The tailbone, or coccyx, is a small, triangular bone structure located at the end of the spine. This structure serves as a point of attachment for multiple muscles, tendons, and ligaments, and it helps distribute weight when a person is seated. Pain localized to this area is medically known as coccydynia, a condition that can be uncomfortable and often worsens with prolonged sitting. Coccydynia often results from trauma like a fall, repetitive strain, or changes related to childbirth, though the exact cause remains unknown in many cases. Treatment involves various approaches, meaning a team of medical specialists manages the condition rather than a single “tailbone doctor.”
The Initial Consultation
A Primary Care Physician (PCP) or general practitioner should be the first point of contact for anyone experiencing persistent coccydynia. The PCP conducts the initial assessment by taking a detailed medical history and performing a physical examination to localize the pain. This initial step is important for ruling out other potential sources of discomfort, such as infections, pilonidal cysts, or referred pain from the lower back.
The PCP often begins with a conservative care plan, which includes non-steroidal anti-inflammatory drugs (NSAIDs) and instructing the patient on ergonomic adjustments. These adjustments involve avoiding prolonged sitting and using specialized cushions with a cutout to relieve pressure on the coccyx. The PCP manages the initial course of treatment before determining if a referral to a pain specialist or surgeon is necessary for more advanced interventions.
Key Medical Specialists Who Treat Coccydynia
When conservative treatments prove insufficient, a patient is typically referred to one of three primary medical specialists who focus on musculoskeletal and pain disorders. These specialists offer different approaches based on their area of expertise.
Orthopedic Surgeons, particularly those specializing in the spine, focus on structural issues of the coccyx and the surrounding joints. Their approach centers on diagnosing and treating mechanical problems like fractures, dislocations, or abnormal bone morphology. While they perform the last-resort surgical procedure called a coccygectomy, their treatment often includes non-surgical management like targeted injections.
Physiatrists, who specialize in Physical Medicine and Rehabilitation (PM&R), concentrate on non-surgical treatment to restore function and reduce pain. They manage the patient’s recovery by prescribing physical therapy and interventional procedures to improve the function of the surrounding muscles and joints. A physiatrist aims to manage the patient’s condition through a comprehensive, long-term rehabilitation strategy.
Pain Management Specialists are often anesthesiologists or neurologists with advanced training in complex pain relief techniques. Their main contribution is the precise administration of various injections and nerve blocks to interrupt pain signals and reduce inflammation. These specialists are experts in procedures like coccygeal joint injections and ganglion impar blocks, which can provide significant pain relief.
Pinpointing the Cause of Tailbone Pain
Diagnosing the cause of coccydynia involves a combination of a detailed physical examination and specialized imaging studies. During the exam, the specialist performs external palpation to locate the point of tenderness and assess for any palpable bone abnormalities. A rectal examination may also be necessary to assess the mobility of the coccyx and determine if muscle spasms, particularly in the pelvic floor muscles, are contributing to the pain.
Standard X-rays are typically the first imaging tool used, but dynamic X-rays taken while the patient is both standing and sitting provide much more useful information. This dynamic view allows the doctor to measure the change in the coccyx angle and detect hypermobility or subluxation, which occurs when the coccyx moves excessively or shifts out of alignment upon sitting. Hypermobility is often defined as an angular movement greater than 25 degrees between the standing and sitting positions.
Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans are reserved for cases where the initial workup suggests a more complex issue. An MRI is helpful for visualizing soft tissue structures, such as ruling out rare tumors or cysts, and for detecting chronic inflammation or edema around the coccyx tip. CT scans are particularly useful for confirming fractures or dislocations that may not be clearly visible on static X-rays.
Common Treatment Approaches
The vast majority of coccydynia cases are successfully managed with non-surgical, conservative treatments. The initial phase focuses on reducing inflammation and pressure on the coccyx using over-the-counter NSAIDs like ibuprofen, along with ergonomic modifications such as using a wedge or cutout cushion. Specialized physical therapy is often a cornerstone of treatment, targeting the muscles and ligaments surrounding the coccyx.
Physical therapy often involves techniques like manual manipulation, stretching of the levator ani and piriformis muscles, and pelvic floor rehabilitation. Injections offer the next line of treatment for patients who do not respond to physical therapy and medication. These are typically corticosteroid and local anesthetic injections administered directly into the painful sacrococcygeal joint or the surrounding soft tissues, providing temporary relief and aiding in diagnosis.
Advanced interventional procedures, such as a ganglion impar block, may be utilized for chronic cases that fail to respond to simpler injections. Surgery, known as coccygectomy, which involves removing part or all of the coccyx, is considered only as a last resort. This procedure is generally reserved for patients with severe, debilitating pain who have failed at least six months of comprehensive conservative and interventional management.