Coccyx fracture: treatment and recovery time
Fracture of the coccyx, or broken coccyx, is a condition that generally occurs as a result of a backward fall that occurs on a slippery floor such as a wet floor or an icy surface. This condition affects the female sex more, also because another cause that can lead to a fractured coccyx is childbirth. A coccyx fracture, although rare, is evidenced by a pain known as coccygodynia, which is a persistent pain localised at the level of the coccyx, a small ossicle attached to the sacrum, which worsens during weight-bearing activities and especially when sitting. If you think you have been affected by such a condition or have coccyx and sacrum pain and want to make sure you have not broken your coccyx, read this article.
Coccyx fracture: What is it?
You may ask: 'what is a coccyx fracture? Should I be worried?
Let's start by understanding what the coccyx is. The coccyx is the last vertebra of our spinal column. Although it does not have the shape of a true vertebra, this anatomical segment develops phylogenetically together with the rest of the spine, forming its final part. Through an actual joint, it attaches inferiorly to the sacrum, becoming an integral part of the sacro-coccygeal complex. Its basic functions are to protect the end of the bone marrow, support the weight of the body in a sitting position, creating a sort of tripod of support together with the ischial tuberosities, and finally serves as a muscular, ligamentous and tendon insertion surface. Precisely because of its position, its exposure and its intrinsic fragility, it is a structure that, in the event of direct trauma (slips with butt impact on the ground, sporting trauma in contact sports such as knee bumps and childbirth), may suffer a frank fracture, the treatment of which is generally conservative.
Coccyx fracture: causes
Causes of coccyx fractureas we have previously mentioned, are generally of traumatic origin. The most common cause of a coccyx fracture is a fall backwards onto a hard surface, usually caused by a slippery floor because it is wet, icy or a dirty floor (banana peel). In fact, it has been estimated that the incidence of coccyx fractures is much higher in winter due to ice than in warmer seasons. In addition to the purely traumatic cause due to a backwards slide, the coccyx can also break due to direct trauma that is very common in all sports that involve intense physical contact such as football, soccer, rugby, etc.. Another very common cause of a coccyx fracture is childbirth. This partly explains the greater distribution of this pathology in the female sex. The baby in fact, especially in dystocic births, tends physiologically to assume positions that could, especially on a predisposed subject, cause such strong pressure as to exceed the load capacity of the coccyx itself to the point of breaking it. In addition to birth the coccyx fracture appears to be caused in the female sex also because of the numerous cases of early osteoporosis. In addition to being female, prepubertal age also appears to be a risk factor for coccyx fracture, since especially between the ages of 10 and 14, the skeletal structure is still developing and is not well formed. Also at the age of 10 to 14 years, avulsion fractures, i.e. parcellular detachments of bone due to vigorous physical activity, may occur. Remaining with the male sex, although extremely rare, an insufficiency fracture could occur, i.e. due to osteoporosis, especially at a late age when this factor is compounded by frequent falls due to balance problems.
Coccyx fracture: symptoms
Typical symptoms of a coccyx fracture can be summarised in the word coccygodynia. The term coccygodynia means pain in the coccyx, in fact, the most common symptom is precisely that of pain localised in the coccyx. First, at the moment of direct or indirect trauma, you would feel a strong pain localised in the coccyx area. If you had a broken coccyx, in fact, you would feel a persistent pain localised on the end of the sacrum at the intergluteal line. A fracture of the coccyx, like all fractures, also worsens with increased load, for example, it would worsen by playing sports or sitting on a hard surface while it would improve with rest and unloading the area, for example, by lying on your stomach. A fracture of the coccyx generally does not give radiating symptoms, but if the initial trauma was a high-intensity trauma (e.g. a fall down the stairs or a motorbike accident) then this symptom could radiate to other areas, for example, there could be a fracture of the sacrum. The symptoms of a sacrum fracture would be much more serious with implications of nervous tissue and the gynaecological complex (incontinence problems, radiating pain down the leg or in the perineal area). The symptoms associated with a sacrum fracture would determine the immediate need for medical consultation.
Coccyx fracture: diagnosis
The diagnosis of a coccyx fracture is not so obvious. The rarity of this clinical presentation makes it difficult to diagnose. Undoubtedly a specialised physiotherapist in musculoskeletal disorders will be the right person to show you the pathology you are suffering from as well as the best course of treatment to follow. The diagnosis is mainly clinical, in fact, by seeing the triggering mechanism (e.g. falling backwards or childbirth) and the area of pain, the underlying pathology becomes easy to understand. The definitive diagnostic confirmation will be through an X-ray or a CT scan that your referring doctor can conveniently prescribe should he or she assess the need. Once the medical diagnosis has been reached, it will be necessary to act as early as possible to carry out a treatment customised to your needs.
Coccyx fracture: treatment
What is the appropriate therapy in the case of a fractured coccyx?
When a patient has received a correct diagnosis, treatment is in 90% of cases, conservative. The physiotherapist, in agreement with the treating physician, will take charge of the patient by carrying out all that fundamental educational and management process with regard to the pathology. The physiotherapist will be able to advise you on which postures to adopt to improve your pain, as well as being able to advise you on how to manage your activities of daily living and your work. When pain and spontaneous biological repair allow it, the physiotherapist will start to mobilise the surrounding area for antalgic purposes, treating any associated disorders (lumbar muscle contractures, pain during movement). When the development of the pathology allows, the physiotherapist will gradually and steadily show you how to resume physical activity, preparing you specifically for your relevant sport. If conservative treatment should fail or physiological recovery is too slow (more than a month and a half) to bring about a clear improvement in symptoms, then in agreement with your doctor, you can start treatment with non-steroidal anti-inflammatory agents. In particular, epidural steroid injections or pericoccygeal local anaesthetics and/or steroids may also be used if the aforementioned treatments are not sufficient. As a next step, of pericoccygeal injections associated with manipulations (i.e. repeated flexion and extension of the coccyx for 1 minute) under general anaesthesia reported a cure rate of 85%. This type of pathology and its treatment expose patients, especially if treated only pharmacologically, to a recurrence rate of 21%, which is reduced if reconditioning and retraining physiotherapy is prescribed in addition to pharmacological treatment. For patients who do not show a response to the above measures, surgery (coccygectomy) may be indicated. Coccygectomy has been helpful, with success rates of 60%-91%. However, coccygectomy is a more invasive procedure, with a complication rate of up to 22%, usually associated with perineal wound contamination. Other complications may include persistent bleeding from the haemorrhoidal venous complex of the rectum. Furthermore, in a very thin patient with a kyphotic sacrum, the residual component of the sacrum may be a source of persistent pain as well as in a debilitated patient where there may also be an increased risk of pressure ulcer formation. New techniques used in surgery include vertebroplasty and in cases of fracture, sacroplasty. This procedure can theoretically be useful for refractory patients indicating a higher success rate than coccygectomy with a lower complication rate.
Coccyx fracture: healing time
The healing time of a coccyx fracture is variable. Like all fractures, the biological healing time varies between one and a half and two months, but this variable is influenced by age, presence of comorbidities, severity of the fracture, possible associated injuries, earliest conservative treatment and type of eventual surgery. Net of all these aspects, the most frequent causes of coccyx fracture, i.e. childbirth in females and falls backwards in middle age, have a favourable prognosis that with conservative treatment leads to a complete resolution of the pathology and a return in the short term (1 month) to all activities of daily and working life, in the medium to long term (2 to 4 months) to full recovery even of sporting activity. Healing time is extremely dependent on the earliness of the rehabilitation intervention, so don't waste time!
Conclusions
So what to do in case of a coccyx fracture?
In the case of a fractured coccyx in the first instance, rely on a competent professional He will show you the best way to go, i.e. whether to refer you to a doctor if the coccyx pain is hiding a more serious pathology or to take you into care and start conservative treatment. Be confident in conservative treatment, 9 out of 10 people recover completely without recurrence and in the rare cases where this does not happen, don't worry, there are valid therapeutic alternatives that are just as effective, the important thing is not to waste time on useless and potentially harmful therapies as they delay evidence-based treatments.
Bibliography
- Dean LM, Syed MI, Jan SA, Patel NA, Shaikh A, Morar K, Shah O. Coccygeoplasty: treatment for fractures of the coccyx. J Vasc Interv Radiol. 2006 May;17(5):909-12. doi: 10.1097/01.RVI.0000217953.74013.87. PMID: 16687760.
- Won H, Moon SY, Park JH, Kim JK, Kim HS, Baek SH, Kim SY, Lee YK, Koo KH. Epidemiology and risk factors of coccyx fracture. Injury. 2020 Oct;51(10):2278-2282. doi: 10.1016/j.injury.2020.07.019. Epub 2020 Jul 8. PMID: 3266.
