Coccydynia: Chronic Pain After Tailbone Injury in Teens

Coccyx contusion

Hello doctor, I am currently 17 years old.
When I was 10, a classmate played a prank by pulling my chair, causing me to fall to the ground.
I experienced severe pain near my coccyx and it took about five minutes before I could stand up, but I did not seek medical attention at that time.
A few months later, the pain subsided.
Around the age of 12, I began to grow taller, and I started to frequently experience soreness in my pelvis and coccyx, along with knee pain, especially in humid environments.
I only visited an orthopedic doctor at the age of 15, and X-rays showed that my spine and pelvis had a J-shaped scoliosis.
The doctor mentioned that it might be due to an old injury, but there were no signs of past trauma to the coccyx.
I have been undergoing rehabilitation continuously.
Recently, however, my condition has worsened; I can clearly feel discomfort even while sitting in a chair.
After my consultation, the doctor advised me to continue with rehabilitation, but I feel that there has been no improvement.
I would like to ask the doctor whether I should continue with rehabilitation or if I need to go to a larger hospital for further examination?

Tongxue, 10~19 year old female. Ask Date: 2021/05/13

Dr. Chen Yongxue reply Orthopedics

Hello, after a coccyx contusion, it is common to experience recurrent pain; however, knee pain should not be related to this.
The coccyx is rarely in a normal position and often has deformities.
Rehabilitation is not necessary; if there are pain symptoms, it is advisable to apply heat therapy frequently.
If improvement is limited, you may consider taking some pain relief medication.
Thank you.

Reply Date: 2021/05/13

More Info

Coccydynia, or tailbone pain, is a condition that can arise after an injury to the coccyx, which is the small bone at the base of the spine. In your case, the history of trauma at the age of 10, followed by ongoing discomfort and the development of other symptoms, suggests that you may be experiencing chronic pain related to your initial injury.
The pain you describe, particularly in the coccyx area, is not uncommon after a fall or trauma. The coccyx can become inflamed or irritated due to direct injury, leading to coccydynia. This condition can be exacerbated by activities that put pressure on the tailbone, such as sitting for prolonged periods, especially on hard surfaces. The fact that you have also experienced knee pain and discomfort in humid environments may indicate a broader issue with your musculoskeletal system, possibly related to posture or alignment, especially given the J-shaped curvature of your spine noted in your X-ray.

Regarding your current situation, it is essential to consider a few factors:
1. Continued Rehabilitation: Since you have been undergoing rehabilitation without significant improvement, it may be beneficial to reassess your treatment plan. Physical therapy can be effective for coccydynia, focusing on strengthening the pelvic floor muscles, improving posture, and addressing any biomechanical issues. However, if you feel that your symptoms are worsening or not improving, it may be time to consult a specialist, such as an orthopedic surgeon or a pain management specialist, for a more comprehensive evaluation.

2. Further Imaging: If your pain persists, additional imaging studies, such as an MRI, may be warranted to assess for any underlying issues that may not have been visible on X-rays. This could include soft tissue injuries, inflammation, or other structural abnormalities that could be contributing to your symptoms.

3. Pain Management: In the meantime, managing your pain is crucial. Over-the-counter pain relievers, such as NSAIDs (non-steroidal anti-inflammatory drugs), can help reduce inflammation and alleviate pain. Additionally, using a cushion or a specialized seat cushion designed for coccyx pain can help relieve pressure when sitting.

4. Lifestyle Modifications: Consider making some lifestyle changes to help manage your symptoms. This includes avoiding prolonged sitting, especially on hard surfaces, and incorporating gentle exercises or stretches that focus on the lower back and pelvic area. Activities like swimming or cycling may also provide relief without putting too much pressure on your tailbone.

5. Monitoring Symptoms: Keep track of your symptoms and any changes you experience. If you notice increased pain, changes in bowel or bladder function, or any new neurological symptoms (such as numbness or weakness), it is essential to seek medical attention promptly.

In summary, while continuing rehabilitation is important, it may also be necessary to seek further evaluation if your symptoms do not improve. A multidisciplinary approach involving physical therapy, pain management, and possibly further imaging can help address your ongoing discomfort and improve your quality of life. Remember, your health is paramount, and advocating for yourself in seeking the appropriate care is crucial.

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