Broken coccyx: What to do in case of fracture? (Is that bad ?)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

A broken coccyx corresponds to a fracture of the coccyx. It is often accompanied by a sharp pain that can persist for a long time, and does not seem to want to resolve.

Due to the location of the coccyx and its anatomy, some fractures at this level may not be diagnosed immediately. This article explains the symptoms of a broken coccyx, and the management from diagnosis to the various treatment options available.

Definition and anatomy

The coccyx is located at the very bottom of the spine, below the sacrum. It has a triangular shape and is made up of 3 to 5 tiny individual vertebrae.

These bones fuse in adulthood to form the coccyx, although the fusion may be partial in some individuals. In this case, the coccyx is made up of 2 (or more) separate bones.

The coccyx serves as an anchor for several muscles, tendons and ligaments in the pelvic region. For example, muscle gluteus maximus, an important thigh extensor, has one of its origins in the coccyx.

In addition to its role in fixing muscles, the coccyx also plays an important role in supporting the spinal cord. THE terminal filum, a fibrous tissue serving as an extension of the spinal cord, is attached to the coccyx and uses this bone as an anchor for the spinal cord.

Risk factors

A broken coccyx usually comes from a significant external trauma to cause a fracture. This usually occurs following a fall on the buttock, for example a fall down the stairs and landing on the tailbone. A direct trauma with an external force can also cause a fracture.

Furthermore, the anatomical location of the coccyx also makes it susceptible to internal injury. For example, a difficult childbirth or instrumented can theoretically cause a coccyx fracture, although the trauma usually causes a contusion and not a fracture.

Finally, a sitting could also cause a coccyx fracture in some cases. This mainly occurs in people with health problems causing bone fragility such as osteoporosis, or a very weak muscle (in the elderly for example).

Symptoms of the disease

The classic presentation of a broken coccyx is a localized pain in the coccyx. It is typically aggravated by prolonged sitting, bending backwards (lumbar extension), or rising from a chair. Having sex or having a bowel movement can also make symptoms worse.

The pain can sometimes be accompanied by a bruise if the cause is traumatic, as well as a localized swelling at the level of the coccyx.

Diagnostic

Diagnosing a broken tailbone usually begins in the doctor's office. A history helps determine potential causes for the pain (such as a fall), as well as medical conditions that may influence the diagnosis (such as osteoporosis).

A clinical examination clarifies the diagnosis and determines the functional impact of the coccyx fracture. Palpation of the sacrum and coccyx will most often show local tenderness. A rectal examination where the doctor grasps the coccyx through the anus reveals abnormal movement of the coccyx suggestive of a possible fracture.

Medical imaging is also an important asset in determining whether the coccyx is broken. A radiography in a standing and sitting position will allow the doctor to assess the degree of movement of the coccyx by comparing the two images. In some cases, a CT scan or magnetic resonance imaging (MRI) will provide information about the soft tissue surrounding the area.

When to worry

In some rare cases, a coccyx pain can come from a cancer or a serious attack of the vertebral column. If you ever observe any of the following signs and symptoms, it is best to consult your doctor without delay:

• Blood in the stool or urine
• Urinary or fecal incontinence
• Burning sensation during urination or ejaculation
• Sudden onset erectile dysfunction
• Unexplained weight loss
• Chronic fatigue
• Constipation or recurrent diarrhea
• Abdominal cramps
• Loss of sensation and significant weakness in the legs

In addition to damage requiring urgent medical intervention, it is possible that coccyx pain comes from less serious causes, without causing a fracture. To know other causes of coccyx pain, see the following article.

Treatment

Any fracture takes time to heal. In the case of a broken coccyx, the healing time can take eight to twelve weeks. To speed up the healing process and better tolerate pain, the following modalities can be prescribed by a doctor:

Medication

Depending on the patient's condition and medical history, the doctor may prescribe medications aimed at reducing inflammation and controlling pain. If symptoms are aggravated by defecation, laxatives can provide significant relief (in addition to a high fiber diet).

Physiotherapy (physiotherapy)

In physiotherapy, several modalities will relieve pain, accelerate the healing process, and increase functional capacities to better live daily with the fracture of the coccyx. Commonly used modalities include:

• Electrotherapy
• Topical application of anti-inflammatory cream
• Application of heat and/or ice (video explanation)
• Therapeutic exercises (strengthening of the glutes, pelvic floor, etc.)
• Massages and mobilizations
• Coccygeal cushions to relieve pressure on the coccyx in a seated position

Tools and accessories

Here are tools and accessories to relieve tailbone pain (including a broken tailbone). However, it must be ensured that the fracture is consolidated before using them.

Seek professional help before using the following products:

• heat and ice (video explanation to differentiate between the two)

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• Electro-stimulation (TENS and Compex)

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• massage device (for example with a mini massage gun around the coccyx area)

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• acupressure mat

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The coccygeal cushion

As seen previously, coccyx pain can persist for several weeks several months. It is therefore wise to obtain a cushion specially designed to avoid pressure on the coccyx, promote healing, reduce pain and prevent aggravation of symptoms.

This type of cushion differs from a traditional cushion, its horseshoe shape will allow a comfortable seat while decreasing the contact between your support and your tailbone. It will be of great use to you if you have to sit for long hours. Made with a "shape memory" type material, this cushion will adapt to your morphology while avoiding excess pressure on the coccyx. It will be all the more useful if you have to travel by car, for example to help dampen shocks and vibrations.

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As seen above, the coccyx, in a seated position, will help the two seat bones of the pelvis to support the weight of the body. When you use a coccyx cushion it is therefore wise to maintain optimal support for your spine and keep a good posture in order to avoid that certain vertebrae are under too much pressure.

Lumbar support (like this one) can help keep your spine in a healthy posture, while reducing the risk of lower back pain.

Simply place it on your car seat or office chair. Lean forward slightly when you sit on it to limit stress on the tailbone.

Please also readjust your seat (seat height) if necessary to maintain a healthy posture. You can place a small support under your feet if necessary in order to have a more comfortable position. Also, if you put it on a very soft support, for example on the sofa or the bed, you can put a solid board under it to give you more support.

If your cushion does not relieve you or aggravates your symptoms, it may be necessary to opt for a firmer, softer or thicker model, it will depend on you, your situation and your morphology. You can also ask your doctor or healthcare professional for advice.

Infiltration

Cortisone injections into the coccyx are sometimes used to reduce pain and improve healing.

surgery

Surgery is rarely indicated for a coccyx fracture. It is considered during a complex fracture involving damage to the surrounding tissues, or when the pain persists despite well-conducted conservative treatment.

The surgical option is to remove the coccyx, an operation called coccygectomy.

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

• Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.

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• Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).

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• Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly. 

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• Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.

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• wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

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References

• https://www.physio-pedia.com/Coccyx_Fractures
• https://en.wikipedia.org/wiki/Coccyx_fracture