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Coccydynia

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

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Coccydynia

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  1. Coccydynia Pain in the vicinity of the coccygeal bone

  2. Associated Symptoms • Dyspareunia • Dyschezia • Dysmenorrhea

  3. Causes • Trauma from a vertical blow • Difficult vaginal delivery

  4. Pathologic features • Dislocated sacrococcygeal fracture • Ligamentous damage • Most cases the tip of the coccyx is subluxed or hypermobile

  5. 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

  6. Anatomy • Levatorani and coccygeal muscles attach to and support the coccyx during childbirth and defecation • Gluteus maximus also attaches to the lateral coccyx

  7. Anatomy

  8. 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

  9. Symptoms • Pain • Dull and achy • Sensation of pressure • Increased pain with prolong sitting or sitting on hard surfaces

  10. Levatorani syndrome and proctalgiafugax are variants of coccydynia

  11. What is levatorani syndrome?

  12. LevatorAni Syndrome • Dull ache or pressure senation in the rectum • Worse during the day • Tenderness on palpation

  13. Pelvic Floor Muscles – Tension Myalgia

  14. ProctalgiaFugax

  15. ProctalgiaFugax • 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

  16. Physical exam • Tender over the coccyx • Pelvic symmetry • LE neuro exam • Rectal exam • Check lymph nodes

  17. Functional limitations • Driving • Avoid social situations • Equestrian • Sexual

  18. X-rays • Subluxation and fx

  19. Physiatric Prescription • Pain control measures?

  20. Pain relief • Ice • Warm sitz baths • Ultrasound • Galvanic stim

  21. Pain relief • Soft sitting surfaces – donut holes? • Pelvic floor relaxation exercises • Pelvic floor massage • Massage • Injections

  22. What is Thiele’s massage?

  23. Thieles Massage

  24. What is sacral sitting?

  25. Posture • Sitting

  26. Sacral Sitting

  27. Sacral Flexion

  28. Motion • Anti-lordotic exercises – Williams exercises • Hip extensor strengthening

  29. What is Williams Exercises?

  30. Williams Exercises

  31. Alignment/Adjustment – Muscle Energy • Sacral Flexion • Sacral extension • Sacro iliac • Unilateral or Bilateral

  32. Pelvic floor and gluteal relaxation

  33. Other measures • Botox • Prolotherapy • Surgery

  34. Activity modification • No prolong sitting • No sitting on hard surfaces

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