Tailbone Pain: Causes, Treatments, and When to Seek Help

Coccygeal trauma..?

Hello, Director: I apologize for bothering you with a question.
About a year ago, I fell and landed directly on my tailbone, which seemed to have caused an injury.
At that time, the pain lasted for about three to four days, and since it subsided, I didn't think much of it.
However, recently, the area around my tailbone has started to hurt again, and it has been persistent for six months now.
Sometimes when I sit and slightly change my position or stand up, it feels like my entire spine suddenly loosens and causes pain.
Occasionally, while riding a motorcycle, I start to feel a dull ache after sitting for a while.
I also notice that I seem to experience more soreness than before the fall, even when doing laundry.
Now, it seems like I am starting to feel pain even when standing.
I initially thought that only sitting on hard chairs would cause pain, but I later found that even sitting on a soft sofa chair can be painful.
Recently, the pain has become quite unbearable, so I went to see a doctor and had an X-ray done.
The doctor said my spine is straight and there are no fractures, and prescribed anti-inflammatory medication, but honestly, it hasn't been effective for me.
I wonder if you could help me understand what might be wrong with me.
Should I continue taking the anti-inflammatory medication? Also, should I consider getting a massage? Since my injury is in the tailbone area, I'm hesitant about getting a massage.
Additionally, do you have any good suggestions or precautions I should be aware of? I would greatly appreciate your guidance.

Penny, 20~29 year old female. Ask Date: 2003/07/28

Dr. Chen Xingyuan reply Orthopedics

Dear Miss Penny,
Based on your description, the previous coccyx impact may have only resulted in a contusion, which typically heals gradually.
However, if care is not taken or if there is a subsequent impact—such as frequently bending over to perform tasks, lifting heavy objects, riding a motorcycle or bicycle, or maintaining poor posture—this could lead to inflammation or re-injury of the affected area, resulting in pain.
Therefore, if you frequently experience pain in the injured area, it is essential to first identify whether any of the aforementioned activities are occurring in your daily routine.
Pain can be alleviated through medication or physical therapy, but the most important aspect is to exercise caution in daily activities to avoid re-injury or excessive irritation of the affected area.

At home, applying heat to the affected area or soaking in warm water (for 10-15 minutes each time) may also be beneficial.
If the cause of the pain remains unclear or if symptoms do not improve with rest, it is advisable to visit an orthopedic clinic again to determine the underlying issue.
Wishing you safety and happiness!
Sincerely,
Dr.
Chen

Reply Date: 2003/07/28

More Info

Tailbone pain, medically known as coccydynia, can be a frustrating and debilitating condition, especially when it persists for an extended period. Your situation, where you experienced an initial injury a year ago followed by a resurgence of pain, is not uncommon. The tailbone, or coccyx, can be sensitive to trauma, and even minor injuries can lead to long-term discomfort if not properly addressed.

Causes of Tailbone Pain
1. Trauma: As you mentioned, falling directly onto the tailbone can cause bruising, fractures, or even dislocations. While your X-ray showed no fractures, it's possible that soft tissue damage occurred, which may not be visible on imaging.

2. Poor Posture: Sitting for prolonged periods, especially in poor posture, can exacerbate tailbone pain. This is particularly true if you frequently shift positions or if your seating arrangements do not provide adequate support.

3. Muscle Strain: The muscles and ligaments surrounding the coccyx can become strained, leading to pain that may radiate to the lower back, hips, or thighs.

4. Inflammation: Conditions such as bursitis or inflammation of the ligaments can contribute to ongoing pain.
5. Nerve Issues: Sometimes, nerve entrapment or irritation in the lower back can manifest as tailbone pain.

Treatment Options
1. Pain Management: Since anti-inflammatory medications have not provided relief, you might consider discussing alternative pain management strategies with your doctor. Options include:
- Physical Therapy: A physical therapist can provide exercises to strengthen the pelvic floor and core muscles, which may alleviate pressure on the coccyx.

- Coccyx Cushions: Using a cushion designed to relieve pressure on the tailbone while sitting can be beneficial. These cushions often have a cut-out section to reduce pressure directly on the coccyx.

- Heat Therapy: Applying heat to the area can help relax tense muscles and improve blood flow, potentially reducing pain.

2. Injections: If conservative treatments fail, your doctor may suggest a corticosteroid injection to reduce inflammation around the coccyx.

3. Avoiding Aggravating Activities: It’s essential to identify activities that worsen your pain. For example, if sitting for long periods exacerbates your discomfort, try to take regular breaks to stand or walk around.

4. Alternative Therapies: While you expressed hesitation about massage therapy, gentle manipulation by a trained professional may help relieve muscle tension around the coccyx. However, ensure that the therapist is aware of your condition and avoids direct pressure on the tailbone.

5. Surgery: In rare cases, if all conservative measures fail and the pain significantly impacts your quality of life, surgical options may be considered to remove the coccyx (coccygectomy).

When to Seek Further Help
If your pain persists despite these interventions, or if you experience new symptoms such as numbness, tingling, or weakness in your legs, it’s crucial to seek further evaluation. A referral to a specialist, such as a pain management physician or orthopedic surgeon, may be necessary for more advanced treatment options.

Conclusion
Tailbone pain can be complex and multifactorial, often requiring a combination of treatments for effective relief. It's essential to communicate openly with your healthcare provider about your symptoms and the effectiveness of any treatments you try. Keeping a pain diary to track your symptoms, activities, and any interventions can also help your doctor tailor a treatment plan that works for you. Remember, while it may take time to find the right approach, many individuals with coccydynia can achieve significant improvement in their symptoms and quality of life.

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