TAILBONE INJURY - COCCYX PAIN - COCCYDYNIA


Tailbone pain - pain in the coccyx called pain that occurs in the final boundary of the coccyx or thereabout.

The coccyx is the terminal portion of the spinal column and consists of 3-5 vertebrae which is usually complex together (synosteosis). The shape of the coccyx bone is triangular, but the time and the possibility of movement of the vertebrae between them varies from person to person. Over the coccyx adhere various muscles, tendons and joints.
Women are more prone on injuries coccyx because they have a wider pelvis and the coccyx more exposed.


The coccyx is the last segment of the spine (red circle)
 

CAUSES 

The pain of the coccyx are mainly due to injury.

  • Direct injury of coccyx dropping the person sitting on a hard surface and is the most common cause of kokkygodynias (pain in the coccyx)
  • Direct bone injury blow during sports injuries especially in contact sports
  • The coccyx may be injured during birth
  • Repeated loads and friction in the bone of the coccyx as in cycling or in those whose nature of their job is to sit (computer operators) is another common cause kokkygodynias.
  • Less common causes are kokkygodynias local osteophytes, spinal injuries posing pressure on nerve roots, local infections and tumors.
  • Unknown cause of the pain.

WHAT ARE THE SYMPTOMS 

  • Pain is the dominant symptom of injury of the coccyx and accompanied by hematoma in the region it comes from injury
  • Worsening of pain when the person sits for a long time
  • Bowel movements and straining are often painful.
  • Some women may experience pain during sexual intercourse.


Sitting inclined torso rearwardly exerts loads on the tip of coccyx


The inclination of the torso forwards usually relieves coccydynia

EXAMINATION

  • X-ray of the coccyx which mainly gives us information about whether there is a fracture of the vertebrae, their dislocation, to assess the state of the them.
  • Three-phase bone scintigraphy with gamma camera for detailed assessment of local bone metabolism (enhancement of fracture or other causes such as tumors)
  • Magnetic resonance imaging of the lumbar spine, the sacrum and the coccyx to assess soft tissue around the bones, intervertebral discs in the lumbar spine and its relationship with emerging nerve roots.


Angulation of the coccyx after direct trauma - fall on the ground (red arrow)


MRI coccyx (sagittal section)


Inflammation in the lower vertebrae of the coccyx which causes severe pain in the area

PREVENTION

Prevention typically constitutes the soundest address the problem.

  • The most cases of coccygodynias are traumatic (injury during sports activities in the snow or ice) and can hardly be avoided.
  • The use of special protective materials (pads) in the region of the coccyx is an alternative.


 

  • For cases where the coccygodynia due to causes such as chronic friction again use special types of pillows will help effectively. Also, changing the way we sit ie carrying little weight torso forward greatly reduces the pressure on the coccyx.
  • The small and frequent interruption of our sedentary work can help.
  • The alternative work posture - standing position working on computer - has already been implemented in Asian countries.


Special pillow to prevent coccyx bone loading


Seated on the cushion. The point of the coccyx is at a vacuum thereby avoiding pressure therein (arrow)

Special 'Donut' cushion

CONSERVATIVE TREATMENT
THERAPY: 

Treatment of coccygodynias requires special patience and the compliance of the instructions of the attending Orthopedic.

  • Avoid prolonged seat from side asthenousI using special devices - Pillow "donut cushion" (during the sitting position is essential for a long time can reach 3-6 months).
  • The coccydynia from trauma (e.g., repeated drops during learning snowboard) is initially treated with ice pads for the first 48 -70 hours after injury. Apply ice topically to the coccyx 7-10 minutes, 4-8 times per 24 hours for a reasonable proposal.
  • Use of anti-inflammatory drugs the first 7-10 days for coccyx pain not due to injury and use only painkillers p / x paracetamol with codeine (lonarid N) if kokkygodynia due to injury for about 10 days.
  • The local cortisone injection use when coccydynia not subside with conservative measures is another measure
  • The infusion of autologous growth factors in PRP local area helps in curbing local inflammation naturally.
  • Physical therapy provides significant ancillary help in addressing the problem.

Finally, the surgical treatment of the problem if the above measures do not address the problem.