What is the treatment for coccydynia (tailbone pain) resulting from an injury?

Treatment for Coccydynia (Tailbone Pain) from Injury

For tailbone pain (coccydynia) resulting from injury, the first-line treatment should include topical NSAIDs with or without menthol gel, combined with nonpharmacologic approaches such as specialized cushions and early mobilization. 1

Initial Management

Nonpharmacologic Approaches

• Specialized cushions: Use donut-shaped or wedge cushions to reduce pressure on the coccyx when sitting 2
• Ice application: Apply ice for 20 minutes at a time with a thin barrier between ice and skin to reduce inflammation and pain 1
• Heat therapy: May be beneficial after the initial inflammatory phase (48-72 hours) 1
• Positioning: Avoid prolonged sitting; lean forward when sitting to reduce pressure on the coccyx
• Early mobilization: Begin gentle movement as tolerated to prevent stiffness 1, 3

Pharmacologic Management

• First-line: Topical NSAIDs with or without menthol gel 1

  • Most favorable benefit-risk ratio for musculoskeletal injuries
  • Apply directly to the painful area 3-4 times daily

• Second-line: Oral medications 1

  • Oral NSAIDs (ibuprofen, naproxen)
  • Acetaminophen for pain relief
  • Avoid opioids including tramadol (conditional recommendation against their use) 1

Progressive Management for Persistent Pain

If pain persists beyond 2-3 weeks with first-line treatments:

Physical Therapy Interventions

• Pelvic floor rehabilitation exercises 2, 4
• Manual therapy techniques including gentle manipulation of the coccyx 4
• Transcutaneous electrical nerve stimulation (TENS) 1, 4

Interventional Procedures

For refractory cases (pain persisting >3 months despite conservative treatment):

• Local anesthetic and corticosteroid injections around the coccyx 2, 5
• Ganglion impar blocks for persistent neuropathic pain 5
• Consider referral to pain management specialist for advanced interventions

Surgical Intervention

• Coccygectomy (surgical removal of the coccyx) should be considered only in rare cases when all other treatments have failed 2, 4
• Success rates vary, and complications can include infection and delayed wound healing

Diagnostic Approach

• Dynamic X-rays: Standing and sitting lateral views to assess coccyx mobility and morphology 5
• Advanced imaging: Consider MRI or CT for persistent cases to rule out other pathologies 2, 5
• Physical examination: Direct palpation of the coccyx (external and intrarectal) to identify point of maximal tenderness 4

Important Considerations

• Avoid prolonged immobilization: This can lead to deconditioning and delayed recovery 1, 3
• Monitor for pain during treatment progression: Any increase in pain suggests overloading and requires temporary reduction in activity 1
• Obesity and female gender are risk factors for developing persistent coccydynia 4
• 90% of cases respond to conservative treatment without requiring surgical intervention 4

Follow-up Recommendations

• Reassess after 2 weeks of initial treatment
• If symptoms persist beyond 6-8 weeks, consider referral to specialist (orthopedics, physical medicine, or pain management)
• Educate patients that resolution may take several months in some cases

Remember that most cases of coccydynia will resolve with conservative management, though the recovery timeline varies considerably among patients.