to use “the soup can” analogy.
Think of the torso of a powerlifter’s body as a container that has a top, a bottom and reinforced walls wrapping all the way around the midsection. Notice how this is like an unopened soup can.
The top of the soup can in the lifter is the diaphragm (the muscle that pulls air into our lungs when we breathe in). The walls of the soup can are our various layers of abdominal muscles (that lifters often reinforce with a belt during squats) and our pelvic floor muscles are the bottom of the container.
The thrashing begins when we perform the valsalva maneuver during the squat. This is the technique in which a lifter holds their breath throughout the squat and “bears down”. This is done as a means to increase intrathoracic pressure in the abdominal region, which adds rigidity for our spine and thus help us to complete the lift.
Now, the valsalva maneuver is a very beneficial maneuver to perform during heavier squats, so I’m not saying it’s a bad thing in the slightest. Rather, I’m just highlighting how it can contribute to pelvic floor issues, and thus create referred pain to the tailbone region.
So picture this: The valsalva maneuver winds up creating high amounts of increased pressure inside the soup can as we squat. The issue here tends to be that the diaphragm is now rigid and won’t yield to any pressure, nor will the abdominal wall (which is reinforced with a belt wrapped around it).
Related Article: The 9 Best Ab Exercises For Powerlifters
This leaves the much smaller and more delicate pelvic floor muscles (the bottom of the soup can) to deal with and withstand high amounts of pressure now bearing down on them rep after rep after rep.
As they constantly tighten up as a means to withstand and endure this pressure, they can become chronically tight and as a result, dysfunctional. This tightness can then refer pain directly into the tailbone region.
Six steps to take for correcting your tailbone pain
Now that we’ve covered the basics of relative anatomy pertaining to the tailbone and the pelvic floor region, let’s start looking at some universal steps to take that can be extremely beneficial for getting your tailbone pain under control.
You’ll want to run through each of the following strategies as you work to identify and correct your tailbone pain, however the following steps for getting things under control are not meant to be followed in any sort of sequential order.
1. Avoid box squats for the time being (it may be causing direct trauma)
It may very well be that your tailbone pain is a direct result of box squats or a box squat alternative. If you’re performing heavy or high-volume box squats on a regular basis, there’s a chance that your tailbone is sore or irritated from the direct pressure being placed throughout the tailbone region.
Even if your technique is rather on point with this exercise, the tailbone can still become irritated from the chronic pressures it experiences, especially when sitting down onto a firm surface rather than a softer one.
Regardless as to whether your tailbone pain is from direct mechanisms (trauma, physical irritation, etc.) or from other indirect reasons such as low back dysfunction, pelvic floor issues, etc., (which will be covered shortly), ceasing any exercises that put more direct pressure through the tailbone region is a wise idea to implement until you know for certain as to why your tailbone pain is occurring.
There are still plenty of effective squat variations that you can do for effective training, and you’ll likely be able to return to box squats in a short period of time, so don’t freak out if you have to forego box squats until you figure out what’s causing your tailbone pain.
Interested in learning more about low back issues, read my other article on How To Fix Low Back Rounding While Squatting.
2. Check your low back and hip health
If you’re experiencing pain in your tailbone or the general tailbone region during squats, taking a look at your overall low back health and your hip health is a smart move to make.
Checking your low back health
Pain in the generalized tailbone region can often be the result of referred pain coming from an irritated low back or SI joint. Referred pain often throws lifters for a loop since they’re feeling pain in one area of their body that is unknowingly occurring from another area of the body, making it difficult to treat.
When the joints of the lumbar spine or the discs are irritated, their irritation can sometimes be felt around the general tailbone region. If you have a history of low back issues, it would be a wise idea to ask yourself how your back has been feeling ever since your tailbone pain began.
If you suspect your low back is indeed creating your tailbone pain (or at least contributing to it), it may be worth playing around with certain positions and movements with your back to see if you can find any positions that consistently aggravate or relieve your tailbone pain. This will help you know what to avoid or perhaps do more of in order to start getting the pain under control.
Another common culprit of tailbone pain coming from the back muscles is due to deep spinal muscles (known as the multifidi muscles). These are the deepest spinal muscles we have, and they run up the spine on each side, attaching to each vertebrae along the way. They can be thought of as steel girders that support a tall building. They are incredibly important for spinal stability (and overall back health), but when they become tight, they can refer pain down into the tailbone region.
If you want to learn more about spinal stability, check out my other article on Do Squats Work The Core?
How to relax the multifidi muscles
To settle down the multifidi muscles, isolated pelvic tilts are your best bet.
- Simply lay down on your back with your knees bent.
- Now, imagine curling your tailbone up between your legs (you should feel your low back gently flattening into the ground).
- Return to your starting position and keep going in this direction, trying to gently arch your low back (make sure this is pain-free).
- Try your best to do this without moving your ribs at all, isolating all the movement into your low back and hips.
- Congratulations, you’re now isolating your multifidi muscles, forcing them to relax.
Repeat this as much as you’d like and as often as you like. So long as it’s pain-free, it should be very therapeutic. Just make sure to never do this while sitting or standing, as the loaded position can potentially irritate your discs if done enough.
Here is a nice and concise video demonstrating the exercise:
Checking your hip health
The health of your hips, particularly your sacrioiliac joint (often abbreviated as the SI joint), is also rather important to take a look at when experiencing tailbone pain. This is joint on the backside of your hips that connects the hip bone to the sacrum. This joint is in close proximity to the tailbone itself and if it’s a bit jammed up or “stuck” in a slightly rotated position, you can certainly feel it when squatting.
Sometimes people experience pain right at the joint but consider this spot to be part of the tailbone, which is why it’s important to discuss.
From a clinical perspective, there are some tell-tale signs that can let you know if your SI joint is causing your pain. These are:
1. A positive Fortin’s finger test
2. Pain with rolling over in bed
3. Pain going from sitting to standing positions
4. Pain with walking
If you fit the category to more than one of these signs, there’s a high probability that you’ve got some SI dysfunction that’s at least contributing to your pain, if not causing it entirely. The likely situation here is that the joint is a bit stuck in either a slightly forward or backward rotated position. You can opt to get it adjusted by a qualified practitioner, or you can try a self mobilization like the one below.
To mobilize the SI joint, lay on your back and bring one knee up to your chest while keeping your other leg straight. Drop your bent knee out to the side of your body just slightly. Pull this knee up towards your chest while pushing it down with your hands (create as much force as you can).
While doing this, take your straight leg and try to push it away from you, as if trying to stand as tall as possible. The simultaneous motion of each of your legs in this position forces the SI joint to mobilize. Hold each contraction for a couple of seconds, and repeat about ten times. Switch your legs and then repeat. This should feel nice and pain-free, so don’t do it if you’re getting pain each time you try it.
From the side, this is what the self SI joint mobilization should look like. The right leg is pushing straight away while the left leg pulls up towards the chest, but is met with the resistance of the arms.
From a head-on view, this is what the SI joint mobilization should look like. Note how the left leg is slightly turned outwards. This helps to align the self-mobilization force directly through the direction of the SI joint.
3. Try changing your squat depth
Yes, I’m aware that this may sound blasphemous to some, but it may just be worth adopting for the time being until you get your tailbone pain under control.
If any muscles and/or joints in and around your lower spine are acting up (causing referred pain to the tailbone) then it may be worthwhile to change your squat depth for the time being (assuming you want to keep on squatting). Playing around with the depth of your squat to see if there’s any resultant relief to your tailbone may just be what you need.
In particular, decreasing your squat depth while your tailbone is sore may be rather therapeutic. The reason being is that greater squat depth will require greater range of motion from your hips and low back.
If either of these structures are dysfunctional (such as having inadequate range of motion, and irritated sacroiliac joint, etc.) and causing the tailbone pain, then it’s likely that the greater ranges of motion will only further stress the joints and tissues the deeper you go into your squat. Further stress on irritated structures means more pain potentially showing up in the tailbone region.
Remember, it’s worth playing around with how much you alter your squat depth. This isn’t a forever thing; just do it long enough until you get your back and/or hips healthier and the pain under control.
4. Try changing your squat stance
In addition to playing around with your squat depth, you might also get great benefit from playing around with your squat stance, particularly with the width.
The reason for this is that changes in your stance width during a squat can create favorable changes for your lower back mechanics, your hip mechanics and can even change the amount of stretch placed upon the pelvic floor muscles.
If your low back has been sore or acting up, externally rotating your feet (turning them outwards) a bit more might help reduce the amount of lumbar (low back) flexion you undergo during your squat, which should reduce the extent of pelvic rotation (aka butt wink) that occurs at the bottom of your squat depth.
If your tailbone pain is occurring from tight pelvic floor muscles, narrowing your squat stance could provide relief since the pelvic floor muscles may undergo a bit less tension during a more narrow-stance squat than what you’ve typically been doing.
Again, you’ll need to play around with this slightly to see what feels best, but it would be prudent of you to implement this experimentation process for a couple of training sessions as it may very well afford you the ability to keep on squatting without making your tailbone pain any worse.
5. Performing wide straddle stretches
When it comes to giving the pelvic floor muscles some personal and direct attention, a good starting point is to begin incorporating some gentle pelvic floor stretches.
There are no universal rules to follow with the following stretches shown and described below, just take the general principles and play around with them until you find modifications to the movement(s) that feel best for you.
How to perform the stretches
Start by kneeling onto the ground so that one knee is down while the other knee is up. Now take your front leg and move it out to the side so that you have a very wide half-kneeling stance (your legs are spread out wide as if sitting on a horse’s saddle).
Next, rotate your hip bones backwards as if trying to curl your tailbone up between your legs. Hold this backward-rotated hip position as you now lunge forward diagonally. You should now begin to feel a stretching sensation around the perineal area or even into the tailbone itself. Be sure you keep your tailbone curled between your legs/hips rotated backwards the entire time – this is key to make this stretch effective.
Play around with the exact angles that you lunge forward with, along with how wide of a half-kneeling stance that you use while doing so; certain positions will likely produce more stretch than others, simply find what works best for you.
After getting some easy, gentle stretching performed in the positions that feel best for you, switch your stance and perform the same motions lunging to the other side. Keep these stretches gentle but consistent. A few times a day for a week or so should start to get the pelvic floor muscles under control.
Notice in this front view how I’ve got a wide base of support. From here, I’m lunging my body to the 2 o’clock position while holding my tailbone curled between the legs.
From the side view, notice how I’m keeping my tailbone curled underneath me as I lunge into the 2 o’clock position. This should create a gentle stretching sensation through the peritoneal area.
An extra note: When the pelvic floor muscles aren’t playing ball
While beyond the scope of this article, if you’re finding that your tailbone pain is indeed being referred from your pelvic floor muscles and that these muscles are not playing ball when it comes to getting under control through self stretches, getting a pelvic floor examination may be warranted. Getting an examination from a qualified healthcare practitioner, such as a physiotherapist who specializes in pelvic floor treatment could be a smart move to make.
6. Performing diaphragmatic breathing
It may sound overly simplistic, but there is some solid evidence that deep, diaphragmatic breathing can help reduce tension in overly tight pelvic floor muscles. Turns out, the diaphragm and the pelvic floor are closely linked. Makes perfect sense – they’re the top and bottom of “the soup can”, after all.
The great thing with diaphragmatic breathing is that it can be performed pretty much anywhere and at any time. Combine this with the research showing that it can be very effective for reducing pelvic floor tension (and thus your referred tailbone pain) and you stand a good chance of getting some relief if performed properly and on a consistent basis.
How to perform diaphragmatic breathing
Whether you perform it right before a squat session or when unwinding for the night, the key is to try and be in a relaxed and comfortable position. For many people, laying on their back with their knees bent and their hands on their stomach works rather well.
To perform diaphragmatic breathing, slowly inhale through your nose. As you breathe in, let your stomach expand outwards while your chest and ribs stay motionless, not rising during any part of the inhalation. Slowly exhale through your mouth and repeat.
You really can’t overdo it with this breathing technique, so perform for as long as you feel necessary. Usually, a couple of minutes is sufficient. It may not be the most exciting exercise to perform but its certainly simple and should leave you feeling a bit better overall after performing it for a handful of minutes.
Final Thoughts
There can be a few different reasons as to why you’re experiencing tailbone pain when squatting, and it’s important to know that this pain can be directly from an irritated or sore tailbone, or from irritated/unhealthy nearby structures that are sending their pain to the tailbone region itself.
When it comes to determining the cause(s) of your tailbone pain, start with implementing the steps outlined in the article and so long as the pain is manageable, stick to them for a week or two and you should start to see a reduction in the severity and/or frequency of your tailbone pain.
About The Author
Jim is a physical therapist, strength & conditioning specialist, and former competitive powerlifter. He loves treating lifters and other active individuals in the clinic and working with them in the gym in order to help them move better, feel better, and maximize their training potential.
Website: www.strengthresurgence.com
References
1. Morrison P. Musculoskeletal conditions related to pelvic floor muscle overactivity. In: The Overactive Pelvic Floor. Springer; 2016:91–111.
2. Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Man Ther. 2005;10(3):207-218. doi:10.1016/j.math.2005.01.003
3. Park H, Han D. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J Phys Ther Sci. 2015;27(7):2113–2115.
