What can I do about tailbone pain?

Q: I fractured my tailbone in a fall over ten years ago. The pain subsided after about a year of physiotherapy, and since then I haven't much problems with it, until a few weeks ago.

The pain affects me when I sit in my office chair (which is cushioned, and has never given me another problems prior to this), and the pain gets worse whenever I try to stand up from a seated position. At night, I sleep on my side, but I still wake up in pain. Lying flat on my face or standing up are the only positions which are less painful.

I do not recall any falls or other accidents which may have triggered this, and I thought that whatever injury I sustained ten years ago would have completely healed by now. I practise Pilates regularly, and I have little problems with my posture. What could cause this pain, and what can I do about it? 

A: You are right to say that since the tailbone or coccyx fracture had healed, it should not be causing you problems. Your current problem may then arise from a higher region i.e. in the lumbar spine, and what you are experiencing is referred pain to the tailbone area.

I will advise you to see a spine specialist to have a proper evaluation. This will include examination as well as imaging studies, including an MRI.

An MRI maybe done for your lumbar spine to detect any degenerative changes e.g. degenerative disc disease or bulging disc. Further treatment will be based on the findings of the MRI.

For a degenerative disc, the treatment generally involves physiotherapy and modification of lifestyle. Sometimes, acupunture maybe recommended if the patient is not averse to this treatment.

If these measures fail, an injection procedure called nucleoplasty maybe offered, and this technique uses radiofrequency energy to dissolve tissues of the disc so that the pressure on the nerves becomes less.

Answer provided by Adjunct Associate Professor Hee Hwan Tak, Singapore Medical Group's Medical Director, SMG Orthopaedic Group and Centre for Spine & Scoliosis Surgery