From the Research
Management of coccydynia should begin with conservative measures, including physical therapy and pressure reduction, for at least 6-8 weeks before considering more invasive options, as supported by the most recent and highest quality study 1. The initial treatment approach for coccydynia involves a combination of non-pharmacological and pharmacological interventions. Key considerations include:
- Avoiding sitting on hard surfaces and using donut-shaped cushions or wedge cushions to reduce pressure on the coccyx
- Physical therapy focusing on pelvic floor relaxation exercises, manual manipulation, and stretching to relieve muscle tension contributing to pain
- NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for pain relief and to reduce inflammation For persistent cases, local injections may be beneficial, including corticosteroid injections into the painful area. However, the evidence for injection-based therapy is not as strong, and these treatments should be considered on a case-by-case basis 2. Surgery, specifically coccygectomy, is rarely indicated and should be reserved for severe cases unresponsive to all other treatments for at least 6 months, due to the associated risks and variable success rates 1. A multidisciplinary approach, incorporating physical therapy, ergonomic adaptations, medications, and possibly psychotherapy, offers the greatest chance of success in managing coccydynia, as highlighted in recent systematic reviews 1.