Coccyx wounds—often referred to as tailbone pressure injuries—are a common concern for people who spend extended time in wheelchairs. These wounds can be painful, slow to heal, and may recur if the underlying cause is not addressed. Unlike coccyx wounds that develop in hospital beds, wheelchair-related wounds are often linked to seating position, rather than unavoidable pressure alone.
For patients and caregivers, understanding how wheelchair position affects the tailbone is essential for both preventing wounds and supporting healing when they occur.
Why Coccyx Wounds Develop in Wheelchairs
The coccyx is not designed to support body weight. When a person is seated correctly in a wheelchair:
- The hips are positioned fully back in the seat
- The knees are bent at approximately 90 to 110 degrees
- The foot rests and arm rests are properly fitted
In this neutral seated position, body weight is carried primarily through the ischial tuberosities, or “sit bones.” The tailbone remains elevated above the seating surface.
Problems develop when this neutral seating position cannot be maintained. Fatigue, weakness, poor wheelchair fit, or lack of support can result in the person sitting on their coccyx or sacral area, often referred to as “sacral sitting.”
As posture collapses:
- The coccyx shifts downward toward the cushion
- Direct pressure is placed on an area not meant to bear weight
- Blood flow to the area is reduced if pressure remains unrelieved
- As the individual slides forward, the skin is prone to shearing
- All of the above are worsened by incontinence or the presence of heat and moisture
This sustained pressure significantly increases the risk of skin breakdown and wound formation.
The Role of Wheelchair Fit and Support
Wheelchairs that are not properly fitted significantly increase the risk of coccyx wounds. Evaluation by a seating specialist is the best way to ensure proper positioning.
Common contributing factors include:
- Seat depth that does not match the user’s height
- Inadequate pelvic or back support
- Sling seating that causes internal rotation of the hips
- Incorrect footrest or armrest heights
- Incorrect cushioning
- Prolonged sitting without repositioning or breaks
Patient’s Medical Condition
Many medical conditions can affect a person’s ability to sit properly and must be considered when assessing coccyx wound risk.
Common contributing factors include:
- Leaning
- Curvature of the spine or scoliosis
- Deteriorated hips or leg length discrepancies
- Leg or foot amputation
- Neurologic conditions such as cerebral palsy, multiple sclerosis, or ALS
- Spinal cord injury or traumatic brain injury
- Muscle and tone disorders
- Musculoskeletal and structural conditions
- Medical and systemic conditions
As posture worsens, other damaging forces—such as friction, heat, moisture, and shear—intensify and further weaken the skin. As a result, wounds are more likely to develop or worsen.
Understanding the Factors That Affect Skin Health
As with all pressure injuries, several external forces act on the skin simultaneously:
- Pressure
- Shear
- Friction
- Heat
- Moisture
- Positioning
In wheelchair seating, positioning and pressure tend to have the greatest impact. When proper posture cannot be achieved or breaks down, shear and friction increase, particularly when individuals slide forward or frequently reposition. Heat, moisture, and incontinence further contribute to skin breakdown.
How Alternating Pressure Wheelchair Cushions Can Help
When treatment and prevention of pressure injuries to the coccyx, ischial tuberosities, or buttocks are a primary concern, alternating pressure coccyx wheelchair cushions may be used as part of a broader care plan. These specialized cushions gently redistribute interface pressure away from high-risk areas in timed cycles while providing complete off-loading of the coccyx. They may also help offset postural lean by promoting balance.
These cushions may help by:
- Assisting in the treatment and prevention of stage I–IV pressure injuries
- Providing skin protection to the coccyx (tailbone)
- Reducing the duration of pressure on a single area, supporting blood flow
- Supporting and improving circulation during prolonged sitting
- Helping to reduce skin shear
- Helping to manage heat and moisture
It is important to note that these cushions are used in conjunction with proper seating position and wheelchair fit. Their benefit is greatest when fundamental posture principles are already in place.
Practical Steps for Prevention and Healing
Patients and caregivers can take several steps to reduce risk and support recovery:
- Ensure the wheelchair is properly fitted and adjusted
- Use the correct wheelchair cushion matched to the individual’s needs
- Have the cushion pressure-mapped when appropriate
- Check seating posture regularly, especially during periods of fatigue
- Reposition frequently
- Manage heat and moisture at the seating surface
- Seek evaluation from a seating or wound care specialist if skin changes appear
Early attention to posture and wheelchair fit can often prevent minor skin irritation from progressing into more serious wounds.
Key Takeaway
Coccyx wounds in wheelchairs are often rooted in a positioning problem, not simply a pressure problem. When posture collapses, the tailbone is exposed to forces it cannot tolerate. Alternating pressure coccyx wheelchair cushions can provide valuable support, comfort, skin protection, and assistance with healing when used as part of a comprehensive seating and care strategy.
Authored by Jeff Adise
Jeff has dedicated over 28 years to advancing wound care solutions. He is a product specialist and developer of therapeutic support surfaces for the prevention and treatment of Stage I–IV pressure injuries in hospital beds, home recliners, lift chairs, wheelchairs, and more.
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