From the Research
Steroid injections are generally not recommended for a subacute fracture of the coccyx. The primary treatment for coccyx fractures involves conservative measures such as cushions for sitting, pain medications like NSAIDs (ibuprofen 400-600mg three times daily or naproxen 500mg twice daily), and time for healing, which typically takes 8-12 weeks 1. While steroid injections might be considered for persistent coccydynia (tailbone pain) that doesn't respond to conservative treatment, they are usually avoided during the fracture healing phase as corticosteroids can potentially impair bone healing and increase infection risk.
Some key points to consider in the treatment of coccyx fractures include:
- The use of NSAIDs for pain control, which has been shown to be effective in reducing pain and the need for opioids after traumatic fracture, with a small effect on non-union 1
- The importance of avoiding certain medications that may impair bone healing, such as COX-2 inhibitors, during the fracture healing phase 2
- The potential benefits of alternative treatments, such as ganglion impar blocks with local anesthetic, for severe, persistent pain after adequate healing time 3
- The role of physical therapy, including pelvic floor relaxation, as an adjunct treatment once the acute pain subsides 4
In cases of severe, persistent pain after adequate healing time (usually after 2-3 months), a ganglion impar block with local anesthetic (such as 3-5ml of 0.25% bupivacaine) with or without steroids might be considered, but this should be performed by a pain specialist or interventional radiologist after proper imaging confirms fracture status. Physical therapy focusing on pelvic floor relaxation may also be beneficial as an adjunct treatment once the acute pain subsides.