Severe Hip and Tailbone Pain: Causes and Treatment Options

Severe pain in the buttocks with coccyx pain radiating to the groin and right knee pain?

Hello Doctor, my brother is 67 years old.
Since he underwent knee arthroscopy (without joint replacement) last August, he has been experiencing gradually worsening pain in his right hip and coccyx, which has become increasingly severe over the past month.
There are tender points when pressure is applied, and the pain feels like tearing, especially when sitting, which is exacerbated by pressure.
He cannot sit for more than three minutes due to the pain, which has persisted for ten months.
The pain has now spread to the groin and near the anus, accompanied by a sensation of needing to have a bowel movement.
Additionally, he has been experiencing pain in his left hip for the past three months (with a burning sensation in the left foot for ten months).
He also experiences pain when lying down if pressure is applied to the hip.
He has undergone lumbar MRI, pelvic MRI, multiple X-rays, and a nuclear medicine bone scan last September, all of which indicated no significant issues.
He has had three neurotomy procedures (between L5 and S3).
He has also received seven ultrasound-guided injections of 15% dextrose for proliferative therapy and 5% dextrose for neural decompression.
He has been taking pain medications, recently NSAIDs, and last Wednesday received a third steroid injection in the right hip (diagnosed as calcific tendinitis), along with one shockwave therapy session.
However, none of these treatments have been effective.
He has had two PRP injections in the knee, but the pain persists.
This is truly tormenting—he experiences significant pain in the hip and coccyx while sitting or lying down, and moderate pain in the hip while standing, along with knee pain.
It is difficult for him to cope.
Could you please advise what might be causing this and what treatment options are available to help him? Thank you!

Peng O Ren, 60~69 year old female. Ask Date: 2020/07/13

Dr. Li Yanheng reply Rehabilitation

Your pain issue has become chronic, affecting central nervous system pain and neuromuscular regulation.
It is recommended that you visit a specialized pain rehabilitation clinic for a comprehensive examination and treatment.

Reply Date: 2020/07/13

More Info

Severe hip and tailbone pain, especially in a 67-year-old patient who has undergone knee arthroscopy, can be a complex issue involving multiple factors. The symptoms described, including intense pain in the hip and tailbone, radiating pain to the groin and rectal area, and the inability to sit comfortably, suggest a multifaceted problem that may involve musculoskeletal, neurological, and possibly referred pain from other areas.

Possible Causes
1. Post-Surgical Complications: After knee arthroscopy, patients may experience changes in gait or posture due to pain or instability in the knee. This can lead to compensatory mechanisms that place additional stress on the hips and lower back, potentially causing pain in these areas.

2. Coccygodynia: This is a condition characterized by pain in the tailbone area, which can be exacerbated by prolonged sitting or certain movements. It can result from trauma, poor posture, or even prolonged sitting on hard surfaces.

3. Muscle and Ligament Strain: The pain could also be due to strain in the muscles and ligaments around the hip and pelvis. Conditions such as piriformis syndrome, where the piriformis muscle irritates the sciatic nerve, can lead to hip and tailbone pain.

4. Nerve Compression: The description of pain radiating to the groin and rectal area may indicate nerve involvement, possibly from lumbar spine issues or sacral nerve compression.

5. Inflammatory Conditions: Conditions such as tendinitis or bursitis in the hip region can cause significant pain and may be exacerbated by activity or certain positions.

6. Referred Pain: Sometimes, pain in the hip and tailbone can be referred from other areas, such as the lower back or even the abdomen.

Treatment Options
Given the chronic nature of the pain and the ineffectiveness of previous treatments, a multidisciplinary approach may be necessary:
1. Pain Management: Continuing with NSAIDs can help manage inflammation and pain. However, if these are ineffective, other options such as neuropathic pain medications (e.g., gabapentin or pregabalin) may be considered.

2. Physical Therapy: A tailored physical therapy program focusing on strengthening the core and pelvic muscles, improving flexibility, and correcting posture can be beneficial. Techniques such as manual therapy, stretching, and strengthening exercises may help alleviate pain.

3. Interventional Procedures: If conservative measures fail, further interventional options may be explored. This could include:
- Epidural Steroid Injections: To reduce inflammation around the nerves.

- Radiofrequency Ablation: For chronic pain management by disrupting nerve conduction.

- Coccyx Injections: Targeted injections to alleviate tailbone pain.

4. Alternative Therapies: Acupuncture, chiropractic care, or osteopathic manipulation may provide relief for some patients. These therapies can help address musculoskeletal imbalances and improve overall function.

5. Lifestyle Modifications: Encouraging the patient to avoid prolonged sitting and to use cushions designed for tailbone pain can help. Weight management and regular low-impact exercise can also improve overall musculoskeletal health.

6. Psychological Support: Chronic pain can lead to psychological distress. Cognitive-behavioral therapy (CBT) or other forms of psychological support may help the patient cope with the pain and improve their quality of life.

Conclusion
In summary, the severe hip and tailbone pain experienced by the patient is likely multifactorial, requiring a comprehensive evaluation and a tailored treatment plan. Collaboration with a pain management specialist, physical therapist, and possibly a psychologist may provide the best outcomes. It is crucial to address not only the physical aspects of the pain but also the emotional and psychological impacts it has on the patient's life. Regular follow-ups and adjustments to the treatment plan will be essential in managing this chronic condition effectively.

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