Chronic Tailbone Pain and Heat: Seeking Answers After Injuries

Persistent pain in the coccyx and fever?

I had a left ankle fracture five years ago, and although I have recovered and can run and jump, I still hear a clicking sound when I walk.
Two years ago, I fell and injured the same ankle, which bruised and took about six months to slowly heal.
During this time, I also developed lower back pain and discomfort.
After visiting a rehabilitation specialist, I was informed that I have a herniated disc between the fourth and fifth lumbar vertebrae (bone spurs) and scoliosis, but surgery is not yet necessary.
The doctor administered hyaluronic acid treatment and recommended physical therapy with traction equivalent to half my body weight (28 kg), as I weigh 54 kg.
Each traction session has improved my symptoms, but the relief only lasts for a day before the pain and discomfort return.
After the second traction session at 28 kg, I started experiencing warmth in my tailbone area (not feverish), particularly around the sacral region, which is often painful and sore.

Doctors at the hospital suggested that my condition is due to overuse, while a physician from Fu Jen Catholic University diagnosed me with a muscle strain.
Additionally, a traditional Chinese medicine practitioner mentioned that I might have autonomic nervous system dysfunction and sciatica.
I wake up every day with upper back soreness, but my legs do not feel numb.
This has been ongoing for about four months without improvement.
Some doctors have recommended that I go to a major hospital for blood tests to check for ankylosing spondylitis, while others believe it does not seem likely.
There was no warmth during traction therapy until I reached the last weight, which caused the heat sensation.
The doctor at the hospital advised me to exercise, while the physician from Fu Jen only prescribed muscle relaxants.
However, I can’t sit for more than ten minutes at work without experiencing soreness and pain in my hips.
I have tried brisk walking for 3000 to 5000 steps, which temporarily reduces the warmth in the affected area, but even with daily walking, I can only manage half a day before the pain and soreness return in the afternoon.
I am truly unsure which direction to take for treatment.
Can I undergo an MRI to find out the cause? Will a major hospital assist me with this?

Dou Dou, 50~59 year old female. Ask Date: 2021/07/13

Dr. Wang Zhaomin reply Rehabilitation

Magnetic resonance imaging (MRI) can examine soft tissues such as neuromuscular tissues; however, it must be evaluated by a qualified physician on-site to determine if an online consultation is necessary.
It cannot replace an actual in-person consultation.
Please visit an orthopedic, neurology, or rehabilitation department for an accurate diagnosis and to arrange appropriate treatment.

Reply Date: 2021/07/13

More Info

Chronic tailbone pain, particularly after a series of injuries, can be a complex issue that requires a multifaceted approach to diagnosis and treatment. Based on your description, it seems that you have experienced multiple injuries, including a left ankle fracture and subsequent trauma to the same area, which may have contributed to your current symptoms. Additionally, you mentioned having a herniated disc and scoliosis, which can complicate your situation further.

Understanding Your Symptoms
1. Chronic Pain and Heat: The sensation of heat in the tailbone area, along with persistent pain, can be indicative of inflammation or irritation in the surrounding tissues. This could involve the muscles, ligaments, or even the nerves in that region. Chronic pain can also be a result of compensatory mechanisms in your body due to previous injuries, leading to overuse or strain in other areas.

2. Potential Causes: The pain you are experiencing could stem from several sources:
- Coccygodynia: This is a term used to describe pain in the coccyx (tailbone) area, which can be caused by trauma, prolonged sitting, or even childbirth.

- Muscle Strain: Given your history of injuries, it is possible that the muscles around your pelvis and lower back are strained or overworked, leading to discomfort.

- Nerve Involvement: Conditions such as sciatica or other nerve-related issues could also contribute to your symptoms, especially if there is compression or irritation of the nerves in the lumbar region.

Diagnostic Approaches
1. MRI: An MRI (Magnetic Resonance Imaging) is an excellent tool for evaluating soft tissue structures, including muscles, ligaments, and nerves. It can help identify any underlying issues that may not be visible on X-rays, such as herniated discs, nerve compression, or inflammation in the surrounding tissues. If your healthcare provider deems it necessary, they can refer you for an MRI at a hospital or imaging center.

2. Blood Tests: Some doctors may suggest blood tests to rule out inflammatory conditions such as ankylosing spondylitis, which is a type of arthritis that primarily affects the spine and can lead to chronic pain. However, the decision to conduct these tests should be based on a thorough clinical evaluation.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can help you strengthen the muscles around your pelvis and lower back, improve your posture, and teach you techniques to alleviate pain during daily activities.

2. Pain Management: Over-the-counter anti-inflammatory medications (like ibuprofen) can help manage pain and reduce inflammation. In some cases, your doctor may prescribe stronger medications or recommend corticosteroid injections for more severe pain.

3. Activity Modification: It is crucial to avoid activities that exacerbate your pain. Using cushions when sitting, practicing good posture, and taking frequent breaks can help reduce discomfort.

4. Alternative Therapies: Some patients find relief through acupuncture, chiropractic care, or massage therapy. These modalities can help alleviate muscle tension and improve circulation in the affected areas.

5. Exercise: Gentle exercises, such as walking or swimming, can help maintain mobility without putting excessive strain on your back and tailbone. However, it is essential to listen to your body and avoid overexertion.

Future Considerations
1. Pregnancy: If you are considering pregnancy, it is essential to discuss your chronic pain and any potential complications with your healthcare provider. Pregnancy can change your body mechanics and may exacerbate existing conditions, so a tailored approach to prenatal care will be necessary.

2. Delivery Concerns: Chronic tailbone pain may affect your comfort during labor and delivery. Discussing your pain management options with your obstetrician will be crucial for a smoother experience.

In conclusion, chronic tailbone pain following injuries can be multifactorial and requires a comprehensive evaluation and treatment plan. Consulting with specialists in orthopedics, physical therapy, and possibly pain management will be essential in addressing your symptoms effectively.

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