Background Data: Coccydynia is defined as pain in the coccyx or tailbone area, usually caused by sitting acutely on a hard object. Because it often runs a chronic course, the management of this medical problem remains controversial. Different therapeutic options are available for the treatment of this condition. Purpose: To evaluate the effectiveness of a local betamethasone-17α,21-dipropionate and 21-disodium phosphate injections versus NSAIDs and physiotherapy in its management. Study Design: Prospective clinical cases study. Materials and Methods: Forty-eight patients who presented with pain in the tailbone area for more than four weeks were recruited for the study. They were subdivided randomly into two groups:Group I patients were treated with a local injection with betamethasone-17α,21-dipropionate and 21-disodium phosphate (n = 24), whereas Group II were treated with oral NSAIDs and physiotherapy (n = 24). Oral diclofenac sodium (150 mg/day) with physiotherapy program was given to patients in Group II for six weeks. Clinical evaluation was based on the severity of the coccyx pain by Visual Analog Scales (VAS) at 1-, 3-, 6-, and 12-month follow-up and comparison to the baseline pain at presentation. Results: The incidence was more in the third decade (52%, n = 25), with female overbalance (85%, n = 40). In Group I, the mean of VAS was 8.1 before treatment and after one month of treatment, the score reached 3.9 and improved to 0.2 at the end of one year. However, in Group II, the mean of VAS was 7.5 before treatment; then after one month, it changed to 6.6 and improved to 2.5 at the end of one year. Conclusion: The reported outcome in this study suggests that local betamethasone-17α,21-dipropionate and betamethasone 21-disodium phosphate injections are more effective than NSAIDs and physiotherapy for the treatment of coccydynia. (2020ESJ224)