Coccydynia is pain at the coccyx (tailbone). Typical causes include falls, poor sitting posture, and giving birth. Other causes such as infections, cysts, neoplasms and fractures can be ruled out by imaging, which is usually recommended after failed treatment attempts or severe and worsening symptoms. Several people with coccydynia report no direct cause of their pain and their symptoms are resistant to typical treatments including direct manual therapies, exercise, rest, medication and injections. Coccydynia can be present for several years or decades and will be present with other physical and medial complaints. Chronic coccydynia often requires a multi system approach. Dysfunctional and painful tissue at the coccyx can include the bone itself, ligaments, muscles, dura, nerves, arteries and veins. Often, local treatment is not sufficient, however. Other structures far removed from the coccyx can place strain on local structures and maintain coccyx dysfunction. Examples include pelvic floor tightness and pain, breathing pattern abnormalities, dysfunction of the cranium and dura (lining of the spinal cord and brain), lower extremity and pelvic mobility, abnormal visceral mobility at the pelvis and abdomen, emotional trauma, and low back pain.