Post on 02-Apr-2015
Coccydynia
Pain in the vicinity of the coccygeal bone
Associated Symptoms
• Dyspareunia• Dyschezia• Dysmenorrhea
Causes
• Trauma from a vertical blow
• Difficult vaginal delivery
Pathologic features
• Dislocated sacrococcygeal fracture
• Ligamentous damage
• Most cases the tip of the coccyx is subluxed or hypermobile
Anatomy
• Fibrous sacrococcygeal joint connects the sacrum to the one to four bone segments of the coccyx
• Joint is reinforced by sacrococcygeal ligaments which encloses the s5 nerve root
• S4,5 make the coccygeal plexus
Anatomy
• Levator ani and coccygeal muscles attach to and support the coccyx during childbirth and defecation
• Gluteus maximus also attaches to the lateral coccyx
Anatomy
Prevalence
• 5x greater in women
• Female coccyx is more posterior in location and larger
• 3x more frequent in obese women, maybe be related to the decrease pelvic rotation during sitting
Symptoms
• Pain
• Dull and achy
• Sensation of pressure
• Increased pain with prolong sitting or sitting on hard surfaces
Levator ani syndrome and proctalgia fugax are
variants of coccydynia
What is levator ani syndrome?
Levator Ani Syndrome
• Dull ache or pressure senation in the rectum
• Worse during the day
• Tenderness on palpation
Pelvic Floor Muscles – Tension Myalgia
Proctalgia Fugax
Proctalgia Fugax
• Sudden onset of anal pain that last a few minutes or seconds
• Spastic muscle contractions of the pelvic floor muscles
• Five times per year or more
Physical exam
• Tender over the coccyx• Pelvic symmetry• LE neuro exam• Rectal exam• Check lymph nodes
Functional limitations
• Driving
• Avoid social situations
• Equestrian
• Sexual
X-rays
• Subluxation and fx
Physiatric Prescription
• Pain control measures?
Pain relief
• Ice• Warm sitz baths• Ultrasound• Galvanic stim
Pain relief
• Soft sitting surfaces – donut holes?
• Pelvic floor relaxation exercises
• Pelvic floor massage• Massage• Injections
What is Thiele’s massage?
Thieles Massage
What is sacral sitting?
Posture
• Sitting
Sacral Sitting
Sacral Flexion
Motion
• Anti-lordotic exercises – Williams exercises
• Hip extensor strengthening
What is Williams Exercises?
Williams Exercises
Alignment/Adjustment – Muscle Energy
• Sacral Flexion• Sacral extension• Sacro iliac• Unilateral or Bilateral
Pelvic floor and gluteal relaxation
Other measures
• Botox• Prolotherapy• Surgery
Activity modification
• No prolong sitting• No sitting on hard
surfaces