Top Questions asked by DCs:
1. How does management of the S/C syndrome dovetail with other techniques?
Answer: Treating the coccyx, to relieve the SacroCoccygeal syndrome, is not a technique. It is a Procedure that is compatible with every technique. While the S/C syndrome, by definition, has far reaching affects, it should be viewed as a specific treatment for a specific joint injury. For example: my brother dislocated his thumb while we were wrestling as boys. He was as tough as any kid I knew, but until that thumb was set back in joint, there was little point in adjusting the concomitant wrist, elbow, shoulder or neck subluxation. In a full-blown S/C syndrome, the motor weakness and loss of spine flexion is usually so profound that until the patient's coccygeal motion is restored there is little point in adjusting a concomitant SI or LS subluxation or trying to relax a piriformis, hip flexor or pelvic floor muscle spasm. However, once the objective signs of coccyx dysfunction are addressed, your primary technique is more likely to be successful.
2. How can coccyx manipulation be justified when it is not the chief complaint?
Answer: If 6-12 weeks of spinal manipulative therapy has not been effective for low back, pelvic or leg pain and the signs of the S/C syndrome are still present (loss of thigh strength and trunk flexion) the coccyx should be tested, regardless of how little pain may be present at the coccygeal joints. In other words, the S/C syndrome may or may not include coccyx pain / coccydynia.
3. I see lots of patients back pain patients with displaced coccyges but with no coccyx pain. To what extent is it possible that the coccyx has anything at all to do with back pain in these cases?
Answer: As stated in question #3…the S/C syndrome appears primarily as a neurologic event, inasmuch as it involves a reflex hypertonicty that impairs lumbopelvic flexion and weakens sacral distribution motor output as evidenced by obvious disparity in thigh strength (see SacroCoccygeal Reflex link on KTIF.org). Once you document the serious and persistent motor weakness, caused by the S/C syndrome, you will appreciate why we want all spine physicians to start testing for it. Then, once you relieve it with a success procedure, and see the rapid return of motor strength and stability it restores to the lumbopelvic thigh groups, you quickly become a believer. I am not talking about a 10-20% change in one muscle. Typical, increase in motor strength is 40-60% and is often bilateral.
4. I routinely improve my patient's loss of spinal flexion and thigh weakness with my technique. Why would I ever consider treating a mild case of coccydynia if the patient experiences relief with standard care?
Answer: You wouldn't, so long as Trunk Flexion, SLR and thigh strength is truly optimal for your patient. The problem lies in a lack of consensus among spine physicians for these values. KTIF has found that most patients and doctors believe that 75-90 degrees of SLR or Trunk Flexion is normal for many patients. Yet, when coccygeal dysfunction is corrected, regardless of coccyx pain, most of these same patients experience increases in Trunk Flexion and SLR up to 120 degrees or more (see KTIF's Photo Gallery).
5. I have tested several patients for restricted coccyx motion and they all had very little, perhaps 5-10 degrees. My concern is that each patient expressed considerable discomfort with the exam. How can I expect to provoke 30-60 degrees of motion back into the coccygeal joints when the patient is uncomfortable even with the examination?
Answer: Great question! As some dental work requires a local anesthetic, so do many S/C cases. KTIF's 1-day course and in-office consultations are designed to help you assess the ethical need for anesthetic and or sedation among other essential practices for success.
6. I encounter patients who do not want to have their coccyx tested. Assuming they truly have a primary coccyx syndrome and have not improved with standard spinal manipulation and physical therapy, how do you recommend I handle the case?
Answer: Another great question. The answer is… "you don't". Most doctors take on many cases they shouldn't, for a variety of reasons. Attributes of a good S/C case, to name a few, is where the diagnosis is clear, the patient understands their condition, genuinely seeks improvement, can afford and is willing to pay for the care and is self-motivated to perform the necessary daily exercise that go along with coccyx rehabilitation.
7. I have no problem examining the coccyx. My concern is knowing how to handle anxiety about the exam or treatment.
Answer: There are many component to making your patient feel comfortable with the assessment and the procedure. Factors range from good patient education, to knowing you have formal training, to a spouse in the room, to immediate improvement possible and to appropriate medical assistance. Again, this feature of patient selection is covered in detail in the 1-day course and again in the clinical portion of the Program.
8. If providing internal coccyx manipulation was a one time cure, or provided long term benefits, I would, without a doubt, highly recommend it for suitable candidates. My concern is that the procedure is invasive and should not be performed on a regular basis.
Answer: Fortunately, a correctly performed procedure does only need to be performed 1-2 times in about half of well-selected patients. And while the procedure is invasive compared to a C5 manipulation for instance, it is not invasive when compared to an epidural or spine surgery. Moreover, the usual dramatic improvement and long lasting nature of the relief, has a way of quickly assuaging the momentary discomfort of the procedure. Remember, effective coccyx manipulation usually requires less than 60 seconds.