Coccydynia is a musculoskeletal pain condition that can lead to chronic pain and functional impairment, significantly affecting quality of life. Although conservative treatment is effective in many cases, the number of patients with refractory symptoms appears to be increasing, highlighting the need for effective and accessible treatment options.

Prolotherapy is a regenerative injection therapy that aims to stimulate tissue healing and reduce pain through the modulation of nociceptive signaling, most commonly using dextrose solutions.

This retrospective study aims to evaluate the effectiveness of landmark-guided (blind) dextrose prolotherapy in reducing pain and improving functional status in patients with mechanical or idiopathic coccydynia. The study includes patients who underwent prolotherapy to coccygeal ligaments between January 1, 2024, and June 1, 2025, with a treatment protocol consisting of 3-6 sessions administered at 3-week intervals using a 15% dextrose solution.

Coccydynia is a musculoskeletal pain condition characterized by pain localized to the coccygeal region, often leading to chronic pain and functional impairment that negatively affects quality of life. Although conservative treatment is effective in many patients, a growing number of cases remain refractory, highlighting the need for alternative therapeutic approaches.

Prolotherapy is a regenerative injection technique increasingly used in chronic musculoskeletal pain conditions. It aims to stimulate tissue repair and modulate nociceptive signaling through the administration of proliferant solutions, most commonly hypertonic dextrose. By inducing a controlled inflammatory response, prolotherapy is thought to promote fibroblast activity, collagen synthesis, and strengthening of ligamentous structures.

This retrospective cohort study aims to evaluate the effectiveness of landmark-guided (blind) dextrose prolotherapy in reducing pain severity and improving functional status in patients with mechanical or idiopathic coccydynia. The study includes patients who presented to the Physical Medicine and Rehabilitation Clinic of Gaziosmanpasa Training and Research Hospital between January 1, 2024, and June 1, 2025, with coccydynia persisting for at least 3 months and refractory to conservative treatment.

Eligible patients received prolotherapy injections targeting the coccygeal ligaments using anatomical reference points without ultrasound guidance. A 15% dextrose solution was administered in 3 to 6 sessions at 3-week intervals according to a standardized treatment protocol.

Pain severity and functional status were assessed using the Visual Analog Scale (VAS) and the Dallas Pain Questionnaire (DPQ), respectively. Outcome measures were evaluated at baseline (pre-treatment) and at follow-up after completion of the treatment protocol.

A minimum sample size of 30 patients was determined, and a total of 50 patients were included in the study.

Inclusion Criteria:

• Age between 18 and 75 years
• Diagnosis of mechanical or idiopathic coccydynia
• Pain persisting for at least 3 months
• Refractory to conservative treatment

Exclusion Criteria:

• Pregnancy
• Allergy to the proliferant solution
• Active infection
• Use of anticoagulant medications
• Presence of malignancy
• Local abscess
• Documented hemorrhagic diathesis
• Certain types of septic arthritis
• Parafunctional habits

The study population consists of patients aged 18 to 75 years diagnosed with mechanical or idiopathic coccydynia, with symptoms persisting for at least 3 months and refractory to conservative treatment, who underwent landmark-guided (blind) dextrose prolotherapy at the Physical Medicine and Rehabilitation Clinic of Gaziosmanpasa Training and Research Hospital between January 1, 2024, and June 1, 2025.