What is the treatment for a coccyx sprain?

Treatment for Coccyx Sprain

The most effective treatment for coccyx sprain involves a combination of conservative measures including cushioning, pain management, and physical therapy, with surgical intervention reserved only for cases that fail to respond after 6 months of appropriate conservative management.

Initial Management (First 72 Hours)

• Modified PRICE protocol:

  • Protection: Avoid activities that aggravate pain
  • Relative rest: Limit prolonged sitting
  • Ice: Apply for 15-20 minutes, 3-4 times daily
  • Compression: Use only if comfortable
  • Elevation: Not typically necessary for coccyx injuries

• Pain management:

  • NSAIDs: Recommended for pain and inflammation reduction 1
    • Options include naproxen, celecoxib, or diclofenac
    • Use with caution as they may affect healing process
  • Acetaminophen: Alternative option (1000mg every 6 hours, not exceeding 4000mg daily) 1

Supportive Measures

• Specialized cushions:

  • Donut-shaped or wedge cushions to reduce pressure on coccyx 2
  • U-shaped cushions that distribute weight to ischial tuberosities 3

• Functional support:

  • Semi-rigid support may help with pain during daily activities 1
  • Avoid complete immobilization as it delays recovery 4

Rehabilitation Phase (After Acute Phase)

• Physical therapy interventions:

  • Manual therapy: Intrarectal manipulation and massage of coccyx 5
  • Pelvic floor rehabilitation: Relaxation and strengthening exercises 3
  • Progressive strengthening: Focus on core and pelvic muscles 1
  • Proprioceptive training: To improve stability and function 1

• Exercise progression:

  • Begin within 48-72 hours after injury with gentle movement 1
  • Gradually increase intensity as tolerated
  • Continue exercises even after pain resolves to prevent recurrence 1

Advanced Interventions (For Persistent Pain)

• Injection therapy:

  • Local corticosteroid injections around coccyx for persistent pain 6
  • Consider after 4-6 weeks if conservative measures fail
  • May provide significant relief but effects can be temporary 6

• Other interventions to consider:

  • Ganglion impar blocks 7
  • Pulsed radiofrequency ablation 7
  • Transcutaneous electrical nerve stimulation 3

Surgical Management

• Coccygectomy:
  • Only considered when all conservative measures fail after 4-6 months 7
  • Success rates reported between 60-91% 7
  • Reserved for cases with severe, persistent pain affecting quality of life 3
  • Higher success rates observed in traumatic cases versus idiopathic cases 7

Monitoring and Follow-up

• When to seek further medical evaluation:
  • Pain persisting beyond 4-6 weeks despite appropriate management 1
  • Development of neurological symptoms (numbness, weakness)
  • Significant worsening of pain or new symptoms

Special Considerations

• Risk factors for delayed recovery:

  • Longer duration of symptoms before treatment 6
  • Posterior coccyx dislocations may have poorer outcomes with conservative care 6
  • Obesity may complicate treatment and slow recovery 3

• Prognosis:

  • Conservative treatment is successful in approximately 90% of cases 3
  • Many cases resolve without specific medical intervention
  • Chronic cases (>2 months) may have less favorable outcomes, with about 51% still having significant pain at 36 months 6

Remember that early intervention with appropriate conservative measures offers the best chance for recovery from coccyx sprain, with surgical options reserved only for refractory cases.