Coccyx Pain or Coccydynia (tailbone pain)

The coccyx is a small bone (actually a collection of 3-5 small bones) that is connected to your sacrum which by a ligament. The coccyx is commonly known as the tailbone. The bone serves a function for humans as a connection for muscles of the pelvic region.

It is also a part of the weight-bearing tripod structure which acts as a support for a sitting person. When a person sits leaning forward, the ischial tuberosities and inferior rami of the ischium take most of the weight, but as the sitting person leans backward, more weight is transferred to the coccyx.

Pain can orientate from this bone, and is most often characterized by pain in the region of the bone on sitting, particularly on hard surfaces. Coccyx pain may be caused by many injuries such as trauma through falling, but is most commonly idiopathic in nature (reason unknown).

Treatment Options

Treatment may include nonsurgical therapies such as changing sitting positions, which include using a special pillow to sit on, special physical therapy that can involve internal manipulation, coccygeal injections, neuroablative procedure, and coccygectomy.

Coccyx pain can be very complex as to the actual mechanism of pain, and what is actually generating the pain. The pain may be secondary to bone trauma, and this can be innervated by the nerves on the coccyx that are on the side of the bone under the skin. We can attempt to inject these nerves through the skin. But the innervation to the coccyx is diffuse and the nerves on the underside of the coccyx will not respond to these injections as they are not accessible to our medications through injection. There are also multiple ligaments and tendons which connect to the coccyx which can cause pain.

Injections

The coccyx injection involves placing a steroid (strong anti-inflammatory medication) guided by live x-ray guidance (fluoroscopy) onto the bone to decrease inflammation. For patients that cannot have steroid injections, platelet rich plasma (PRP) can be considered or a neuroablative procedure. The coccyx injection can also be diagnostic. If a small amount of numbing medication is placed on the coccyx with steroid, and the pain dissipates, then we know that the pain is related to the nerves on the posterior aspect of the coccyx. This would let us believe that could destroy these nerves with a neuroablative procedure we could potentially get longer term relief.

Neuroablative procedures

Phenol neural ablation

Involves the placement of phenol on the coccyx. Phenol is a chemical that can destroy nerve tissue, which is less destructive than placement of alcohol. This procedure can potentially give longer term relief than the steroid injection.

Endoscopic radiofrequency

This procedure involves placing an endoscope onto the coccyx and using thermal ablation under direct visualization. A camera is attached though a small port and a cautery type of device is used to destroy the nerves that innervate the posterior aspect of the coccyx. To learn more about this procedure click here.

To Learn More

If you have been diagnosed with coccydynia, or coccyx related pain or are interested in learning how about treatment options to manage your pain, please contact our pain management experts at The Spine and Pain Institute of New York in Manhattan, Staten Island, Brooklyn, and Long Island New York. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.

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