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Coccydynia
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Coccydynia - March 9, 2008 10:06:39 PM
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katieptatc
Posts: 21
Joined: June 19, 2005
From: Georgia
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Has anyone treated a person with Coccydynia. My patient is a 37 year old male with a history of a post op coccyxectomy on Nov 18th. His coccyx has been fractured and pointing posteriorily. He continues with severe pain with sitting. He has no pain in any other position. He has a history of HairyCell Leukemia. ANy suggestions would be helpful. Thanks.
Katie Wilson , PT
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RE: Coccydynia - March 10, 2008 7:42:40 AM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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Always a tough, and awkward one. Definitely a seat cushion with relief hole.....Altmeyers sells the wedge seat cushion that works great. Anti-inflammatory modalities, mobilization of coccyx (theory: if hypomobile, lack of ability to move and relieve pressure when sitting causing tissue compression and irritation). Some theorize that mobilizing the sacrum helps as well, as some increase in sacral mobility may reduce need for coccyx to move as much. Soft tissue work always works for me with these patients, and last resort options include injection and coccyx removal surgically.
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Coccydynia - March 10, 2008 2:51:01 PM
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johnczyk1
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I would lean towards the soft tissue work and some modalities around the area to hopefully desensitize the free nerve endings in the area.I wouldn't try mobilizing the sacrum or coccyx.It will probably take some time for the soft tissues to calm down.
JOHN LEWCZYK PT
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RE: Coccydynia - March 10, 2008 9:28:24 PM
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PTupdate.com
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Soft tissue work is going to be, and usually is, far more irritating and uncomfortable than the mobilization, which is RARELY uncomfortable. One has a better chance to "calm down" the tissues by removing the abnormal stress (compression from sitting, tissue strain due to mobility issues) via mobilization.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Coccydynia - March 11, 2008 9:19:57 AM
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bobmfrptx
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Joined: December 12, 2006
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Soft tissue work done correctly with gentle pressure feeling the direction of ease and not forcing rarely aggrivates . The mechanical form of STM can be irritating. Did I not read that this client had a coccyectomy?
What would you be mobilizing? Scar tissue work and lumbar decompression as well as pelvic floor self stretches work well after this surgery in my experience, sorry no research yet.
Bob
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RE: Coccydynia - March 16, 2008 2:45:15 PM
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katieptatc
Posts: 21
Joined: June 19, 2005
From: Georgia
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Since I posted this request - I have tried ionto - with out any success. Standard coccyx pillows have not helped. and Bob you are correct - there is nothing to mobilize. I have tried some STM which just seems to aggreivate. The scar doesnt have any adhesions. and forgive me but how would I do pelvic floor self stretches on a male? and about the lumbar decompression - what would be the best way of doing that? Thanks so much. I just don't deal with many backs. KT
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RE: Coccydynia - March 17, 2008 5:34:25 PM
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bobmfrptx
Posts: 47
Joined: December 12, 2006
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The lumbosacral decompression can be done prone or supine if tolerated. I prefer the supine method because you can switch to pelvic floor technique easily.
Have patient lie supine place one hand between his legs and cup the sacrum lightly. The other had is placed under the lumbar spine. Your hands will form a T with the sacral hand 's finger tips touching the hypothenar edge of the lumbar hand. Gently compress the lumbo sacral junction... ounces of pressure and hold for 90 to 120 secs. Then gently pull the two apart for the same period of time , longer if tolerable. There should be no pain. Feelings of warmth, lengthening tingling may be felt.
Next take the top hand out from the back and rest it lightly on the abdomen with fingers pointing to the head. Gently stretch the tissue cephalad holding for 90 to 120 secs. The client should feel no pain and continue to breathe normally. Avoid setting up protective reactions.
The prone method is described here http://books.google.com/books?id=1NG3Cqh2GiwC&pg=PA134&lpg=PA134&dq=manual+lumbar+sacral+decompression&source=web&ots=EBukXuAfGO&sig=okBCSc6gp6ZUMyImBVj3IK9cbjs&hl=en
Pelvic floor stretching for males...Farni Postures (Squat) , lying supine with two 4 inch balls under the hips, knees bent, hips flexed to 90- degrees and allow legs to drop to sides. Supine pelvic tilts with the legs held slightly abducted externally rotated and soles of feet together. Do the pelvic tilt and pull the heels toward the buttocks until stretch is felt.
Good luck it is hard to describe techniques, but these have worked well for me in the past.
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RE: Coccydynia - March 17, 2008 6:17:42 PM
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kiwi PT
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From: MI, USA (dreaming of New Zealand)
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Might be best to send to a women's health specialist. The pelvic floor of males can be assessed and treated internally, and could easily be irritated in pt senario you describe. But I wouldn't go "exploring" with out training in such techniques.
Kyle PT
_____________________________
"I have never let my schooling interfere with my education."
Mark Twain
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