Treatment of chronic coccydynia by intrarectal manipulation

A randomized single-blinded study

Presented at the meeting of the International Society for the Study of the Lumbar Spine, May 2005, New York

Jean Yves Maigne, MD, Gilles Chatellier, MD, Marie Archambeaud, MD, Marie Novotny, MD


A 25% success rate of manipulation in chronic coccydynia was observed in an observational study. We designed a randomized single-blinded trial.


102 patients with CC were enrolled. Non-inclusion criteria were age <25, current depression, work injury, previous manual treatment. We recorded: gender, age, time from onset to enrollment, BMI, causative trauma within the month preceding onset. Patients were classified in either stable or unstable (luxation or hypermobility) coccyges, according to the results of stress radiographies.

The treatment group (M) received 3-4 sessions of intrarectal manipulation combining stretching of Levator ani and coccygeal mobilization. The control group (P) received 3-4 sessions of an external sacral shortwaves therapy at the lowest level, assumed to be a placebo. Assessments took place at 0, 1 and 6 months (these latter by an independent observer). We used 3 pain questionnaires (McGill, Dallas (modified) and Hotel-Dieu) and the Visual Analog Scale (VAS). A written consent was obtained. Study was approved by our ethical committee.

We used Chi-2 tests (categorical variables) and either T test or Kruskal-Wallis test as appropriate.


2 patients were lost for follow up, letting 50 in each group. At baseline, the 2 groups were similar regarding all items. At 1 month, the median values on various different pain scales were all statistically different between the 2 groups:

  Pain scale (probability value in brackets)
McGill (p=.03) Hotel-Dieu (p=.02) VAS (p=.09) Dallas (p=.02)
Treatment group 11.5 40.0 40.5 24.5
Control group 18.0 60.0 55 35

Good results were twice more frequent (borderline significance) in group M than in group P at one month (36% vs 20%, p=0.075), and at 6 months (22% vs 12%, p=0.18)

Main factors of good prognosis were: stable coccyx, shorter time from onset, presence of causative trauma, lower score at the psychological parts of the McGill and Dallas questionnaires and increased pelvic tone.


Intrarectal manipulation induces mild improvement of chronic coccydynia.

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