From the Research
X-rays are indicated for patients with coccydynia (tailbone pain) when the pain is severe, persists for more than a few weeks, or follows a traumatic injury, as they can help identify fractures, dislocations, or abnormal alignment of the coccyx. The procedure is quick, painless, and involves lying on an X-ray table while images are taken from different angles, with no special preparation needed beforehand 1. However, it's essential to note that X-rays have limitations, as they show bone structures well but can't visualize soft tissues like muscles, ligaments, or nerves that might also contribute to tailbone pain.
Some key points to consider when evaluating coccydynia include:
- The etiology of coccydynia, which can include trauma, obesity, and female sex, as well as special coccyx morphology and coccygeal hypermobility 1
- The classification of fractures of the coccyx, which can be described according to their mechanism, including flexion, compression, and extension (types 1,2, and 3, respectively) 2
- The importance of dynamic X-ray examination of the coccyx in standing and sitting position to evaluate morphologic parameters and hypermobility causing idiopathic coccydynia 1
If the X-ray is normal but pain continues, the doctor might recommend additional imaging, such as an MRI or CT scan, for a more detailed evaluation. While waiting for imaging or if X-rays don't show a specific cause, treatment typically includes pain relievers like acetaminophen or NSAIDs, sitting on cushions designed to relieve pressure on the tailbone, and avoiding prolonged sitting when possible. The most recent and highest quality study 1 supports the use of X-rays as a first step in evaluating coccydynia, and highlights the importance of considering the etiology and classification of fractures when making a diagnosis and developing a treatment plan.