Recovery from chronic pain after 1 visit to orthopaedic doctor

For more information on butt pain, see What is buttock pain?

Christie -

After 5 months with constant coccyx pain and trying different things and consulting a couple of doctors, I finally start feeling a LOT better after just one visit to a good orthopaedic doctor who also practices osteopathy.

Background on my pain: my pain was pretty sharp and I felt it mainly when sitting down and when getting up from a sitting position. It just started gradually and built up to pretty strong pain (I did not have fall - at least not that I could remember from the last several years). I had virtually no pain standing, walking or lying down - just when sitting down (only when pain flared up particularly strongly would I feel some pain even when walking, but a lot less strongly than when sitting down). Interestingly, my pain was particularly acute in the following 3 situations: (1) right after sitting down, for approximately 30-60 seconds (after this, it's almost as if the pain "adjusted" and became normalized while sitting down). (2) when standing up from a seated position: ouch! a sharp pain on my tailbone would flare up. It felt almost like a sort of shock. The pain would then linger for some minutes after getting up. (3) When sneezing while in a seated position: this was probably the most painful situation of all!! A sharp, shock-like pain on my tailbone.

Also as background, I am a healthy 29 year-old female with a healthy weight (57 kilos for a height of 1.66 meters) and I am not the type of person who gets back pain frequently at all. I have some lumbar scoliosis but it has never given me any problems. The type of job I do is mostly desk work.

Treatments (not successful): after a couple of months of having the pain I went to an orthopaedic doctor. At first I thought it would just go away but since it didn't, I went to the orthopaedic doctor. The doctor didn't do anything other than check if I had reflexes on my knees and check if I had proper sensation in my legs. He then noticed my scoliosis and immediately attributed my pain to my scoliosis. Also, I admitted that I had been going through a relatively inactive period in terms of physical exercise - other than some sporadic yoga sessions, I was not doing very regular exercise. I told the doctor that for the last several months I had done little physical activity and so he said that this plus my scoliosis where the causes of my pain. I was still left a bit perplexed that he did not examine my coccyx or even my lower back or sacrum area. He ordered me to take an X-ray just in case. I came back with the X-ray which showed I did not have any structural damage on the discs, etc.. He then ordered me to go to 15 sessions of physiotherapy. For the physiotherapy he prescribed: ultrasound treatment, massage, and exercise. My physiotherapist combined these three things in each session, though I did have ultrasound in each of the 15 sessions. At this point, I also tried to be more physically active to try to help alleviate the pain: I walked a lot more, I did abdominals very frequently, I did yoga and pilates a lot more frequently (pretty much every day!) and I also practiced at home all the exercises that my physiotherapist taught me.

Still, in spite of the physio sessions and increase physical activity, my pain was still there. The pain might have been relieved only a bit - but I am not sure it was the physiotherapy or if it was simply the yoga/pilates/and more walking I was doing. It simply went down from "it hurts quite a lot" to "it still hurts a lot." There was only one day that the pain really diminished and it was after the very first session of physio, when my pain sort of transferred to the cervical / thoracic area. But the next day, the pain reappeared on my coccyx.

After my physio sessions were over (expensive too!), I was very disappointed to still have the pain! I went soon after on a 3-week vacation. I thought that after 3 weeks of not working, and of basically not sitting in front of a computer, it would help to get rid of the pain. I walked all day long during my holiday and continued to do yoga, ab exercises and the exercises that my therapist had recommended - but I still had the pain on my coccyx! There were only 3 days when the pain mysteriously disappeared during the holiday and then it came back again - strange, I did not do anything differently those days.

I developed this constant feeling of tension on my buttocks as well, though a bit more on my left buttock.

I felt so demoralized about coming back to work and feeling the exact type and intensity of pain as I did before my summer holidays!

After my holidays, I decided to go see my general doctor (GP) to see if she had a recommendation on what I could do. I had been thinking as a next step to go to an osteopath and wanted to get her point of view on whether it was worth it (I had never been to an osteopath). I also wanted to see if she thought we had to rule out other type of illnesses that could be causing the pain which were not necessarily linked to the tailbone itself. I was shocked when all my GP said was that "it's been a very humid summer and when the heaters get switched on this fall, you'll feel better - trust me!" I just could not believe she was attributing my chronic coccyx pain to the humidity! She made no relevant questions, did not examine me at all and only when she noticed the concerned look on my face did she say that maybe "just in case, if it makes you feel better, I'll send you to get a cat scan to rule out a herniated disc." And she added: "even if it you have a herniated disc, the advice will be the same: continue doing exercise, and do more physiotherapy as the 15 sessions you did are not that many and, anyways, you will only start feeling the effects of the therapy and your increased exercise routine after several months". I felt very dubious about her conclusions. I also think that my pain could not just be caused by my deskwork activity and by stress / tension as she hinted. I was on a relaxed holiday for 3 weeks, sitting down very little and doing good exercise, and still no signs of the pain diminishing?

Successful treatment (at least for now!): after this rather demoralizing visit to my GP, I decided to look up for a good osteopath. I found one who is both an orthopaedic doctor who then later studied osteopathy. I thought this combination was the best as, where I live (Italy), you can be an osteopath but not necessarily have studied general medicine. My opinion is that someone who is a doctor, an orthopaedic specialist and an osteopath can probably have a good perspective on my type of pain.

This osteopath almost immediately deduced that my pain was due to a fall that occurred perhaps many years ago. I am pretty sure I have fallen at some point in my life as I child right on my bottom but it is difficult to remember the exact incident. He told me that one can start having pain problems from a trauma on the tailbone even after several years (decades even!) have passed since the incident.

He deduced my pain was due to a trauma because of two things he checked: he touched my coccyx (which the other doctors had not done) and noticed it had a very pronounced forward curve (significantly more curved than normal). He explained that one is usually not born with the tailbone like that, but that you have to have suffered from some trauma for your coccyx to be as curved as mine was. Secondly, he checked for mobility in the area that connects my sacrum to the pelvis (I don't know how to explain this exactly in English as he explained it to me in Italian, so I'll try my best) and noticed that I had very different mobility on the left side compared to the right side. My left side was ! basically "blocked," it showed almost no movement and flexibility, it was as he described "hard as concrete." My right side instead showed a lot more normal mobility. He also checked that when I was in lying face up position with my legs bent and he pulled my legs apart and asked me to move both of my legs towards each other, he could feel I pushed a lot stronger on my right leg (the one with normal mobility compared to the other one).

What he did: he did a few things. He applied pressure on my coccyx, not on the tip, but on the upper part of the coccyx. This was very painful indeed. He applied the pressure twice, holding for almost 1 minute.

The second thing is more difficult for me to explain. He made me lie down on one side, and he did a manipulation - sort of like pushing one side and pulling on the other. I am probably not explaining this correctly, so sorry for that - in this manipulation at one point he also pressed hard enough that it made me expel air from my lungs quite strongly. He did this twice. Then he also applied pressure to two points on my abdomen - this also hurt. He noticed I had a lot of tension on my abdominal area - due to all the muscle tension created by my "blocked" left lower back and the coccyx pain. In fact, one ! thing I noticed was that in these months when doing yoga or whenever I tried to breathe deeply, I had a really hard time getting a lot of air in deeply - my stomach would only raise very slightly when I tried to breathe in deeply - he told me that this was explained by all the tension I had in the abdominal area.

Results: after these movements, he made me sit down on the chair in his office. I already felt a LOT better! He told me that this was not going to be something that was going to be solved in just one sitting so asked me to come back in 1 month.

I wanted to see if the following day at work, I would feel the improvement as well. Incredibly, I felt almost no pain! Next day, still no signs of pain! My painless state has lasted for 1 week and half and only after 10 days or so, I have started to feel some tiny signs of pain. It is not the same, sharp, shock like pain, it's just like a weak, subtle general soreness of the tailbone area. I am also feeling a very subtle something on my left buttock, like a very weak, sciatica on my left leg. But I can still get up from a chair without that horrible sharp ! pain that would flare up my tailbone (I don't do faces anymore when I stand up!). When I sit down I do not feel that annoying pain either. Like I said, it's now more like a weaker and more generalized soreness in the area, but the pain is quite minimal. Yesterday I sneezed while sitting down, and I felt a bit of pain, but a LOT lot less than I did before. So I guess my problem is still not structurally solved 100% but I do feel that I have now found the right path to eliminate my pain. For now, I am quite optimistic that seeing the osteopath again in 3 weeks will get me closer to the elimination of my pain.

In the meantime, I am walking to and back from work every day (1 hour worth of walking a day) and doing yoga frequently plus some cardio exercise.

Time will see if this osteopath is able to cure my 100% from my tailbone pain. I will try to post another message after I see the osteopath a second time.

For now though, I am very happy to be able to resume activities like dining out, going to the movies, sitting in long office meetings - without the fear of the pain I will feel when standing up from the seated position, and the inevitable awkward expressions I have on my face when experiencing the pain, or the usually very slow movement I had to make when standing up to try to reduce a bit the shock-like pain - people noticed there was something wrong with me when I stood up, I would get up very slowly and when I could trying to bear more of the weight on my arms, if there was an armrest and on my legs.

Bottomline: nothing better than finding a good doctor that really understands this type of pain, who is a good listener and knows what he is doing!

Updated 2004-09-19

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