Sacro-coccygeal pain

Michael K - cdkmek@cfl.rr.com

Having sacro-coccygeal pain since October 2001. Tried several Chiropractors, Acupuncture, Orthopedic Surgeon, Neurosurgeon, Physiatrist, Neuros, Physical Therapy, and Massage. Currently on Vioxx once a day, Neurontin twice a day, and various narcotics. All but the neurotin help to some degree.

I've only had internal message of soft tissue along with coccyx movement. Has anyone had success or experience with doctors Wooley or Kemper in California that do coccyx manipulation? Any thoughts on this?

Also looking for any feedback on the following injection technique: Coccydynia/Levator Syndrome, A Therapeutic Test, or others.

So I don't have to repeat myself whenever I see a new practitioner, I give them a copy of the following. Any comments you have after reading the profile that follows is appreciated. Thank you.

History of Back and Sacro-coccygeal Pain

• 2001-02-23 Left L5-S1 microdiscectomy, several large free fragments of herniated nucleus removed
• 2001-10 Initial sacro-coccygeal pain while starting yoga
• 2002-03 Trigger point injection 1x. No effect
• 2002-03 Caudal block 1x. Local anesthetic had temporary relief (6 hours)
• All imaging scans negative

Symtoms of Sacro-coccygeal Pain

• Sitting or standing: Gradual (10-20 minute) building of pain initially to the anterior aspect, right lateral to sacro-coccygeal joint area. Pain feels like sacrospinous ligament, sacrotuberous ligament, and or levator ani are being stretched and getting inflamed. If remain sitting or standing pain spreads bilaterally 3-4 inches.
• Bending over touch toes: Immediate sharp pain bilateral near sacro-coccygeal joint. As head is tilted down pain intensifies. Pain feels like two longitudinal bands on either side of lower sacrum are being stretched.
• Hanging upside down from inversion table: Immediate sharp pain around sacro-coccygeal joint. Feels like sacrum and coccyx are being pulled from one another.
• Rectal Exam: Coccyx somewhat hypo-mobile. When held in posterior position strain is felt bilaterally around sacrococcygeal joint. Surrounding soft tissue tender on moderate palpation
• External palpation: No pain

Body Positions that aggravate sacro-coccygeal symptoms:

• Sitting with or without donut (10-20 minute limit)
• Standing (10-20 minute limit)
• Lumbar flexion - If standing and lean forward to touch ground, pain in sacro-coccygeal joint occurs at 15 inches off ground. As head is tilted down pain is more immediate and intense
• Hanging upside down on inversion table causes immediate sharp pain limited to sacro-coccygeal joint
• If currently in painful state, then bowel movements, sneezing, passing gas all causes mild-moderate pain
• Stretches or exercises such as push-ups where buttock is fulcrum causes immediate pain to sacro-coccygeal area

Relieves symptoms:

• Supine and prone positions
• Analgesics and anti-inflammatories (relieves some pain up to 2-3 hours)

Neutral to Aggravates Symptoms:

• Walking/hiking up to 8 miles
• Stairs

Neutral to Symptoms:

• Lumbar extensions
• Lumbar twisting
• Transitioning between sitting and standing

Possible Contributing Factors to Sacro-coccygeal Pain

FACTS:

• Loss 8% body weight from time of disk surgery to 6 months post-op. Slender to begin with, now 5 feet 8 inches and 141 pounds.
• Continued dull ache on outside lateral aspect of left leg, buttock to knee.
• Left hamstring not fully releasing after extensive regular stretching
• Initially noticed sacro-coccygeal pain while taking yoga which includes sitting on blocks and holding various poses for 30 seconds
• 3 cortizone injections before disk surgery

OPINIONS BY OTHERS:

• Adhesions/scaring formed as a result of surgery and or epidural injections
• Abnormal sacrococcygeal (sacro-coccygeal) mobility due to sitting on blocks during yoga
• Nerve irritation causing inflammation of soft tissue
• Chronic inflammation of soft tissue attaching in the sacro-coccygeal area (levator ani, ligaments, etc) caused by one of the above factors
• This sacro-coccygeal syndrome tensions the dura around the sciatic nerve preventing hamstrings from being able to "stretch out" and is a key indicator of tailbone injury

Questions to Ponder:

• Pudendal nerve involvement?
• When bending forward to touch toes feels like 2 longitudinal bands on either side of sacral midline are pulling. Why not inject with lidocaine to confirm source? Would temporary relief, or lack of it, mean something?
• What's keeping hamstring from releasing and why does stretching irritate sciatic nerve (left buttock pain day after)?
• Is the sacro-coccygeal pain referred from a disc problem? MRIs look good and sacro-coccygeal pain is not a normal by-product of discectomy. What about the loss of weight and sitting on hard yoga blocks?
• What about a discogram? If it generates pain in the sacro-coccygeal area during procedure does this prove a diskogenic problem being referred?
• Since hanging upside down on inversion table causes immediate pain to sacro-coccygeal joint does this give a clue toward diskogenic problem or not?
• Is the 6 hour relief from local anesthetic during caudal block meaningful diagnostic information?

Updated 2002-05-05