Michael Durtnall - mail@sayerclinics.co.uk
(See personal experiences of Helen Buckthorp, Anonymous, Lee, Becky, Mel, Monica, Kim, Chris, Pauline, Adam Pymble, Debbie Dale, Vijay, Alan, Amanda, Nicole, Katy.)
Original posting, 2003-03-16:
As a chiropractor practising for twenty years in central London I have treated well over a hundred cases of coccygeal pain - many due to dislocation after a fall or during pregnancy or as referred pain from sacro-iliac or lumbo-sacral disc or facet joint lesions. I have been successful in every case to resolve all symptoms of pain and disability using manipulation treatment aimed at restoring function to joints which are locked or dislocated/subluxated whilst reducing mobility in hypermobile (loose or unstable) joints by core stability exercises and postural rehabilitation. Specifically, careful and skilled coccygeal manipulation is a crucial factor for good results.
Update, 2004-10-10:
Most of the above cases were of relatively recent onset - up to twelve weeks - and most responded rapidly to treatment. Since my listing on www.coccyx.org I have treated very many more people who have suffered coccyx pain of much longer duration (up to thirty years) and who have, in many cases, had multiple cortisone injections (up to fifteen injections in one case). I have reviewed these cases and have concluded that approximately 70% of these patients reported improvement of 75-100% in symptoms.
I suspect that cortisone injections damage the coccygeal joint cartilage thus accelerating calcification and fusion of the joint and thereby minimising any chance of regaining normal pain-free joint function, particularly when repeated many times. Of course it will usually reduce the pain temporarily but without having regained any improvement in joint mobility and or position. So, the longer the delay in manipulative treatment after onset of pain or injury and the more cortisone injections tend to make the condition more difficult to treat effectively.
Many patients bring their x-rays and MRI scans from referring GPs which is very helpful - but in several cases the MRI scans missed the lower sacrum and coccygeal joints completely. Many patients have been prescribed anti-depressants. Many patients have not had any examination of the actual area of pain.
In summary, when coccyx pain is of long duration and if coccygeal joints are completely fused, especially in extension (bent backwards) and more particularly if the person is thin (lacking padding), then the chances of improvement are reduced dramatically. In these cases the last option is surgical removal. But - here's a possibility - buttock implants for thin patients - it is performed for cosmetic reasons, so why not to reduce agonising pressure on a prominent, fused coccyx?
I have been consulted by email by many patients, osteopaths, physiotherapists and chiropractors from all over the world via www.coccyx.org and have done my best to explain treatment and techniques. I am certainly still learning and I only wish I could have helped more of those suffering this painful and demoralising condition.
Update, 2006-07-02:
Over the last two years I have been seeing a higher proportion of overweight, very sedentary, typically 'IT'/computer patients in their 30's to 60's with extended (bent backwards) and calcifying or osteoarthritic sacro-coccygeal joints. There has typically been no significant history of traumatic injury.
This is clearly shown on standing lateral coccyx x-rays which are VERY closely collimated (angled, narrowed down and lead shielded) to ABSOLUTELY MINIMISE the area of the x-ray and avoid pelvic organs, especially testes and ovaries. Of course even these x-rays are not taken if there is any chance of pregnancy.
Most patients had been refused x-ray or MRI evaluation in NHS hospitals from all parts of the UK where standard x-rays ( without extreme collimation) of the entire pelvis would have had to routinely be taken.
I have concluded that most of these cases have been caused by long-term leaning back and slumping in bad car, office, and home seating at the computer or TV which, with the pelvis slid-forward against the leading edge of what Homer Simpson calls 'an arsegroove', over time, produces a depression in the middle of the seat cushioning with a frontal ridge against which the coccyx is pressed backwards, gradually over months and years, into extension.
The higher the person's BMI (BODY MASS INDEX) or more overweight they are, the greater this pressure on the coccyx.
I treat but also IMPORTANTLY help my patients to ensure their employer gets them a Swedish HAG Credo or HO4 chair WITH neckrest... (these chairs are fantastic but expensive)... which allows the chair to recline RIGHT BACK at a dramatic angle with a supporting neckrest for surfing the net, phoning and talking , BUT can then tilt far forward with the feet tucked under the chair & thighs tilted down at 25 degrees & 'back straight' to work on the keyboard... which takes all pressure off the coccyx and gives good working posture with no neck strain! I love them...all my clinic staff and family have had them over the last 20 years. Find a HAG chair supplier and try them out as I have described.
When these coccydynia patients have been previously assessed or treated medically, in my opinion, they have generally been misdiagnosed with the assumption that it is the more distal, flexed and supposedly hypermobile coccygeal joints which are the cause of the chronic and often extreme pain.
Mobilisation at the correct level, patient exercises which I have developed, medical acupuncture to acutely focus the healing process and correct seating brings good and rapid resolution in most cases. Acupuncture around the joint is designed to OVERWHELM the relevant brain area linked to the chronic coccyx pain and which has typically become hypersensitive and which is easily triggered by emotional upset and stress and which potentiates the onset and perception of acute pain.
There are some cases when it is too late and where the joint cannot be mobilised sufficiently to improve symptoms.
I have received many more requests for help and advice from coccydynia sufferers, osteopaths, physiotherapists doctors and chiropractors from all over the world thanks to www.coccyx.org and have done my best to liase,train and explain my evolving treatment techniques and protocols.
This research and continuing re-evaluation of treatment protocols has been extremely useful in improving results in patient pain reduction and improved function in my practice. I have been heartened by positive reports via email from chiropractors and therapists around the world who are learning from my experience.
My advice is :-
Update, 2007-05-27:
In April 2007 we installed and have seen the benefit of using the new Fuji Computed Digital x-ray system at Sayer Clinic, Kensington for very high quality x-ray imaging of the spine, pelvic and coccyx joints. We can now manipulate and magnify the images and more precisely show the coccyx sufferer the position and condition of the joints, make a clearer diagnosis and better explain the likely timescale for improvement of symptoms.
I have been seeing more sedentary, computer/IT patients suffering coccyx pain than ever and usually with associated postural problems affecting the whole spine.
More and more patients from all over the world are flying in to see me in London UK for a course of treatment, or booking to see me at the Saad Specialist Hospital (SSH) in Al Khobar, Saudi Arabia where I am a visiting Consultant for a week each month.
Please email mail@sayerclinics.co.uk for booking details for Saudi Arabia.
Dr Michael Durtnall
Chiropractor
Chairman : Sayer Clinics, www.sayerclinics.com