Coccyx pain after acute trauma

[cocoapuffs]

Hi Physios,

I injured my coccyx with blunt trauma five days ago. Went to ER because of nausea and syncope. No x-rays were taken due to risk of irradiating reproductive organs, so I don't know if it's a bruise or a fracture. I was told it doesn't matter because the treatment is the same either way, just that the healing time might be longer for a fracture. I have no pain or tingling down my legs or anywhere else. The pain is mostly located at the bottom left.

I was told to avoid sitting and to use a wedge cushion if I did, and was given percocet to manage pain this week.

I have an appointment with my GP on Monday. He is not very good with MSK stuff. Will probably repeat what was told at the ER. I could see a sports med at a private clinic I've gone to, if I need an image. They don't like it, though, because I already have a great physio who's affiliated with another clinic (which *doesn't* have a sports medicine doctor, so I can't get images there). I will not be able to see my physio until next week.

Questions until then:

- Is it worth seeing the sports med to get an image now?

I've read that only sit-stand x-rays can show anything when it's clearly traumatic, and I don't know which of the private radiology labs around here do that or how to go about finding out. My GP will definitely not know how to order that (I know from past experience). Or should I wait to see if this improves in 6 weeks, like I was told at the ER, and only try then?

I'm terrified of this going chronic. I've seen tons of reports of this getting to be a lifelong disability, and I want to prevent that. I know that coccyx injuries take a long time to heal because people keep sitting on them.

But, I work from home so I don't have to sit at all. I can lie or stand. I'm willing to avoid sitting completely for a few weeks to speed healing. How long should I do that?

- How much of the day should I stand vs. lie down? Lying down too much can't be that great.
- I don't want muscles to fall into disuse. How can I keep my back, glutes and hips healthy while resting? Any exercises I should do in this acute phase (five days, right now)?
- I need to use a laptop. What's the best position to use?

Lying exclusively on my stomach, as I've been doing, is causing mild lower back pain. I'm supporting myself with dense foam pillows to try to keep a neutral spine, but I still hyperextend a bit, because I have to crane my neck and upper back up to use my laptop.

Lying on my side with a small pillow between my knees is ok, but I can't work.

I've tried bending over a large Swiss ball, but my shoulders and neck are taking a lot of strain no matter where I put the laptop.

I've tried resting in a sort of very wide V shape on my back, using pillows and bolsters to support my upper back, lumbar area and thighs, leaving my coccyx to sort of hang. This is *ok* for a bit. I don't know if this will still put pressure on it.

I have a hard time concentrating on work when I write standing up.

Background: 38 year old normal-weight woman, lots of soft tissue injuries (both acute and chronic tendinopathy in multiple areas in the upper body and quads; plantar fasciitis, heel spurs), mild arthritis in knees and toes. I try to stay as active as possible within my limits, with my physio and mild cardio, but my muscles aren't as strong as I'd like. I'm always working around injuries.

Thanks!

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[ethanl]

do a lateral x-ray of your pelvis and check the position of coccyx