Chronic coccydynia in adolescents. A series of 53 patients

Eur J Phys Rehabil Med. 2011 Jun;47(2):245-51.


Background: Little is known about coccydynia in adolescents.

Aim: The aim of this study was to explore causes, clinical and imaging features and response to treatment of chronic coccydynia in adolescents.

Design: This was a cohort study.

Setting: The study included patients followed up at a specialized consultation in a university hospital.

Methods: A series of 53 adolescent patients with chronic coccydynia were followed for 1-4 years. Investigations included dynamic X-ray films, with a magnetic resonance imaging scan of the coccyx in 26/53. Treatment was by coccygeal steroid injection or non-steroidal anti-inflammatory drugs (NSAIDs). Amitriptyline or coccygectomy were used as second-line treatment. Outcomes were assessed at a consultation two months after the treatment, then between one to four years later, by telephone interview, questionnaires and by a visual analogue scale (VAS). Fifty-one adult patients with coccydynia formed the control group.

Results: In 20 cases (37.7%) the coccydynia was subsequent to trauma. Obesity was not a risk factor. Abnormal mobility was rarer and spicules more frequent compared to adult patients (P<0.001); 11/27 MRI scans showed a hypersignal within the disc or adjacent bone and 6/27 a hypersignal surrounding the tip of the coccyx (bursitis). Initial treatment was a coccygeal steroid injection for 41 patients and NSAIDs for 12. Ten were given amitriptyline and 3 a coccygectomy. At final assessment, there was no pain or almost no pain in 32/53 (60.4%), moderate pain and functional impairment in 12/53 (22.6%) and severe pain and functional impairment in 9/53 (17%).

Conclusion: Coccydynia in adolescents differs from coccydynia in adults. A MRI scan is helpful and should be obligatory for diagnosis. Prognosis is relatively good.

Clinical rehabilitation impact: Our results should help clinicians manage this rare and debilitating condition.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Amitriptyline / administration & dosage
  • Amitriptyline / therapeutic use
  • Analgesics, Non-Narcotic / administration & dosage
  • Analgesics, Non-Narcotic / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Case-Control Studies
  • Child
  • Chronic Disease
  • Coccyx / injuries
  • Coccyx / pathology*
  • Coccyx / surgery
  • Humans
  • Injections, Spinal
  • Low Back Pain / etiology
  • Low Back Pain / therapy*
  • Magnetic Resonance Imaging
  • Outcome and Process Assessment, Health Care
  • Pelvic Pain / etiology
  • Pelvic Pain / therapy*
  • Prednisolone / administration & dosage
  • Prednisolone / therapeutic use
  • Sacrococcygeal Region / injuries
  • Sacrococcygeal Region / pathology*
  • Sacrococcygeal Region / surgery
  • Steroids / administration & dosage*
  • Steroids / therapeutic use


  • Analgesics, Non-Narcotic
  • Anti-Inflammatory Agents, Non-Steroidal
  • Steroids
  • Amitriptyline
  • Prednisolone