Non-Surgical Treatment of Coccygodynia with Manual Therapy - Case Report
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Medical Rehabilitation / Rehabilitacja Medyczna (Med Rehabil) 2021, 25 (1): 37-43 DOI: 10.5604/01.3001.0014.8762 eISSN 1896–3250 © AWF Krakow
Non-Surgical Treatment of Coccygodynia with Manual Therapy
– Case Report
Nieoperacyjne leczenie coccygodynii z zastosowaniem terapii
manualnej – opis przypadku
Bogumiła Dampc 1 (A-F), Krzysztof Słowiński 2 (A,D,E)
1
Centre of Manual Therapy, Sierosław – Tarnowo Podgórne, Poland
2
Emeritus Professor of Surgery at Karol Marcinkowski University of Medical Sciences in Poznań, Poland
Key words
coccygodynia, conservativetreatment of coccygodynia, manualtherapy
Summary
Introduction: Coccygodynia – pain in the coccyx and tissues lying in its immediate vicinity is a known problem, however, little
examined and assessed. The problem affects only 1% of people with spinal problems. This may be for many reasons – from
organic to functional, to a number of extra-local causes.
Study aim: The aim of the study is to present the diagnostic process and course of non-surgical – physiotherapeutic treatment –
of a 12-year-old boy with idiopathic coccyx pain syndrome using the methodology of manual therapy proposed by Rakowski,
with an assessment of immediate and final treatment points.
Materials and methods: Research was carried out among a group of 13.793 subjects at the Centre of Manual Therapy in Sier-
osław near Poznań. From this group, individuals with tailbone pain were extracted, which accounts for 1.15% of the remain-
ing participants. The following case report is a representative example selected from the above group. Diagnostics were based
on subjective assessment and medical examination (performed at a children’s hospital), including medical examination with
access through the anus and physiotherapeutic manual examination.
Results and conclusions: Coccygodynia requires detailed imaging and functional diagnostics, with particular attention being
paid to the structures directly related to the sacro-coccygeal region, as well as to the place lying outside the area of the expe-
rienced ailments. The solution to idiopathic pain syndrome in the coccygeal region is targeted manual therapy, taking select-
ed elements of the musculoskeletal structures into account. The described procedure is in line with the methods created by
Rakowski, along with local and non-local therapeutic interventions. In the described case, total alleviation of the ailments was
achieved, both in short-term assessment and 3 years after completion of treatment.
Słowa kluczowe
coccygodynia, leczenie zachowawcze coccygodynii, terapia manualna
Streszczenie
Wstęp: Coccygodynia – ból kości ogonowej i tkanek leżących w jej najbliższym otoczeniu to problem znany, choć jeszcze mało
zbadany i poznany. Problem dotyczy tylko 1% osób skarżących się na dolegliwości odkręgosłupowe. U jej podłoża może leżeć
wiele przyczyn – od organicznych do czynnościowych, uwzględniając szereg przyczyn pozamiejscowych.
Cel: Przedstawienie procesu diagnostycznego i przebiegu leczenia nieoperacyjnego – fizjoterapeutycznego – dwunastoletniego
chłopca z idiopatycznym zespołem bólowym kości ogonowej z zastosowaniem metodyki terapii manualnej według Rakowskie-
go z oceną doraźnego i odległego efektu leczenia.
Materiał i metody: Badania prowadzone w Centrum Terapii Manualnej w Sierosławiu pod Poznaniem na grupie 13 793 osób
wyłoniły grupę z bólem kości ogonowej, która stanowiła 1,15% spośród badanych. Poniższy opis przypadku jest przykładem
reprezentacyjnym wyodrębnionym z powyższej grupy. Diagnostykę oparto na badaniu podmiotowym, przedmiotowym bada-
niu lekarskim (wykonanym w szpitalu dziecięcym), w tym lekarskim badaniu z dostępu przez odbyt oraz fizjoterapeutycznym
badaniu manualnym.
The individual division of this paper was as follows: A – research work project; B – data collection; C – statistical analysis; D – data interpretation;
E – manuscript compilation; F – publication search
Article received: 11.03.2020; Accepted: 09.05.2021
Please cite as: Dampc B., Słowiński K. Non-Surgical Treatment of Coccygodynia with Manual Therapy - Case Report. Med Rehabil 2021; 25(1):
37-43. DOI: 10.5604/01.3001.0014.8762 (Epub ahead of print)
Internet version (original): www.rehmed.pl
This article is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License CC BY-SA (http://creativecommons.org/licenses/by-sa/4.0/)
37Medical Rehabilitation / Rehabilitacja Medyczna (Med Rehabil) 2021, 25 (1): 37-43 DOI: 10.5604/01.3001.0014.8762 eISSN 1896–3250 © AWF Krakow
Wyniki i wnioski: Coccygodynia wymaga szczegółowej diagnostyki zarówno obrazowej jak i czynnościowej ze szczególnym
zwróceniem uwagi na struktury bezpośrednio związane z rejonem krzyżowo-guzicznym, jak również tkanki leżące poza miej-
scem odczuwanych dolegliwości. Rozwiązaniem dla idiopatycznego zespołu bólowego okolicy guzicznej jest celowana tera-
pia manualna biorąca pod uwagę zaburzenia czynności wybranych struktur narządu ruchu. Opisywane postępowanie zgod-
ne z metodyką opracowaną przez Rakowskiego obejmuje zarówno miejscowe jak i pozamiejscowe interwencje terapeutyczne.
W opisywanym przypadku osiągnięto całkowite ustąpienie dolegliwości zarówno w ocenie krótkoterminowej jak i po 3 latach
od zakończenia leczenia.
INTRODUCTION STUDY AIM periencing tailbone traumatic mecha-
nisms. He declared that the ailments
Coccygodynia – pain of the tail bone The aim of the study was to pres- began without specific reasons and
– according to the great medical dic- ent the course of non-surgical phys- without prior indications. He de-
tionary1, is: “coccygeal pain; tail- iotherapeutic treatment of a 12-year- scribed the pain as pressure from the
bone pain, occurring or worsening old boy suffering from idiopathic centre of the coccyx that increased
only when seated, usually caused by coccyx pain syndrome, along with after 5 minutes of sitting to level 8
trauma”. Lewit2 and Rakowski3 de- the assessment of short- and long- on the visual pain scale (VAS) and ra-
fine this concept as idiopathic coc- term treatment effects. The following diated to the sacrum. Pain also ap-
cyx pain. This condition “often af- questions were adopted: peared getting up from a sitting posi-
fects the entire area: the anus, coc- 1. What diagnostic procedures does tion. While lying down and walking,
cyx, lower segments of the sacrum the idiopathic pain syndrome in the symptoms almost completely dis-
and the adjacent part of the gluteal the coccyx require? appeared. The boy denies that there
muscles. It may include the coccyx, 2. What physiotherapeutic treatment was significant stress prior to the on-
levator ani, sacrotuberous ligaments is the solution to idiopathic pain in set of the symptoms.
and supraspinal ligaments of the sa- the coccygeal area? During examination at the chil-
crum”3. dren’s hospital, the following were
The causes of coccygodynia can performed: X-ray of the sacrum
be both organic (including: pilonidal MATERIAL AND METHODS and coccyx, ultrasound of the coc-
cyst, arachnoid cyst4, irritation of cyx area and pelvic organs, as well
the surrounding nerve structures5,6, In the research conducted at the Cen- as rectal examination (per rectum).
inflammation6, diseases of the less- tre of Manual Therapy in Sierosław No lesions were found in these as-
er pelvis organs4) and functional (in- near Poznań on a group of 13.793 in- sessments. Soreness was revealed
cluding: abnormal sitting, accumu- dividuals, a group suffering from coc- around the apex of the coccyx and
lation of micro-traumas, excessive cyx pain identified, which constitut- between its apex and the edge of
tension in the structures of the sac- ed 1.15% of the subjects. The follow- the anus. Despite the exclusion of
ro-caudal region: coccygeal muscles, ing case report is a representative ex- the traumatic mechanism concern-
levator ani, gluteus maximus and also ample from the above group, illus- ing the ailments, on the basis of
the piriformis muscles2,3,7). trating the manual treatment of idio- the clinical image, a diagnosis was
Coccygodynia accounts for a small pathic coccygodynia. made: “contusion in the coccygeal
part, approx. 1%, of complaints in the The patient’s diagnosis was based area, coccygodynia”. With the fol-
population suffering from back pain6- on medical history (interview), physi- lowing recommendations: offload-
8
. The dynamics regarding the occur- cal examination (performed at a chil- ing the tailbone (lying down), an-
rence of ailments varies from per- dren’s hospital), including per rec- algesic treatment (naproxen), regu-
son to person. Most often, the pain tal medical examination and manu- lar defecation (lactulosa), oak bark
worsens when sitting3,6,9-11, some- al physiotherapeutic examination of hipbaths, the boy was sent home.
times when switching position from the: sacroiliac, thoracic spine (Th) After two months of compliance,
sitting to standing, in chronic and and lumbosacral joints (L/S). Piedel- there was no improvement. Fol-
more severe conditions, pain even oc- lou’s and Derbolowsky’s symptoms lowing another X-ray examination,
curs when walking, lying down and were also examined, as well as Pat- which showed no changes, the boy
sleeping3,5,6,9-12. The discussed pain rick’s test (Faber test) modified by was proposed a cocccygectomy. The
syndrome requires detailed imaging Rakowski, and muscle balance. boy’s mother did not consent to the
(X-ray, USG, MRI) and functional di- operation and looked for another
agnostics (manual examination of the solution – she reported with her son
sacro-caudal area from external and CASE STUDY to the Centre of Manual Therapy in
per rectal access, and comprehen- Sierosław near Poznań. After a de-
sive manual examination of musculo- A 12-year-old male patient report- tailed interview and reading the ex-
skeletal disorders). Depending on the ed to the Centre of Manual Therapy isting medical documentation, the
data obtained in the study, coccygo- with pain in the coccyx lasting about physical therapist began manual ex-
dynia may be treated conservatively 3 months. The boy has been training amination and planning the treat-
or surgically. athletics for 3 years. He denied ex- ment process.
38Medical Rehabilitation / Rehabilitacja Medyczna (Med Rehabil) 2021, 25 (1): 37-43 DOI: 10.5604/01.3001.0014.8762 eISSN 1896–3250 © AWF Krakow
MANUAL TEST AND ITS − right lower limb shorter lying the spinous processes revealed a dis-
RESULTS down, turbance at the following segment
− the right lower limb leading in the levels:
Manual examination in coccygody- Derbolowsky test. − Th5/Th6/Th7/Th8 and Th9/Th10/
nia must be comprehensive and mul- The Patrick’s test (Faber test) modi- Th11.
tifaceted, therefore, it includes: ex- fied by Rakowski3,13,14 is used to dif- Muscle imbalance included the fol-
amination of pelvic static balance, ferentiate whether the symptoms are lowing muscles:
the sacroiliac and hip joints, lumbar caused by disorders of the hip or sac- − biceps femoris,
and thoracic spine, coccygodynia pal- roiliac joints, or motor segments of − gastrocnemius,
pation, connective tissue and mus- the lumbar spine. The patient lays − gluteus medius,
cle structures of this area externally down on his/her back, with one low- − iliopsoas,
and through the anus (per rectum)3. er limb in extension, the other flexed − rectus femoris,
In this case, however, due to the pa- in the knee joint, the foot of the limb − piriformis,
tient’s age, no rectal examination was in flexion resting over the kneecap − adductors.
performed during the physiothera- of the extended limb. The physio- The following structures were pain-
peutic procedures. Manual exami- therapist stabilises the patient's pel- ful during examination via palpation:
nation also includes the assessment vis with one hand and guides the − apex and lateral edges of the coc-
of muscle length3,13 which influence patient's flexed limb with the oth- cyx,
the static balance of the pelvis and, er hand to abduction. Any symptom, − sacrotuberous ligaments at inser-
through it, coccygodynia. apart from the sensation of muscle tions to the sacrum and ischial tu-
Pelvic static balance was tested in stretching in the adductor area, in- berosity,
the following positions: standing, sit- dicates a disturbance in the hip3,14 − supraspinous and interspinous lig-
ting, lying, and also during the tran- or sacroiliac joints3,14, or in the loco- aments of the Th10/Th11/Th12
sition from lying down. The symme- motor sections of the L-segment of motor segments of the spine,
try of the position of the crests of the the spine3,14 – which should be dis- − supraspinous ligament of the sa-
iliac plates, the posterior superior ili- tinguished in specific tests. In the crum S2/S3/S4/S5,
ac spine and the signs of the so-called case of the studied boy, Patrick's test − piriformis muscle insertions on the
Piedellou symptom3,13 (Figure 1 a and was positive for both sides, indicat- apices of the greater trochanter of
b), as well as and the so-called Derbo- ing a disorder at the hip joint level. the femurs.
lowsky symptom regarding the lower Joint play in the hip joints – distrac- The above examination techniques
limb during transition from a lying to tion – was disturbed bilaterally. Dis- and further therapeutic procedures
seated position3,13 (Figure 1 c). These traction is a paraphysiological move- allowed for precise, targeted manu-
occurring symptoms indicate dys- ment (performed in a joint passive- al procedures based on knowledge of
function of the sacroiliac joints. ly by a physiotherapist) occurring in the tissues’ symptomatic characteris-
In the study, a disturbance was a healthy hip joint, which is often dis- tics3. Through the implementation of
shown in static balance of the pelvis turbed by excessive resting tension of a control test3, which is each move-
in the form of: the joint capsule and the muscles that ment (active or passive) or a static po-
− posterior superior iliac spine in activate this joint. sition of the body in which the sub-
lower position, standing, Manual examination of the lumbar ject feels pain known to him/her, the
− right iliac crest in lower position, and thoracic spine motor segments physiotherapist verified the correct-
standing, by pressing on the lateral surface of ness of the posed hypotheses as to the
− posterior superior iliac spine in cause of pain generation. The thera-
lower position, sitting, peutic techniques used are: pressure
− right iliac crest in lower position, mobilisation3, joint mobilisation – bi-
sitting, omechanical procedures (joint mobi-
− right-sided Piedellou symptom, lisation and manipulation in a pain-
Figure 1 a-c
Examination of: a, b – Piedellou symptom, c – Derbolowsky symptom (photos reprinted with the consent of the author3)
39Medical Rehabilitation / Rehabilitacja Medyczna (Med Rehabil) 2021, 25 (1): 37-43 DOI: 10.5604/01.3001.0014.8762 eISSN 1896–3250 © AWF Krakow
pain; it was only the movement from
lying down to sitting (Figure 3 b) that
caused coccyx pain on the VAS to be
at the level of 3. During the final 2
meetings, Derbolowsky’s test and
Patrick’s test were used as controls
because neither of the above-men-
tioned test positions, or even direct
pressure on the tailbone, did not pro-
voke any symptoms.
Figure 2 a i b During all of the sessions, ther-
Palpation of: a – sacrotuberous ligament, b – interspinous ligaments in the Th/L
apeutic interventions – therapeu-
segment tic stimuli – tissues critical to alter-
ing coccyx pain perception were tar-
geted. During the 1st manual proce-
less direction)3, post-isometric muscle 5th meeting to test the short-term ef- dures, compression mobilisation of
relaxation or stretching (techniques fects and self-management of symp- the sacrotuberous ligaments reduced
stretching the muscles to bring them toms through learned self-therapy the pain in the above-described test
to normal length and flexibility), nee- techniques. from an 8 to a 1 on the VAS. After
dle therapy3 (puncture and touching Each meeting began with a re-in- the 1st visit, the pain decreased sig-
via an injection needle, without giv- terview and performance tests to ver- nificantly; at maximal intensity, it
ing any substances, the muscle inser- ify the current condition of the pa- was up to 3 on the VAS.
tion and ligaments as well as the per- tient. The physical therapist imple- During the 2nd meeting, the key
iosteum itself in their vicinity). This mented examination and the ther- factor was biomechanical treatment
procedure is performed in order to apeutic techniques described above of the Th10/Th11 facet joints, which
consolidate the outcomes, includ- during each session. Together with reduced symptoms from 3 to 1 on the
ing those analgesic, of the above-de- the patient, a control test adequate VAS. The result of the 2nd meeting
scribed actions. The effects of nee- was chosen, to his current condition. was the possibility to maintain a sit-
dle therapy have been confirmed in At the first visit, the control test ting position for 2 hours without any
many years of observation)3. was sitting on a hard chair with pelvic complaints.
We assumed the key role here for tilt (Figure 3 a) – the patient reported At the 3rd visit, the pain intensity in
self-therapy3 – active involvement tailbone pain at the level of 8 on the the sit-down test increased to VAS 8.
of the patient in performing learned VAS. Over the course of the therapy, The sacroiliac joints were mobilised;
‘homework’ tasks, which included the patient’s feelings during the tests there was an immediate reduction of
simple techniques of stretching the changed. The 1st treatment during the symptoms to 6 on the scale. Biome-
muscles and independent pressure 2nd session did not provoke known chanical treatment for the facet joints
mobilisation on the structures identi-
fied in the study.
Only therapeutic actions aimed at
tissues that immediately change the
patient’s symptoms in a control test
turned out to be effective in the treat-
ment process. This means that the
therapeutic stimulus must be applied
in the area of access to interference3 –
to the structures directly involved in
the functional disease process.
COURSE OF TREATMENT
AND RESULTS
Over a period of 4 months, 7 treat-
ment sessions were performed. They
were held on average once a week
and lasted 60 minutes. Halfway
through the treatment, there was Figure 3 a i b
a 1-month break due to the boy’s Control test: a – sitting in pelvic retroflexion position, b – switching from lying
illness, and a 6-week break after the position to sitting
40Medical Rehabilitation / Rehabilitacja Medyczna (Med Rehabil) 2021, 25 (1): 37-43 DOI: 10.5604/01.3001.0014.8762 eISSN 1896–3250 © AWF Krakow
in Th9/Th10 – reduced symptoms ter compressive mobilisation was per- Conservative treatment currently in-
to a 5, and at the level of Th6/Th7 formed there, the overtaking symp- cludes pharmacological treatment16,17,
– to 1 on the VAS. Following com- tom subsided. A biomechanical pro- caring for regular and free bowel
pressive mobilisation of the S2/S3 su- cedure was carried out for the sac- movements, unburdening the coccyx
praspinous ligament, the pain disap- ro-iliac, and facet joints at the Th5/ and physical therapy18-20. If the-above
peared. At the end of the session, the Th6 level, and distraction in both is ineffective, injections in the coccyx
therapist, the boy and his mother de- hip joints was reconstructed. Needle area are performed8,16,20. Still, a lit-
cided to perform needle therapy for therapy of supra- and inter-spinous tle-appreciated and implemented tool
the ligament, in order to consolidate ligaments at the Th10/Th11 level was for the conservative treatment of coc-
the achieved outcome. As a result, performed to maintain the positive cygodynia is manual therapy2-3.
the patient did not feel any discom- effect of therapy. The functional causes of this prob-
fort for 18 days, the pain changed to After 1 week, during the control lem are described by several authors.
tingling in the coccyx area, reaching visit, the patient did not report any As it turns out, spontaneous pain in
the maximal value of 3 on the VAS. symptoms. Patrick’s tests remained the coccyx is not always associat-
During the 4th meeting, a biome- positive in the case of manual exam- ed with its pressure soreness. Lewit2
chanical procedure was performed ination. Therefore, they became the suggests that only 1 in 5 of people
for the facet joints in Th7/Th8 - this control tests. Compression mobilisa- who experienced painful palpation
reduced the tingling sensation in the tions of the insertion of the of the piri- have tailbone pain. Others complain
coccyx area from 3 to 1 on the VAS. formis muscles at the apex of the larg- of pain in the lumbosacral region.
After compression mobilisations per- er femur trochanters were performed, Rakowski3 writes that excessive
formed on the left sacrotuberous lig- after which the results of Patrick’s pressure sensitivity of the coccyx
ament, at the insertion to the sacrum, tests were negative. Pelvic static bal- apex may occur due to a function-
the symptom resolved. Needle thera- ance was achieved. This was the com- al change in connective tissue struc-
py was performed on the above-men- pletion of the series of meetings. tures and the attached muscles,
tioned ligament. Correct joint play The patient came to the physio- which may lead to spontaneous pain.
was restored for both hip joints – dis- therapist’s office with a feeling of Andres and Chaves20, Nathan et al.6,
traction. tactile hypersensitivity in the area of Maigne et al.21, Rakowski3 and Le-
The 5th meeting was a follow-up the thoracic-lumbar spine transition wit2 see a correlation between pain
test: as before, the tingling sensation 3 years after the above described in the coccyx and levator ani mus-
at 3 on the VAS. The following were therapeutic treatment. The ailments cle, Rakowski3 and Maigne et al.21
performed: mobilisation of sacro-ili- in the tailbone area did not return. – with the pirifromis muscle, and
ac joints with the effect of alleviating The symptoms with which the pa- Rakowski3 with the sacrospinous,
the sensations to a 1, after compres- tient reappeared were resolved after anococcygeal, sacro-caudal and sac-
sion mobilisations of the right sac- 2 meetings, following mobilisation ro-spinal ligaments. Nathan et al.6
rotuberous ligament at the insertion of the Th11/Th12 and Th6/Th7 fac- (as cited in MennellA and ThieleB),
to the sacrum, the symptom disap- et joints, mobilisation of the sacro-il- Maigne et al.21, Lewit2, Rakowski3
peared. Needle therapy was carried iac joints and needle therapy for the – report the effectiveness of coccy-
out on the field of trigger points gen- supra- and Th11/Th12 inter-spinous godynia treatment by using manu-
erated by this ligament (the area gen- ligaments. al coccyx mobilisation in the dorsal
erating ailments radiated beyond the and/or abdominal direction. Various
place of its occurrence). After the de- authors describe possible non-local
scribed action, the symptoms subsid- DISCUSSION causes of coccygodynia, such as: pel-
ed for 1 month. After 4 weeks, tail- vic disturbances2-3,7 and in the motor
bone pain was only felt at the end of Coccygodynia – pain in the coccyx segments of the thoracic and lumbar
the day and was at the level of 1 on and surrounding tissues5,15,16 is an ac- spine3,7,20,22.
the VAS. knowledged problem, although not The proposal of coccygectomy, af-
Since 1st meeting, the patient per- yet studied or well-understood. The ter unsuccessful conservative treat-
formed the learned self-therapy tech- problem affects only 1% of 6-8 peo- ment, is the next step in trying to
niques every day, after which the ail- ple complaining of spinal disorders. deal with the problem. This radical
ments always subsided. It can be based on many causes - action is justified by the experience
At the 6th meeting, the control from organic to functional, including of many centres and authors to date.
test was the right-sided Derbolowsky a number of non-local causes. Mszwidobadzei Ałborow23 report-
symptom in the absence of coccyx The relationship between the de- ed the effectiveness of coccygectomy
pain. The supra- and inter-spinous scribed problem and the traumatic treatment to be at 90.3%, Maigne et
ligaments at the Th10/Th11 level mechanism seems to be obvious. Less al.4 at 62%, Sarmast et al.5 at 87.5%,
turned out to be the key structure. Af- obvious is idiopathic coccyx pain7. although research by De Andres
A
Mennell J.B. The science and art of joint manipulation. Vol. III. Churchill. London: 1952
B
Thiele G.H. Coccygodynia: cause and treatment. Dis Colon Rectum 1963; 6: 422-436.
41Medical Rehabilitation / Rehabilitacja Medyczna (Med Rehabil) 2021, 25 (1): 37-43 DOI: 10.5604/01.3001.0014.8762 eISSN 1896–3250 © AWF Krakow
i Chaves20 (as cited in Tilscher et al.C) of the ailments described. Physi- spontaneous coccygodynia may con-
was also reported, in which no long- otherapeutic/manual examination tribute to the determination of the
term improvement was observed. requires functional diagnostics of functional causes regarding this prob-
Based on the example described the musculoskeletal system, with lem, and initiation of manual physi-
in the work, in light of the patient’s particular attention paid to the otherapeutic treatment in order to
and his mother’s refusal to consent structures functionally related to bring the tissues of the patient’s loco-
to surgery, we undertook conserva- the sacrococcygeal region. The ex- motor system to joint and muscle bal-
tive (non-surgical) treatment using amination should include: palpa- ance in order to permanently cure the
examination (joints, muscles, liga- tion examination of the sacrotu- ailments. Such cooperation between
ments, functional tests) and thera- berous ligaments sensitivity, piri- a doctor and a physical therapist
peutic techniques (normalising the formis muscle insertions to the would be a beneficial combination of
functional state of muscles, liga- greater trochanter of the femurs, knowledge and skills from both spe-
ments, joints and other tissues of the the supra- and inter-spinous liga- cialties in solving the problems of pa-
musculoskeletal system) used in the ments, the supra-spinous ligament tients with coccyx pain.
concept of Rakowski Manual Thera- of the sacrum and periarticular tis-
py. The main emphasis was placed on sues of the facet joints of the tho-
non-local causes of the ailments. As racic and lumbar spine. Diagnostic Conflict of interest
a result, complete relief of tailbone management should include pelvic The authors do not declare any con-
pain was achieved, assessing both static balance (including Piedel- flict of interest.
the short-term and long-term effects lou’s and Derbolowsky’s symp-
– 3 years after the initiation of treat- toms), muscle balance, and Pat-
ment. Surgery and possible compli- rick’s test (Faber test), modified References
cations were avoided. The present- by Rakowski. In adults, the exami- 1. Piernikowska-WidłakT. (ed.). Wielki Słownik
ed case proves the effectiveness of nation should be supplemented by Medyczny. Wydawnictwo Lekarskie PZWL,
Warszawa 1996: 573.
the procedure according to the prin- rectal examination of the pelvic 2. Lewit K. Leczenie manualne zaburzeń czyn-
ciples of the described method and is structures. ności narządu ruchu. Wydawnictwo PZWL,
Warszawa 1984: 198, 326.
an argument for using coccygectomy 2. The solution for idiopathic pain 3. Rakowski A. Terapia Manualna Holistycz-
only in special and complicated sit- syndrome in the coccygeal region na. Wydawnictwo PWN, Poznań 2017: 132-
133,135,139, 226-227, 233, 237, 245, 253.
uations as the final method of treat- is targeted manual therapy taking 4. Maigne J.Y., Rusakiewicz F., Diouf M. Post-
ment8,6,16-19,21,23-25. the dysfunction of individual struc- partum coccygodynia: a case of series stu-
dy of 57 women. Eur J Rehabil Med 2012; 48:
In the available literature, there is tures regarding the musculoskeletal 387-392.
a lack of research results and descrip- system into account. The described 5. Sarmast A.H., Kirmani A.R., Bhat A.R. Coc-
cygectomy for coccygodynia: a single cen-
tions of the use of a complex, mul- procedure, in line with the method- terexperienceover 5 years. Asian J Neuro-
ti-faceted forms of therapy for people ology developed by Rakowski, in- surg2018; 13: 277-282.
6. Nathan S.T., Fischer B.E., Roberts C.S. Coc-
with coccyx pain, which would include cludes both local and non-local ther- cygodynia – a review of pathoanatomy, aeti-
various complementary and com- apeutic interventions. The scheme ology, treatment and outcome. J Bone Joint
Surg [Br] 2010; (92-B): 1622-1627.
bined forms of conservative treatment: of the action includes biomechanical 7. Dampc B., Słowiński K., Pruciak A.Coccy-
non-surgical and physiotherapeutic. procedures for the sacro-iliac joints, godynia - Causes, Local Symptoms and
otherConditionswithin the Motor System -
thoracic and lumbar joints, recon- Concurrence and Correlation. J Surg2020;
struction of articular play elements 5: 1342.
8. Paczkowski D., Harat M. Coccygodynia jako
CONCLUSIONS in the hip joints, pressure mobilisa- problem diagnostyczny i leczniczy. Valetudi-
tion and needle therapy for individ- naria Post Med Klin Wojs 2003; 8: 3-4.
9. Simpson J.Y. Clinical Lectures on the diseas-
Non-surgical, conservative, physio- ual connective tissue structures and es of women, lecture 17. Medical Times Ga-
therapeutic treatment of idiopath- individually adjusted self-therapy of zette, 1859; 40: 1-7.
10. Dampc B., Słowiński K. Coccygodynia-pa-
ic coccygodynia with the use of the the musculoskeletal system. togeneza, diagnostyka i terapia. Przegląd-
Rakowski’s Manual Therapy meth- piśmiennictwa. Pol PrzeglChir 2017; 899(4):
34-41.
odology is presented. 11. Sarmast A.H., Kirmani A.R., Bhat A.R. Coc-
cygodynia: A Story Retold. Austin J Surg
1. Coccygodynia requires detailed di- SUMMARY 2016; 3(3): 1091.
agnostics, both imaging and func- 12. Maigne J.Y., Doursounian L., Chatellier G.
Causes and Mechanisms of Common Coc-
tional. The basic imaging exami- Rakowski’s manual therapy is an ef- cydynia, role of body mass index and coccy-
nation is X-ray and ultrasound of fective method for treating patients geal trauma. Spine 2000; 25(23): 3072-3079.
13. Zębaty A. (ed.). Kinezyterapia. Tom I. Wy-
the coccyx area. The medical ex- suffering from spontaneous ccocygo- dawnictwo Kasper, Kraków, 2002: 194, 196,
amination includes: interview, pal- dynia without organic causes. 459.
14. Buckup K. Testy Kliniczne w badaniu kości,
pation of this region and an exam- Performing the basic functional stawów i mięśni. Wydawnictwo Lekarskie
ination through the anus in order tests described in the above article by PZWL, Warszawa 2007: 176.
15. Śpiewakiewicz B. (ed.). Zespół bólowy mied-
to exclude morphological causes a physician examining patients with nicy mniejszej, problem interdyscyplinarny.
C
Tilscher H., Kantor H., Gangl W., Bogner G. Die Coccygodynie – ein diagnostisches und therapeutisches Problem der Orthopädie [Coccygodynia – a diagnostic and
therapeutic problem in orthopedics]. Z Orthop Ihre Grenzgeb 1986; 124(5): 628-632 [German].
42Medical Rehabilitation / Rehabilitacja Medyczna (Med Rehabil) 2021, 25 (1): 37-43 DOI: 10.5604/01.3001.0014.8762 eISSN 1896–3250 © AWF Krakow
Wydawnictwo Lekarskie PZWL, Warszawa cygodynia With Intrarectal Manipulation. Address for correspondence
2014: 103-104. Spine 2006; 31(18): 621-627.
16. Szypula J., Iwulski P., Czarnecka W. Wyniki 22. Polkinghorn B.S., Colloca C.J. Chiropractic Bogumiła Dampc
operacyjnego leczenia pourazowej kokcy- Treatment of Coccygodynia via Instrumental Centrum Terapii Manualnej
godynii. Kwart Otrop 2010; 2: 257-262. Adjusting Procedures Using Activator Me- Sierosław, ul. Leśna 1, 62-080 Tarnowo Podgór-
17. Patel R., Appannagari A., Whang P.G. Coc- thods Chiropractic Technique. J Manipulati- ne, Poland
cydynia. Curr Rev Musculoskelet Med 2008; ve PhysiolTher 1999; 22(6): 411-416. Mobile: +48 513 460 666
1: 223-226. 23. Mszwidobadze M., Ałborow G. Taktyka le-
e-mail: b.dampc@interia.pl
18. Fogel G., Cunningham P., Esses S. Coccy- czenia kokcygodynii. Chir Narz Ruchu Ortop
godynia: evaluation and managment. J Am Pol 1990; 55(4-6): 519-521.
AcadOrthopSurg 2004; 12: 49-54. 24. Lirette L., Chaiban G., Tolba R., Eissa H.
19. Dalbayrak S., Yaman O., Yilmaz T., Yilmaz M. Coccygodynia: An overview of anatomy,
Treatment Principels for Coccygodynia. Turk etiology and treatment of coccyx pain.Ochs-
Neurosurg 2014; 24(4): 532-537. er J 2014; 14: 84-87.
20. De Andres J., Chaves S. Coccygodynia: A 25. Hanley E.N, Ode G., Jackson III J.B., Seymo-
proposal for algorithm for treatment. J Pain ur R. Coccygectomy for patients with chronic
2003; 4(5): 257-266. coccygodynia: A prospective, observational
21. Maigne J.Y., Chatellier G., Le Faou M., Ar- study of 98 patients. Bone Joint J 2016; 98-
chambeau M. The Treatment of Chronic Coc- B: 526-533.
43You can also read
