The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy

PM R. 2017 Apr;9(4):367-376. doi: 10.1016/j.pmrj.2016.08.007. Epub 2016 Aug 24.

Abstract

Background: Coccydynia is a challenging disorder that often is refractory to treatments such as medications and injections. Physical therapy for coccydynia rarely has been studied.

Objective: To evaluate the efficacy of pelvic floor physical therapy for reducing pain levels in patients with coccydynia.

Design: Retrospective chart review.

Setting: The pelvic floor rehabilitation clinic of a major university hospital.

Patients: A total of 124 consecutive patients over age 18 with a chief complaint of coccydynia between 2009 and 2012. A subgroup of 17 of the 124 patients had previously undergone coccygectomy with continued pain postoperatively.

Methods or interventions: The primary treatment intervention was pelvic floor physical therapy aimed at pelvic floor muscle relaxation. Secondary treatment interventions included the prescription of baclofen for muscle relaxation (19% of patients), ganglion impar blocks (8%), or coccygeus trigger point injections (17%).

Main outcome measures: Primary outcome measures included final minimum, average, and maximum pain numeric rating scales. A secondary outcome measure was the patient's subjective percent global improvement assessment. Baseline demographics were used to determine which pretreatment characteristics were correlated with treatment outcomes.

Results: Of the 124 patients, 93 participated in pelvic floor physical therapy and were included in statistical analysis. For the 79 patients who completed treatment (with a mean of 9 physical therapy sessions), the mean average pain ratings decreased from 5.08 to 1.91 (P < .001) and mean highest pain ratings decreased from 8.81 to 4.75 (P < .001). The mean percent global improvement was 71.9%. Mean average pain ratings in postcoccygectomy patients improved from 6.64 to 3.27 (P < .001). Greater initial pain scores and a history of previous injections were correlated with P < .001 pain scores on completion of physical therapy. Pain duration and history of trauma did not affect treatment outcomes.

Conclusions: Pelvic floor physical therapy is a safe and effective method of treating coccydynia.

Level of evidence: III.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Chronic Pain / rehabilitation
  • Coccyx / injuries*
  • Coccyx / surgery*
  • Cohort Studies
  • Female
  • Hospitals, University
  • Humans
  • Male
  • Middle Aged
  • Osteotomy / methods
  • Osteotomy / rehabilitation
  • Pain Measurement
  • Pain, Postoperative / rehabilitation*
  • Pelvic Floor / physiopathology*
  • Physical Therapy Modalities*
  • Prognosis
  • Regression Analysis
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome