Chronic Coccyx Pain: Seeking Solutions After Nearly a Year of Discomfort

Coccyx pain for nearly a year?

Hello, Dr.
Shen.
I have been experiencing pain in my coccyx since early May of last year.
The pain is located about 2 centimeters above the tip of the coccyx, seemingly at the junction with the sacrum.
The pain is triggered by certain positions, such as leaning too far back while sitting (half-sitting, half-lying), riding a motorcycle (when my condition is better, I can ride for over 40 minutes without pain, but when it's worse, I feel a dull ache after just 10 minutes), sitting on hard chairs or the floor that puts pressure on the affected area, performing sit-ups, and weight training exercises that require gluteal engagement (for example, squats and lunges; in severe cases, even squeezing my glutes causes pain).
The main symptoms are tenderness in the affected area and pain during exertion.
1.
Initially, I visited an orthopedic clinic where X-rays showed no issues with the bones.
It was suspected that the ligaments connecting to the coccyx might be injured, so I took some anti-inflammatory pain medications, but there was little improvement.
The doctor then recommended shockwave therapy with a physical therapist, who assessed my weight training posture and found no problems.
During this time, I also adjusted my sitting posture and purchased a donut cushion.
After undergoing 9 sessions of shockwave therapy, my condition improved somewhat, but I still experienced pain during gluteal exertion and when the affected area came into contact with harder surfaces.
Subsequently, the physical therapist and doctor suggested I start exercising to help the affected area adapt to weight.
2.
Within a month after I stopped therapy and began exercising (the affected area actually hurts during exercise), the pain became more pronounced.
In October of last year, I went to K Medical Center's neurosurgery department for an examination.
After arranging nerve conduction studies and electromyography, the doctor determined that there were no nerve issues.
After about 1-2 months of follow-up in the neurosurgery department with no significant progress, I returned to the original orthopedic clinic for treatment.
3.
Starting in December of last year, the orthopedic doctor performed two to three sessions of glucosamine prolotherapy on my coccyx, but the recovery was limited.
The doctor then suggested trying shockwave therapy again, which he personally administered.
After about 9 sessions, the pain during the shockwave treatment on my glutes significantly decreased, but I still experienced pain during gluteal exertion and when the affected area came into contact with harder materials.
Therefore, I transitioned to K Medical Center's rehabilitation department for treatment.
4.
Around the end of March this year, I went to K Medical Center's rehabilitation department, where the doctor also took X-rays and assessed that there were no bone issues.
He then performed glucosamine prolotherapy, but instead of injecting directly at the pain point or coccyx, he injected into other areas and combined it with rehabilitation (shortwave, magnetic field, and vector therapy).
After three sessions, I still have not recovered, including pain during gluteal exertion, contact with hard surfaces (even with a yoga mat on the floor, it still hurts), and soreness during longer motorcycle rides.
These treatments seem to only prevent my symptoms from worsening rather than achieving complete recovery.
However, whenever I stop treatment, the pain in the affected area becomes more pronounced.
5.
During this nearly year-long period, I have also consulted several traditional Chinese medicine practitioners for electrotherapy and acupuncture, but the results were similarly limited.
6.
I would like to ask the doctor if there are any recommendations regarding my condition.
The nearly year-long treatment has been financially burdensome and mentally exhausting.
Should I ask the current rehabilitation doctor to consider arranging further examinations or manual therapy? However, since this is the doctor's expertise, I hesitate to suggest anything unless the doctor brings it up.
I kindly request your advice.
Thank you.

Hank, 20~29 year old female. Ask Date: 2024/04/27

Dr. Shen Boquan reply Orthopedics

Hello, the causes of lower back pain are numerous.
Statistics show that 90% of cases are related to soft tissue issues, commonly referred to as "muscle strain." Sports injuries, excessive fatigue, poor posture, or high stress levels can all contribute to discomfort.
If you experience symptoms of nerve compression, such as numbness in the toes or the top of the foot, and conservative treatment does not improve your condition, surgical intervention may need to be considered.
You likely do not have issues with bone density or joint degeneration.
Engaging in moderate exercise can help maintain muscle and joint flexibility.
If you wish to assess for any spinal issues, you can consult an orthopedic surgeon or a neurosurgeon.
For rehabilitation treatment, please seek a physical medicine and rehabilitation specialist.
It’s important to discuss your concerns with your physician.
Additionally, be mindful of whether work-related fatigue or stress exacerbates your back pain.
If it significantly affects your quality of life, appropriate use of anti-inflammatory and analgesic medications or rehabilitation can be beneficial.
Wishing you good health.
Sincerely, Shen Bai-Chuan.

Reply Date: 2024/04/27

More Info

Chronic coccyx pain, often referred to as coccydynia, can be a frustrating and debilitating condition, especially when it persists for an extended period, as in your case. Your detailed account of the pain and the treatments you've undergone provides a clear picture of your situation. Let's explore some potential avenues for relief and management of your symptoms.

Understanding Coccydynia
Coccydynia is characterized by pain in the coccyx or tailbone area, which can be exacerbated by sitting, standing, or certain movements. The pain can stem from various causes, including trauma (such as a fall), prolonged sitting on hard surfaces, or even repetitive strain from activities like cycling or certain exercises. In your case, it seems that the pain is linked to both mechanical stress and possibly inflammation of the surrounding soft tissues.

Treatment Approaches
1. Physical Therapy: Since you've already undergone several treatments, including shockwave therapy and prolotherapy, it may be beneficial to continue with physical therapy focused on strengthening the pelvic floor and surrounding muscles. A specialized physical therapist can provide tailored exercises and manual therapy techniques that may help alleviate pain and improve function.

2. Pain Management: If over-the-counter anti-inflammatory medications have not provided sufficient relief, discussing other pain management options with your healthcare provider may be worthwhile. This could include prescription medications, topical analgesics, or even nerve blocks if appropriate.

3. Coccyx Cushion: You mentioned using a donut cushion, which can be helpful. Ensure that the cushion is appropriately designed to relieve pressure on the coccyx. Some cushions are specifically contoured to provide better support and comfort.

4. Activity Modification: It’s essential to modify activities that exacerbate your pain. For instance, if certain exercises or prolonged sitting positions trigger discomfort, consider adjusting your routine. Low-impact activities, such as swimming or cycling with a well-padded seat, may be more tolerable.

5. Alternative Therapies: While you have tried acupuncture and electrotherapy with limited success, some patients find relief through alternative therapies such as chiropractic care or osteopathic manipulation. These approaches can sometimes address underlying musculoskeletal issues contributing to pain.

6. Further Evaluation: Given that your symptoms have persisted for nearly a year with limited improvement, it may be prudent to discuss further diagnostic imaging or evaluations with your healthcare provider. An MRI could provide more insight into soft tissue structures around the coccyx and rule out any underlying conditions that may not be visible on X-rays.

7. Psychological Support: Chronic pain can take a toll on mental health. Engaging with a psychologist or counselor who specializes in chronic pain management can provide strategies to cope with the emotional aspects of living with persistent pain.

8. Surgical Options: In rare cases, if conservative treatments fail and the pain significantly impacts quality of life, surgical options such as coccygectomy (removal of the coccyx) may be considered. This is typically a last resort and should be discussed thoroughly with a specialist.

Conclusion
Your journey with chronic coccyx pain has been challenging, and it's understandable to feel frustrated with the lack of significant improvement. It’s crucial to maintain open communication with your healthcare providers about your ongoing symptoms and treatment responses. Don’t hesitate to advocate for yourself by requesting further evaluations or exploring new treatment options. Chronic pain management often requires a multifaceted approach, and finding the right combination of therapies can take time. Remember, you are not alone in this, and support is available to help you navigate your recovery journey.

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