Treatment for Coccydynia and the SacroCoccygeal Syndrome

The Kemper Tailbone Injury Foundation (KTIF) recognizes benefits associated with many treatments and procedures available for coccyx pain or coccydynia.

KTIF recommends that prior to obtaining therapy or injections for Coccydynia or coccyx pain, that patients be tested for the 3 components of the SacroCoccygeal syndrome, to help insure long term improvement of both pain and other symptoms known to be associated with coccyx dysfunction.

Examples of physical therapy and medical procedures that can provide relief, particularly if the SacroCoccygeal syndrome is not present, are listed in alphabetical order and not necessarily in order of effectiveness for a given diagnosis. Warning: The treatments listed below may be contra-indicated for certain patients depending on the actual diagnosis and whether the condition is in the acute, sub-acute or chronic phase.

Anti-inflammatories, Blocks (Pudendal nerve or Impar ganglion), Cryotherapy, Cushions, Electrical muscle stimulation, Exercise & stretching, Homeopathy, Manipulation externally according to Logan Basic or Sacral Occipital Technique, , Massage, Surgery, and Ultrasound.

If coccyx pain is accompanied by coccygeal displacement and or loss of coccygeal range of motion, termed “the SacroCoccygeal Syndrome” by Kemper and Wooley, the most effective treatments will be those that not only address coccyx pain but restore loss of coccygeal range of motion with internally mobilization, according to Wooley-Kemper as necessary, to ease coccyx-induced spinal cord and meningeal tension believed to accompany many cases of Coccydynia and every case of the SacroCoccygeal syndrome.

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.
  • 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.

The 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.

Surgery

The Kemper Tailbone Injury Foundation acknowledges the need for surgical removal of the coccyx in specific situations.

One or more of the coccyx segments can fracture, splinter and fragment into pieces that must be removed. In other instances the coccyx can be sufficiently torn from its attachments and become so loosely attached that ligament strengthening injections may need to be provided. Prolotherapy, also known as “Proliferant”, is very effective in stimulating re-growth of ligament tissue when ligamnets have been partially torn up to only about 50-75%. When successful, Prolotherapy is a safe, effective and long lasting answer to chronic joint instability of all types and often times eliminates the need for surgery. However, when coccygeal ligaments are more than 50-75% torn or detached, Proliferant may not be able to stimulate enough growth of new ligament tissue to stabilize the coccyx. In these cases surgery is often necessary.

Surgery is also indicated in the rare instance where a fracture occurs and bony splinters or fragment protrude through the local tissues causing severe pain.

Surgery should not be performed however, if the coccyx is displaced but not unstable. In these cases, which are very common, the Kemper-Wooley Procedure is usually effective in restoring coccygeal function and reducing pain.

Jean Yves Maigne, M.D. and associates have had achieved good results with coccygectomy. He emphasized the need for meticulous technique. He has seen a small percentage of post surgical infections that cleared up with additional treatment. Dr. Maigne is the world’s top authority on coccygeal anatomy and has published several studies. However, Drs. Maigne, Kemper and Wooley have yet to formally discuss their differing opinions regarding normal coccygeal range of motion, At the present time Dr. Maigne’s group states that coccygeal motion more than 30 degrees represents hypermobility (too much motion).

Whereas Kemper’s group is of the opinion that most cases of coccyx pain and the SacroCoccygeal Syndrome are due to the coccyx losing mobility when displaced or injured, thereby creating direct tension on the spinal cord as well as chronic pelvic floor muscle strain and associated coccyx pain. In either case, both groups generally agree that conservative treatment should be performed first.

References:

  1. Maigne JY, D. Lagauche, L. Doursounian. Instability of the coccyx in coccydynia. J Bone Joint Surg (Br) 2000;82-B:1038-41.
  2. Maigne JY, Guedj S, Straus C. Idiopathic coccygodynia. Lateral roentgenorams in the sitting position and coccygeal discography. Spine 1994;vol.19:No.8. pp. 930-4.
  3. Clinical and radiological differences between traumatic and idiopathic coccygodynia. Yonsei Med J, 1999 Jun, 40:3, 215-20. Kim NH; Suk KS. Department of Orthopaedic Surgery, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul 120-752, Korea.Tel:82-2-361-5640,Fax:82-2-363-1139,E-mail:os@yumc.yonsei.ac.kr
  4. Wooley J, Kemper C. Hypothesis: Is sacrococcygeal hypomobility related to chronic low back pain and stiffness. J orthopaedic medicine 1998; 20:17-20.
  5. Kemper C. Tailbone Pain 911: The most under diagnosed cause of chronic low back pain. Create Books, Calgary. 2006.