What is the treatment for a coccygeal (tailbone) fracture?

Treatment for Coccygeal (Tailbone) Fracture

Conservative management is the first-line treatment for most coccygeal fractures, including rest, pain management, cushioning, and physical therapy, with surgical intervention reserved only for refractory cases that fail to respond after several months of conservative treatment. 1, 2

Initial Management

• Conservative treatment is recommended for the majority of coccygeal fractures as they typically heal well without surgical intervention 1, 3
• Initial management includes:
  • Rest and activity modification to avoid prolonged sitting 1
  • Pain management with non-steroidal anti-inflammatory drugs (NSAIDs) 4
  • Use of specialized cushions (donut or wedge-shaped) to reduce pressure on the coccyx while sitting 2

Pain Management Options

• Oral analgesics including NSAIDs and acetaminophen for pain control 4
• Topical medications may provide localized relief 2
• For more severe pain:
  • Local anesthetic and corticosteroid injections into painful structures (sacrococcygeal joint, intercoccygeal joints, or Walther's ganglion) 1
  • Caudal blocks can provide significant pain relief in refractory cases 5

Physical Therapy Interventions

• Manual therapy including:
  • Massage and stretching of the levator ani muscle 1
  • Mobilization techniques for the coccyx 1
• Pelvic floor physical therapy to address muscle tension and dysfunction 2
• Exercises to strengthen supporting musculature 1, 2

Advanced Conservative Therapies

• For cases not responding to initial conservative measures, consider:
  • Radiofrequency ablation of coccygeal discs and Walther's ganglion 1, 3
  • Extracorporeal shock wave therapy has shown benefit in some refractory cases 5, 3
  • Low-level laser therapy (laser acupuncture) has demonstrated efficacy in reducing pain and promoting healing in refractory cases 4

Diagnostic Evaluation

• Dynamic lateral radiographs in standing and sitting positions to assess for abnormal mobility, which is present in approximately 70% of patients with coccygodynia 1
• MRI may be useful to evaluate soft tissue involvement and rule out other pathologies 2, 5
• Diagnostic injections with local anesthetic can confirm the coccyx as the source of pain 1

Surgical Management

• Coccygectomy (partial or total surgical removal of the coccyx) is reserved for refractory cases that fail to respond to at least 2-3 months of conservative treatment 1, 4
• Best surgical outcomes are seen in patients with:
  • Documented abnormal mobility of the coccyx 1
  • Presence of coccygeal spicules (bony excrescences) 1
• Important considerations before surgery:
  • Coccygectomy carries a high complication rate 4
  • Surgical intervention should only be considered after exhausting all conservative options 1, 4

Monitoring and Follow-up

• Most patients with coccygeal fractures respond well to conservative management 1, 3
• Follow-up should assess:
  • Pain levels during sitting and transitions from sitting to standing 2
  • Functional improvement in daily activities 5
  • Radiographic evidence of healing when appropriate 4

Special Considerations

• Pregnancy and childbirth-related coccygeal fractures may require specialized management approaches 5
• Persistent pain beyond 2-3 months warrants reassessment and consideration of advanced treatment options 1, 4
• Abnormal mobility of the coccyx, which can be seen on dynamic radiographs, is the most common pathological finding in patients with persistent coccygodynia (70% of cases) 1