Background: Coccydynia is a rare condition in the adolescent population, especially in adolescent boys. Chronic coccydynia negatively impacts quality of life, participation in school, and recreational activities. Evidence is largely lacking for physical therapy approach to treatment for chronic coccydynia. Case Description: This case report describes a 14-year–old adolescent boy, presenting with chronic coccydynia. This patient presented with poor posture, myofascial restrictions, coccyx hypomobility, and deficits in soft tissue length and core strength. Treatment was 45 to 60 minutes, twice per week for 12 sessions, then reduced to once per week for 2 sessions. Outcomes: Symptoms appeared to be as a result of prolonged poor posture, contributing to adaptive shortening of soft tissues and pelvic floor overactivity. Treatment focused on improving posture, restoring soft tissue length, addressing myofascial restrictions in the abdomen, and improving core strength to maintain proper posture. Symptoms decreased as diaphragmatic motor control improved, and myofascial restrictions lessened with instrument-assisted soft tissue mobilization and cupping. The patient was able to resume prior level of function with few activity modifications. Discussion: A multifaceted physical therapy treatment approach was utilized, including a combination of therapeutic exercise and manual therapies. Myofascial trigger points were difficult to address due to patient sensitivity with myofascial techniques; instrument-assisted soft tissue mobilization and cupping were effective in treatment of trigger points. Physical therapy was effective in resolving this case of coccydynia.