A tailbone injury is a pain in the butt.
HEALTH The coccyx is the anatomical region at the lower end of the spine, often called the tailbone, that in 80 percent of people comprise four coccygeal vertebrae. Ordinarily only slightly concave anteriorly, osteoporosis or trauma may cause a slight deviation posteriorly or anteriorly as much as 90 degrees. This can interfere with bowel function, urinary discharge and vaginal childbirth.
Prolonged sitting, bicycling, canoeing, horseback riding or even extended standing inflames nearby tissues, weakens ancillary muscles and causes considerable discomfort. Tailbone pain, or coccydynia, as it is commonly called, can be persistent and severe. Less frequently the term coccygodynia is used.
The coccyx not only serves as somewhat of a weight-bearing structure but also provides support for several ligaments. Patients with pain in this region often try to cope while sitting by leaning forward, with bilateral weight on the inferior ischial regions of the pelvis and the posterior femur (thigh bone). They may alternatively sit mainly on one ischial tuberosity (hip) or the other. This leaning, however, can lead to secondary back pain higher up the spine or concomitant ischial bursitis.
In spite of all the pain, suffering and reduced quality of life, patients often report that their physicians minimize, dismiss, or belittle their symptoms. Relief may be sought through anti-inflammatory drugs, cold compression, and special seat cushions with a wedge for coccyx removed. Relatively few physical therapists have expertise in pelvic pain syndromes. However, a small but growing number of therapist are receiving specialized training in this area.
Coccygectomy is the removal of the coccyx. This radical surgical intervention is associated with extremely high rates of bacterial infection due the proximity of the incision to the anus. Infection often results in secondary surgery. Extreme care must be taken to properly anchor multiple muscular and ligamentous attachments from the coccyx.
In a retrospective study of 32 patients with coccydynia who were treated by an orthopedic spine surgeon, 11 (34%) underwent surgical treatment via coccygectomy. Marked improvement was reported in 9 (28%) of the surgical patients, but 3 (27%) of the 11 developed wound infections and 1 (9%) developed wound dehiscence. (Foye PM. Reasons to delay or avoid coccygectomy for coccyx pain. Injury. Nov 2007;38(11):1328-9.) Because of many potential complications, coccygectomy is generally reserved for patients with a cancerous coccyx or those for whom all alternative measures have brought no relief.
In his article, Successful injection for coccyx pain (American Journal of Physical Medicine and Rehabilitation. 2006 Sep;85(9):783-4), Dr. Foye describes a special injection where the physician performs a nerve block at the ganglion Impar. This is very different than a typical coccyx injection that many physicians attempt in their offices. This is not an epidural steroid injection. It is a special type of nerve block. This injection requires fluoroscopy for accurate placement of the injection. (If your doctor gave you a local injection at your tailbone, without using a fluoroscopy machine to guide the injection to the exact location, it is very unlikely that you received a ganglion Impar nerve block.) This article documents that a single injection (when properly performed) can sometimes provide a patient with 100% permanent relief of tailbone pain (coccyx pain).
In conclusion, coccyx pain can be debilitating. Though radical surgical intervention is possible, there are many prior treatment options to consider. The key is to locate a care provider with much successful experience in treating patients with coccydynia.
Synopsis of article at eMedicine by Patrick Foye, MD, FAAPMR, FAAEM.
Dr. Foye is well-known for his expertise in non-surgical treatment a variety of painful conditions of the coccyx (tailbone), back and limbs.