ESWT for Coccydynia (Tailbone Pain)

ESWT for Coccydynia (Tailbone Pain)

The end portion of your spine below the sacrum is called the coccyx, or tail bone, made up of three to five bones fused together to form a triangular shape. Fibrous joints and ligaments allow for some limited motion within the coccyx, enabling it to move backward and forward with movements of the legs, hips and pelvis, and adjusting for support and balance during standing and sitting. When seated, your body weight is distributed among your ischium (sit bones) and your coccyx.

Coccyx Pain

Coccydynia is localized pain that gets worse during activities that put pressure on the lower spine, like sitting, having a bowel movement, and during sex. The condition is more common in females, and often occurs from childbirth trauma, or after a fall. Obesity increases your risk of coccydynia.

Diagnosis and Treatment

Coccydynia is usually diagnosed through medical history and a clinical exam. At NYDNR, we use diagnostic ultrasound to visualize and confirm coccydynia.

Coccydynia can be treated conservatively, using non-invasive therapies. Traditional treatments for coccydynia include:

  • Ice and/or heat
  • Activity modification
  • Cushioned seating
  • Dietary modifications to reduce constipation
  • Manual therapies
  • Stretching
  • Injections to reduce pain and inflammation

ESWT for Tail Bone Pain

At NYDNR, we use extracorporeal shock wave therapy (ESWT) to treat tailbone pain. The treatment uses a sequence of short-duration sonic pulses with high peak pressure, directed at the tailbone. A recent randomized study (Lin et al, 2015) compared ESWT to other common therapies, and found it to be more effective and satisfactory in reducing tailbone pain.

In another study (Marwan et al., 2014), patients who did not respond well to traditional treatment methods reported a dramatic reduction in pain and discomfort, 12 months following their ESWT therapy.

The sports medicine team at NYDNR uses cutting edge technologies and innovative therapies to treat coccydynia. We are dedicated to getting to the source of your pain and correcting it, so you can return to your busy life, pain-free.


Lin, Shih-Feng, et al. “The effects of extracorporeal shock wave therapy in patients with coccydynia: a randomized controlled trial.” PloS one 10.11 (2015): e0142475.

Marwan, Yousef, et al. “Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases.” The Spine Journal 14.1 (2014): e1-e4.

Research at NYDNRehab

Comparative Study of Dry Needling under Ultrasound Guidance and Extracorporeal Shock Wave Therapy for Myofascial Pain and Spasticity Management Meeting: 2019 International Congress R. Bubnov, L. Kalika (Kyiv, Ukraine)
Comparative Study of Dry Needling under Ultrasound Guidance and Extracorporeal Shock Wave Therapy for Myofascial Pain and Spasticity Management Meeting: 2019 International Congress R. Bubnov, L. Kalika (Kyiv, Ukraine) (part2)

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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