Coccydynia: Managing Tailbone Injuries and Recovery

Coccygeal contusion

Hello, Doctor: I have researched all the issues related to the coccyx.
My condition is that three years ago, I paid for an MRI from the cervical spine to the sacrum, and at that time, my coccyx was normal.
In March of this year, I slipped and fell, resulting in a coccygeal contusion.
X-rays showed a right displacement.
I have been continuously taking non-steroidal anti-inflammatory drugs (NSAIDs) and purchased a coccyx cushion to avoid irritation.
From March 1 to June 13, I have been doing heat therapy almost every day, but there has been no relief so far.
On June 5, I had an ultrasound examination of the ligaments in the rehabilitation department, and the doctor suspected that the ligaments were nearly torn and advised me to see an orthopedic surgeon.
However, when I went to Long X Hospital, the orthopedic surgeon dismissed it, believing it was not serious.
For more than three months, I have only been able to lie down, and even when dining out or driving, I sit on the coccyx cushion.
Should I continue to wait for natural healing? I would appreciate your clarification.
Thank you very much.

Li Qi, 50~59 year old female. Ask Date: 2023/06/15

Dr. Shi Guozheng reply Orthopedics

Coccyx bone contusions typically heal with rest and pain medication.
What is needed is time for recovery, which usually takes about three to six months.

Reply Date: 2023/06/15

More Info

Coccydynia, or tailbone pain, is a common condition that can arise from various causes, including trauma, prolonged sitting, or even certain medical conditions like Tarlov cysts. Your situation, involving a fall that resulted in a coccyx injury, is not uncommon, and it’s understandable that you are seeking clarity on managing your symptoms and recovery.

Understanding Your Condition
From your description, it seems you have experienced a coccyx injury that has led to persistent pain and discomfort. The X-ray indicating a rightward displacement of the coccyx suggests that there may have been some structural change due to the injury. The fact that you have been experiencing pain for over three months, despite conservative management strategies such as NSAIDs (non-steroidal anti-inflammatory drugs), heat therapy, and the use of a coccyx cushion, indicates that your injury may be more complex than initially thought.

Symptoms and Recovery Timeline
Coccydynia can manifest as localized pain at the base of the spine, which may worsen with sitting, standing, or certain movements. The recovery timeline can vary significantly from person to person. Generally, mild cases may resolve within a few weeks, while more severe injuries can take several months to heal. Given that you have been experiencing symptoms for over three months, it is crucial to continue monitoring your condition closely.

Treatment Options
1. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can provide targeted exercises to strengthen the pelvic floor and surrounding muscles, which may help alleviate pain and improve function.

2. Pain Management: If NSAIDs are not providing sufficient relief, your doctor might consider other pain management strategies, including corticosteroid injections or alternative medications.

3. Coccygeal Manipulation: In some cases, manual manipulation of the coccyx may be performed by a trained healthcare professional to realign the coccyx and relieve pain.

4. Surgical Options: Surgery is typically considered a last resort for coccydynia, especially if conservative treatments fail. Surgical options may include coccygectomy (removal of the coccyx), but this is usually reserved for severe cases.

Tarlov Cysts and Their Implications
Regarding the Tarlov cyst you mentioned, it is essential to understand that while many individuals have Tarlov cysts without experiencing symptoms, larger cysts can potentially cause neurological symptoms, including bowel and bladder dysfunction. Your cyst, measuring approximately 1.9 cm, is close to the threshold where surgical intervention might be recommended, especially if you begin to experience worsening symptoms. However, many doctors prefer to monitor the cyst unless it is causing significant issues.

Monitoring Your Condition
Since you are experiencing ongoing symptoms, it is crucial to keep an open line of communication with your healthcare providers. If you notice any new symptoms, such as increased pain, changes in bowel or bladder function, or neurological symptoms (like numbness or tingling), you should seek medical attention promptly. Regular follow-ups with your orthopedic or neurosurgeon can help ensure that any changes in your condition are addressed in a timely manner.

Conclusion
In summary, managing coccydynia involves a combination of conservative treatments, monitoring, and possibly more advanced interventions if symptoms persist or worsen. Given your ongoing discomfort and the complexity of your case, it may be beneficial to seek a second opinion from a specialist who focuses on coccyx injuries or pain management. Remember, recovery can take time, and patience is essential as you navigate this process.

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