THE CLINICAL SYNDROME

Coccydynia is a common pain syndrome that is characterized by pain localized to the tailbone that radiates into the lower sacrum and perineum. Coccydynia occurs most commonly after direct trauma to the coccyx from a kick or a fall directly onto the coccyx. Coccydynia can also occur after difficult vaginal delivery. The pain of coccydynia is thought to be the result of strain of the sacrococcygeal ligament or occasionally due to fracture of the coccyx. Less commonly, arthritis of the sacrococcygeal joint can result in coccydynia.

SIGNS AND SYMPTOMS

On physical examination, the patient will exhibit point tenderness over the coccyx with the pain being increased with movement of the coccyx. Movement of the coccyx may also cause sharp paresthesias into the rectum, which can be quite distressing to the patient. On rectal examination, the levator ani, piriformis, and coccygeus muscles may feel induce severe spasm. Sitting may exacerbate the pain of coccydynia, and the patient may attempt to sit on one buttock to avoid pressure on the coccy.

The pain of coccydynia is localized to the coccyx and is made worse by sitting.

TREATMENT

A short course of conservative therapy consisting of simple analgesics, nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors, and a foam donut to prevent further irritation to the sacrococcygeal ligament is a reasonable first step in the treatment of patients suffering from coccydynia. If the patient does not experience rapid improvement, the following injection technique is a reasonable next step.

To treat the pain of coccydynia, the patient is placed in the prone position. The legs and heels are abducted to prevent tightening of the gluteal muscles, which can make identification of the sacrococcygeal joint more difficult.

Coccydynia should be considered a diagnosis of exclusion in the absence of trauma to the coccyx and its ligaments. The use of a foam donut along with the treatment modalities discussed may provide symptomatic relief and allow the sacrococcygeal ligament to heal. The injection technique is extremely effective in the treatment of coccydynia. Coexistent sacroiliitis may contribute to coccygeal pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate. The use of physical modalities including local heat as well as gentle range of motion exercises and rectal massage of the affected muscles should be introduced several days after the patient undergoes this injection technique for coccygeal pain. Vigorous exercises should be avoided as they will exacerbate the patient’s symptomatology. Simple analgesics and nonsteroidal anti-inflammatory drugs may be used concurrently with this injection technique.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.