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Saddle Region Pain

Saddle pain is pain that is experienced in the region between the hips that would contact a saddle when riding a horse or bicycle. You may have heard this region referred to as the perineal or pelvic floor region.

There are many potential causes for saddle pain. Explore the information under each tab below to understand more about the anatomy of the area and things that may go wrong.

If you have already visited our Hip Pain Explained page, you may have already read some of this information. On this page you will find information specific to conditions related to pain in the Saddle Region.


Common conditions associated with saddle pain:

  • Coccydynia – see Joint Related Pain
  • Pelvic Floor Dysfunction, Hypertonic Pelvic Floor, Vaginismus – see Soft Tissue Related Pain
  • Pudendal Neuralgia – see Peripheral Nerve Related Pain

Pain experienced in the saddle region may be related to:

  • joints of the hip & pelvis, where two bones meet
  • ‘soft tissues’, non-bony structures, such as muscles
  • bones, such as the coccyx (tip of the tailbone)
  • the spine
  • nerves that run into the saddle region
  • pelvic organs or blood vessels, or other health issues masquerading as saddle pain

Explore each of these further in the tabs below

What is pain?

Pain is an experience that the brain creates for the purposes of stimulating you to change your behaviour or seek help for a perceived problem with your body. Irritating or potentially damaging stimuli in your body (like high levels of pressure, tension or extremes of temperature) activate sense receptors (danger sensors) in the area. Signals from danger sensors in the body travel through the nervous system to the brain. Here the information is processed and the brain sometimes (but not always) produces a pain experience.

If you would like to read more about understanding what pain is, PLEASE CLICK HERE.

Joint Related

Joint-Related Pain

A joint is formed where two bones are joined together, with varying amounts of movement occurring between them. Pain may be related to the structures involved in the function and support of a joint. The only joint in the saddle region is the sacrococcygeal joint at the bottom of the tailbone (sacrum) (Figure 1):

  • The sacrococcygeal joint is the joint in the tailbone formed between the sacrum and the coccyx (Figure 1).
  • The coccyx is a small triangular shaped bone made up of 3-5 fused segments. Many ligaments attach to the coccyx helping to provide stability and support for the pelvis, its muscles and contents.

Pain related to the Sacrococcygeal Joint – Coccydynia

Pain relating to the coccyx and sacrococcygeal joint is known as coccydynia (pronounced cox-y-dynia). A sudden onset of coccygeal pain is usually associated with trauma, externally such as from a fall backwards onto the bone, or internally such as in childbirth. Onset can also be gradual, commonly related to sustained pressure from sitting or local muscle forces.

Factors associated with an increased risk of developing coccydynia are:

  • being overweight
  • being female–women are 5 times more likely to develop the condition
  • increased flexibility or mobility of the joint (hypermobility)
  • reduced flexibility or stiffness of the joint (hypomobility)
  • variants of coccyx shape
  • pelvic floor muscle weakness or overactivity
  • other general health factors (see other causes section): These must be ruled out.

Your Hip Pain Professional can reduce your pain associated with coccydynia by:

  • Addressing factors such as:
    • excessive weight bearing on the coccyx due to  seating or habitul sitting postures. You can buy a coccyx cushion specifically for reducing pain when sitting by clicking here.
    • weakness, spasm or altered activity in the muscles that attach to the coccyx including the gluteus maximus (buttock) and pelvic floor muscles (see the soft tissue section)
    • altered stress and strain on the structures that attach to the coccyx which may have occurred after trauma or as a gradual build up over time
  • Providing or referring you for a pain-relieving injection into the area or in very rare cases, to a surgeon.
Soft Tissue Related
Bone Related
Back Related
Peripheral Nerve
Other causes

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