Kelly M Scott1, Lauren W Fisher2, Ira H Bernstein3, Michelle H Bradley4. 1. Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9055(∗). Electronic address: kelly.scott@utsouthwestern.edu. 2. Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX; Department of Physical Medicine and Rehabilitation, Providence St. Peter Medical Center, Olympia, WA(†). 3. Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX(‡). 4. Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX(§).
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.
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.