Functional examination and therapy in primary coccygeal syndrome
Authors:
Fabičovic K. 1,2; Novák J. 1; Angerová Y. 2; Machač S. 1; Kobesová A. 1
Authors‘ workplace:
Klinika rehabilitace a tělovýchovného lékařství, 2. LF UK a FN Motol, Praha
1; Klinika rehabilitačního lékařství, 1. LF UK a VFN v Praze
2
Published in:
Rehabil. fyz. Lék., 30, 2023, No. 3, pp. 120-132.
Category:
Original Papers
doi:
https://doi.org/10.48095/ccrhfl2023120
Overview
Aim: To explain the term coccygodynia, define its kinesiological and neurophysiological basis, and present the diagnostic and therapeutic options. The aim of the experimental part is to evaluate the effect of physiotherapy in both the acute and chronic stages of primary coccygodynia and to evaluate the correlation between sonopalpation, X-ray assessment and the palpation of the coccyx per rectum. Methods: Six female subjects with primary coccygodynia received five individual physiotherapy sessions during the first 3 months of the study, practicing self-treatment for the next 3 months. The Short Form-36 (SF-36) Quality of Life Questionnaire, The Female Sexual Function Index (FSFI) questionnaire and The Oswestry Questionnaire, Version 2.1a were used to subjectively assess the effect of therapy. Gynaecological history (GA) was assessed, and the Ohmbelt device was used to verify abdominal wall activity. Skeletal pain was assessed by sonopalpation. Results: The FSFI questionnaire showed a significant decrease in painful intercourse at the end of the study (3rd measurement) compared to baseline data (2.0 ± 2.1 vs 3.3 ± 2.5; P = 0.042). The SF-36 questionnaire showed a significant improvement in the Vitality domain when comparing the 1st and 2nd measurements (41.7 ± 21.8 vs 55.0 ± 25.3; P = 0.038). Sonopalpation results correlated with per rectum examination in all subjects. Conclusion: The application of manual techniques including per rectum mobilization of the coccyx and pelvic floor soft tissues treatment at the very beginning of therapy, supplemented with neurophysiological methods and self-treatment, had a positive effect on the quality of life of patients with primary coccygodynia. The findings of sonopalpation correlate with the per rectum examination.
Keywords:
Physiotherapy – coccygodynia – sonopalpatio
Sources
1. Čihák R. Anatomie. 3., uprav. a dopl. vyd. Praha: Grada 2016. ISBN 978-80-247-5636-3.
2. Lirette LS, Chaiban G, Tolba R et al. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J 2014; 14(1): 84–87.
3. Kerr EE, Benson D, Schrot RJ. Coccygectomy for chronic refractory coccygodynia: clinical case series and literature review. J Neurosurg Spine 2011; 14(5): 654–663. doi: 10.3171/2010.12.SPINE10262.
4. Marek J et al. Syndrom kostrče a pánevního dna. 2. vyd. Praha: Triton 2005. ISBN 80-7254-638-4.
5. Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br 2010; 92(12): 1622–1627. doi: 10.1302/0301-620X.92B12.25486.
6. Pennekamp PH, Kraft CN, Stütz A et al. Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma 2005; 59(6): 1414–1419. doi: 10.1097/01.ta.0000195878.50928.3c.
7. Tichý M. Dysfunkce kloubu. Praha: Miroslav Tichý 2009. ISBN 978-80-254-3963-0.
8. Doursounian L, Maigne J-Y, Jacquot F. Coccygectomy for coccygeal spicule: a study of 33 cases. Eur Spine J 2015; 24(5): 1102–1108. doi: 10.1007/s00586-014-3753-5.
9. Foye PM. Coccydynia: tailbone pain. Phys Med Rehabil Clin N Am 2017; 28(3): 539–549. doi: 10.1016/j.pmr.2017.03.006.
10. Patijn J, Janssen M, Hayek S et al. 14. Coccygodynia. Pain Pract 2010; 10(6): 554–559. doi: 10.1111/j.1533-2500.2010.00404.x.
11. Gunduz OH, Sencan S, Kenis-Coskun O. Pain relief due to transsacrococcygeal ganglion impar block in chronic coccygodynia: a pilot study. Pain Med 2015; 16(7): 1278–1281. doi: 10.1111/pme.12752.
12. Maigne J-Y, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine 2000; 25(23): 3072–3079 doi: 10.1097/00007632-200012010-00015.
13. Maigne J-Y, Pigeau I, Aguer N et al. Chronic coccydynia in adolescents. A series of 53 patients. Eur J Phys Rehabil Med 2011; 47(2): 245–251.
14. Preziosi G, Emmanuel A. Neurogenic bowel dysfunction: pathophysiology, clinical manifestations and treatment. Expert Rev Gastroenterol Hepatol 2014; 3(4): 417–423. doi: 10.1586/egh.09.31.
15. Hwang U-J, Lee M-S, Jung S-H et al. Effect of pelvic floor electrical stimulation on diaphragm excursion and rib cage movement during tidal and forceful breathing and coughing in women with stress urinary incontinence: a randomized controlled trial. Medicine 2021; 100(1). e24158. doi: 10.1097/MD.0000000000024158.
16. Bitnar P, Stovicek J, Hlava S et al. Manual cervical traction and trunk stabilization cause significant changes in upper and lower esophageal sphincter: a randomized trial. J Manipulative Physiol Therap 2021; 44(4): 344–351. doi: 10.1016/j.jmpt.2021.01.004.
17. Qandeel H., O’Dwyer PJ. Relationship between ventral hernia defect area and intra-abdominal pressure: dynamic in vivo measurement. Surg Endosc 2016; 30(4): 1480–1484. doi: 10.1007/s00464-015-4356-x.
18. Hagins M, Lamberg EM. Individuals with low back pain breathe differently than healthy individuals during a lifting task. J Orthop Sports Phys Ther 2011; 41(3): 141–148. doi: 10.2519/jospt.2011.3437.
19. Raimondo D, Cocchi L, Raffone A et al. Pelvic floor dysfunction at transperineal ultrasound and chronic constipation in women with endometriosis. Int J Gynecol Obstet 2022; 159(2): 505–512. doi: 10.1002/ijgo.14088.
20. Del Forno S, Arena A, Pellizzone V et al. Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial. Ultrasound Obstet Gynecol 2021; 57(5): 726–732. doi: 10.1002/uog.23590.
21. Beltrán Molano ML, Pinilla Bonilla LB, Dussan EHB et al. Anatomo-functional correlation between head zones and acupuncture channels and points: a comparative analysis from the perspective of neural therapy. Evid Based Complement Alternat Med 2014; 2014: 836392. doi: 10.1155/2014/836392.
22. Bath M, Owens J. Physiology, viscerosomatic reflexes. StatPearls 2023. [online]. Awailable from: https://www.ncbi.nlm.nih.gov/books/NBK559218/.
23. Mabrouk A, Alloush A, Foye P. Coccyx pain. In: StatPearls 2023. [online]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563139/.
23. Lewit K. Manipulační léčba v myoskeletální medicíně. 5. přeprac. vyd. Praha: Sdělovací technika ve spolupráci s ČLS JEP, c2003. ISBN 80-86645-04-5.
25. Maigne J-Y, Pigeau I, Roger B. Magnetic resonance imaging findings in the painful adult coccyx. Eur Spine J 2012; 21(10): 2097–2104. doi: 10.1007/s00586-012-2202-6.
26. Hrazdira L, Skotáková J. 3D ultrasonografické vyšetřování pohybového aparátu. Acta chirurgiae orthopaedicae et traumatologiae Čechoslovaca 2006; 73(6): 414–420.
27. Woon JTK, Magine J-Y, Perumal V et al. Magnetic resonance imaging morphology and morphometry of the coccyx in coccydynia. Spine 2013; 38(23): E1437–E1445 doi: 10.1097/BRS.0b013e3182a45e07.
28. Postacchini F, Massobrio M. Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx. J Bone Joint Surg Am 1983; 65(8): 1116–1124.
29. Kim NH, Suk KS. Clinical and radiological differences between traumatic and idiopathic coccygodynia. Yonsei Med J 1999; 40(3): 215–220. doi: 10.3349/ymj.1999.40.3.215.
30. Maigne J-Y, Guedj S, Straus S. Idiopathic coccygodynia. Lateral roentgenograms in the sitting position and coccygeal discography. Spine 1994; 19(8): 930–934. doi: 10.1097/00007632-199404150-00011.
31. Maigne J-Y, Chatellier G. Comparison of three manual coccydynia treatments: a pilot study. Spine 2001; 26(20): E479–E483. doi: 10.1097/00007632-200110150-00024.
32. Trollegaard AM, Aarby NS, Hellberg S. Coccygectomy: an effective treatment option for chronic coccydynia: retrospective results in 41 consecutive patients. J Bone Joint Surg Br 2010; 92(2): 242–245. doi: 10.1302/0301-620X.92B2.23030.
33. Chen Y, Huang-Lionnet JHY, Cohen SP. Radiofrequency ablation in coccydynia: a case series and comprehensive, evidence-based review. Pain Med 2017; 18(6): 1111–1130. doi: 10.1093/pm/pnw268.
34. Gonnade N, Mehta N, Khera PS et al. Ganglion impar block in patients with chronic coccydynia. Indian J Radiol Imaging 2021; 27(03): 324–328. doi: 10.4103/ijri.IJRI_294_16.
35. Gönen Aydin C, Örsçelik A, Gök MC et al. The efficacy of extracorporeal shock wave therapy for chronic coccydynia. Med Princ Pract 2020; 29(5): 444–450. doi: 10.1159/000505835.
36. Kolář P. Rehabilitace v klinické praxi. Praha: Galén 2009. ISBN 9788072626571.
37. Escobar-Hurtado C, Ramírez-Vélez R. Proprioceptive neuromuscular facilitation (PNF) and its impact on vascular function. Colombia Medica 2011; 42(3): 373–378. doi: 10.25100/cm.v42i3.885.
38. Lee J-H, Park SJ, Na SS. The effect of proprioceptive neuromuscular facilitation therapy on pain and function. J Phys Ther Sci 2013; 25(6): 713–716. doi: 10.1589/jpts.25.713.
39. Ferro JKO, de Moura Filho AG, de Amorim KCS et al. Electromyographic analysis of pelvic floor muscles during the execution of pelvic patterns of proprioceptive neuromuscular facilitation‐concept: an observational study. Neurourol Urodyn 2022; 41(6): 1458–1467. doi: 10.1002/nau.24981.
40. Pachruddin I, Rusly H, Nasaruddin F. Effect of proprioceptive neuromuscular facilitation (PNF) on standing balance control among post stroke patients. J Phys Conf Ser 2020; 1529(3): 032033. doi: 10.1088/1742-6596/1529/3/032033.
41. Kennedy S. Primary dysmenorrhoea. Lancet 1997; 349(9059): 1116. doi: 10.1016/S0140-6736(05)63018-8.
42. Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. J Bodyw Mov Ther 2012; 16(1): 76–82. doi: 10.1016/j.jbmt.2011.02.004.
43. Volejníková Hana. Zkušenosti s rehabilitační léčbou některých druhů funkční ženské sterility na rehabilitačním oddělení Fakultní porodnice KÚNZ, Brno. Československá gynekologie 1991; 56(1): 21–26.
44. Hnízdil J. Léčebné rehabilitační postupy Ludmily Mojžíšové. Praha: Grada 1996.
45. Novak J, Jacisko J, Busch A et al. Intra-abdominal pressure correlates with abdominal wall tension during clinical evaluation tests. Clin Biomech 2021; 88: 105426. doi: 10.1016/j.clinbiomech.2021.105426.
46. Novak J, Busch A, Kolar P et al. Postural and respiratory function of the abdominal muscles: a pilot study to measure abdominal wall activity using belt sensors. Isokinet Exerc Sci 2020; 29(2): 175–184. doi: 10.3233/IES-203212.
47. Mezian K, Steyerová P, Vacek J. Introduction to neuromuscular ultrasound. Cesk Slov Neurol N 2016; 79/112(6): 656–661. doi: 10.14735/amcsnn2016656.
48. Douglas J, Pearson S, Ross A et al. Eccentric exercise: physiological characteristics and acute responses. Sports Med 2017; 47(4): 663–675. doi: 10.1007/s40279-016-0624-8.
49. Bártlová S, Tóthová V, Chloubová I et al. The quality of health of the Czech population at the age of 40+ using the Short Form-36 (SF-36) questionnaire. Kontakt 2020; 22(1): 16–26. doi: 10.32725/kont.2020.003.
50. Haluzíková J, Wieclawová G. Quality of life in patients with chronic back pain. Profese online 2020; 13(1): 29–37. doi: 10.5507/pol.2019.005.
51. Wiegel M, Meston C, Rosen R. The Female Sexual Function Index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 2005; 31(1): 1–20. doi: 10.1080/00926230590475206.
52. Shahraki Z, Tanha FD, Ghajarzadeh M. Depression, sexual dysfunction and sexual quality of life in women with infertility. BMC Womens Health 2018; 18(1): 92. doi: 10.1186/s12905-018-0584-2.
53. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25(22): 2940–2953. doi: 10.1097/00007632-200011150-00017.
54. Mičánková Adamová B, Hnojčíková M, Voháňka S et al. Oswestry dotazník, verze 2.1a – Výsledky u pacientů s lumbální spinální stenózou, srovnání se starší verzí dotazníku. Cesk Slov Neurol N 2012; 75(4): 460–467.
55. Jenkinson C, Stewart-Brown S, Petersen S et al. Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health 1999; 53(1): 46–50. doi: 10.1136/jech.53.1.46.
56. Petr P. Dotazník SF-36 o kvalitě života podmíněné zdravím. Kontakt 2000; 2(1): 26.
57. Meston CM, Freihart BK, Handy AB. Scoring and interpretation of the FSFI: what can be learned from 20 years of use? J Sex Med 2020; 17(1): 17–25. doi: 10.1016/j.jsxm.2019.10.007.
58. Wang D, Luo J, Li J-D et al. Case control study on clinical effects of sacrococcygeal manipulation in the treatment of coccyx pain. Zhongguo Gu Shang 2016; 29(9): 831–835. doi: 10.3969/j.issn.1003-0034.2016.09.012.
59. Seker A, Sarikaya IA, Korkmaz O et al. Management of persistent coccydynia with transrectal manipulation: results of a combined procedure. Eur Spine J 2018; 27(5): 1166–1171. doi: 10.1007/s00586-017-5399-6.
60. Madle K, Svoboda P, Stribrny M et al. Abdominal wall tension increases using Dynamic Neuromuscular Stabilization principles in different postural positions. Musculoskelet Sci Pract 2022; 62: 102655. doi: 10.1016/j.msksp.2022.102655.
61. Pirri C, Stecco A, Fede C et al. Ultrasound imaging of a scar on the knee: sonopalpation for fascia and subcutaneous tissues. Eur J Transl Myol 2020; 30(1): 8909. doi: 10.4081/ejtm.2019.8909.
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Physiotherapist, university degree Rehabilitation Sports medicineArticle was published in
Rehabilitation and Physical Medicine
2023 Issue 3
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