The SacroCoccygeal Syndrome

The SacroCoccygeal Syndrome is diagnosed when a patient tests positive for two or more of the signs described below.

Patients with the syndrome are usually recalcitrant (only temporary relief) to physical therapy and injections that do not primarily address range of motion necessary for a healthy pain-free coccyx.

However, physical therapy and injectable blocks, provided in combination with the Kemper-Wooley Procedure can enhance outcomes by temporarily easing pain and pelvic floor muscular spasms while coccygeal motion is increased to optimal levels.

Three Clinical Signs of the SacroCoccygeal Syndrome

1. Internal contact assessment of Coccygeal Range of Motion

A normal test reveals a pain free and supple or “spring-like” coccyx with more than 30 degrees of combined flexion and extension, performed with firm but careful bi-digital contact. Bi-digital contact meaning the physician uses one finger with internal contact on the coccyx against the external thumb of the opposite hand.

An abnormal test reveals little or no palpable coccygeal motion accompanied by discomfort.

2. Test for Loss of Thigh Strength or Motor Weakness

Motor Weakness, in this context, refers to a measurable loss of strength of the pelvic muscles that collectively rotate the thigh inwards or outwards.

A normal test in adults elicits an effort so strong that the examiner cannot prevent the action.

An abnormal test reveals an obvious loss of strength in the magnitude of 20-60% or 2-4 on the 5 scale. The weakness is alarming, as if the patient was not really trying their best, but they really have lost partial function of the leg. The examiner should encourage the patient to make their very best effort to avoid a false positive and to reinforce the fact that any weakness discovered is real.

3. Test for impaired Trunk Flexion and Straight Leg Raise

A normal test is the ability to freely touch the fingertips to the floor with plenty of flexion in reserve.

An abnormal test is where the patient fails the floor, often by 6 inches or 30 degrees.

The SacroCoccygeal syndrome is gradually becoming known as a unique and distinct group of treatable symptoms. Existence of the syndrome was first suspected by Wooley and Kemper back in the late 80s. The condition has been observed and studied for several years before the signs, symptoms and Kemper-Wooley Procedure was announced.

The SacroCoccygeal syndrome is being increasingly recognized by spine physicians for the following reasons:

  1. A clear clinical profile - easy to confirm with simple X-ray, palpation and one-minute assessment of thigh strength and loss of spine flexibility it classically causes.
  2. Its logical origin due to the relationship between the coccyx and the spinal cord.
  3. The syndrome’s responsiveness to treatment
  4. The syndrome’s multifactor impact on spinal pain as well as spinal function
  5. It prevalence, estimated to affect 1 in three people with chronic back pain and nearly every case of coccydynia.