What is the treatment for a bruised coccyx (tailbone)?

Treatment for a Bruised Tailbone (Coccygodynia)

The primary treatment for a bruised tailbone (coccygodynia) consists of conservative measures including NSAIDs, specialized cushions, and activity modification, with most cases resolving within weeks to months without surgical intervention.

Initial Management

Pain Relief Medications

• NSAIDs/COXIBs at maximum tolerated dose are recommended as first-line treatment 1
  • Ibuprofen, naproxen, or diclofenac for anti-inflammatory and analgesic effects
  • Acetaminophen can be used as an alternative or in combination with NSAIDs
  • Topical diclofenac gel or patch may provide localized relief with minimal systemic effects 2

Sitting Modifications

• Specialized coccyx cushions with a cutout area to reduce pressure on the tailbone 3
  • U-shaped or V-shaped cushions that prevent direct pressure on the coccyx
  • Avoid sitting on hard surfaces
  • Lean forward slightly when sitting to reduce pressure on the coccyx

Activity Modification

• Avoid prolonged sitting when possible
• Take regular standing breaks
• Avoid activities that worsen pain (cycling, rowing, horseback riding) 4
• Apply ice in the first 48 hours to reduce inflammation and swelling
• Apply heat after 48 hours to improve blood flow and promote healing

Physical Therapy Interventions

Manual Therapy

• Massage and stretching of the levator ani muscle 4
• Mobilization of the coccyx by a trained physical therapist
• Pelvic floor physical therapy, especially important as nearly 50% of patients with pelvic pain have coexisting coccygodynia 5
• Focus on external and internal soft tissue mobilization techniques

Exercise Therapy

• Core strengthening exercises
• Pelvic floor relaxation techniques
• Stretching exercises for piriformis and gluteal muscles

Advanced Interventions (for persistent cases)

Injection Therapy

• Local anesthetic and corticosteroid injections into painful structures 4
  • Sacrococcygeal joint
  • Intercoccygeal joint
  • Walther's ganglion (ganglion impar)
• Ganglion impar block for refractory cases 6
  • Performed under fluoroscopic guidance
  • Can provide complete pain relief in idiopathic coccygodynia cases

Minimally Invasive Procedures

• Radiofrequency ablation of coccygeal discs and Walther's ganglion for persistent cases 4
• Consider when conservative treatments fail after 6 months

Surgical Management

• Coccygectomy (surgical removal of the coccyx) is rarely indicated 4, 3
• Only considered in refractory cases that have failed all conservative treatments
• Most appropriate for patients with:
  • Abnormal mobility of the coccyx confirmed on dynamic radiographs
  • Coccygeal spicules (bony excrescences)
  • Clear correlation between symptoms and pathology

Diagnostic Considerations

• Dynamic lateral radiographs in standing and sitting positions to assess for abnormal mobility 4
• MRI or CT may be considered to rule out other pathologies
• Diagnostic injections with local anesthetic can confirm the coccyx as the pain source 4

Important Considerations

• Coccygodynia significantly impacts quality of life due to sitting intolerance 4, 3
• Abnormal mobility of the coccyx is the most common pathological finding (70% of patients) 4
• In 30% of cases, no specific cause can be identified (idiopathic coccygodynia) 4
• Women with coccygodynia often have higher rates of pelvic floor dysfunction, muscle spasm, and sacrococcygeal joint hypomobility 5
• Conservative treatment is successful in the majority of cases 4
• Recovery time varies from weeks to several months depending on severity

Remember that most cases of coccygodynia will resolve with conservative management, and patience is often required as healing can take time. Surgical intervention should only be considered after exhausting all non-surgical options.