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

Physical Medicine and Rehabilitation

2016 Aug 24. pii: S1934-1482 (16) 30880-2. [Epub ahead of print]

Scott KM, Fisher LW, Bernstein IH, Bradley MH.

Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9055.

Email - kelly.scott@utsouthwestern.edu

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:

To be determined.

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