Sometimes coccyx pain results from a direct fall but pregnancy and childbirth can also be a cause. Coccyx pain can also result from pelvic floor muscle dysfunction, constipation, lumbar spine or sacroiliac joint issues, or hypermobility syndrome. One of the first tests we do is to determine the alignment of the coccyx in relation to the sacrum (the fused bone directly above it). By palpating along the joint line we can determine if there is misalignment. One side may feel more prominent or rotated posterior and the other side may feel deeper or more anterior. Identifying a misalignment is key in treating for the right dysfunction. A rotation dysfunction can cause pain along the joint line, refer pain down the coccyx, torsion the intraarticular disc, tension the coccygeal nerve plexus, and cause tension of the pelvic floor muscles. Other orthopedic static and mobility tests occur to be as specific as possible to come to an efficient treatment plan. The coccyx can be sidebent, hyperflexed, extended, inferior, superior, and/or rotated. Treatment approaches to correct the alignment can be external, transvaginal or transrectal. The goal is improve spinal and coccyx alignment, resolve soft tissue dysfunction, and resume all activities especially sitting.