From the Guidelines
Treatment for a coccyx fracture should focus on conservative management, with surgery considered only for severe cases with persistent pain after conservative treatment has been exhausted. The diagnosis of a coccyx fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1. Conservative management typically involves rest, avoiding prolonged sitting, using donut-shaped cushions or wedge pillows to reduce pressure on the tailbone, and taking over-the-counter pain medications such as acetaminophen or NSAIDs as needed for pain.
- Initial treatment may include:
- Rest and avoiding activities that exacerbate the pain
- Using donut-shaped cushions or wedge pillows to reduce pressure on the tailbone
- Taking over-the-counter pain medications such as acetaminophen 500-1000mg every 6 hours or NSAIDs like ibuprofen 400-800mg every 6-8 hours as needed for pain
- Applying ice packs for 15-20 minutes several times daily for the first few days to reduce inflammation and discomfort
- For more severe pain, doctors may prescribe stronger pain medications or local steroid injections, and physical therapy exercises to strengthen pelvic floor muscles may be recommended after the acute pain subsides 1.
- Most coccyx fractures heal within 8-12 weeks without surgical intervention, and surgery is rarely needed and only considered for severe cases with persistent pain after 6 months of conservative treatment.
From the Research
Treatment Options for Coccyx Fracture
- Conservative treatment is successful in 90% of cases, and many cases resolve without medical treatment 2
- Treatments for refractory cases include:
- Pelvic floor rehabilitation
- Manual manipulation and massage
- Transcutaneous electrical nerve stimulation
- Psychotherapy
- Steroid injections
- Nerve block
- Spinal cord stimulation
- Surgical procedures
- A multidisciplinary approach employing physical therapy, ergonomic adaptations, medications, injections, and, possibly, psychotherapy leads to the greatest chance of success in patients with refractory coccyx pain 2
- Nonsurgical management, including cushions, nonsteroidal anti-inflammatory drugs, and corticosteroid injections, can be successful in up to 85% of patients 3
- For patients with conservative therapy-resistant coccygodynia, operative treatment with coccygectomy is a feasible management option 3, 4
- Other interventions available for patients who do not respond to conservative therapies include:
- Local injection of local anesthetics and steroids
- Neurolysis of sacral nerve roots
- Caudal epidural block
- Pulse radiofrequency (PRF)
- Intra-rectal massage and manipulation
- Ganglion impar block
- Levator ani massage and stretching
- Coccyx manipulation
- Coccygectomy 4
- Coccygeoplasty, a procedure involving the injection of polymethylmethacrylate cement, has been suggested as a treatment for fractures of the coccyx 5