Comments from Dr. Brian Chan about treatment of coccydynia

My name is Dr. Brian Chan, a Chiropractic Physician in the Seattle, Washington area. I wanted to share with you my recent successful treatment of a patient that had coccyx pain after slipping down the stairs.

On January 8, a patient presented to my clinic with reports of coccyx pain after slipping on the stairs and falling onto her buttocks on January 4. She noted that crouching, sneezing, crawling, sitting, all caused pain. She explained the pain felt like a pulling sensation or pinched nerve in her tailbone. She rated the pain at 8 out of 10.

I decided to obtain X-rays of her coccyx, which indicated that she had a subluxated (malaligned) coccyx. Exam findings also found that she had pain when changing positions (standing/crouching). Pelvic floor contractions also caused increased pain. Palpation of her coccyx was painful. Motion palpation of the coccyx was also extremely painful. Myofascial tender points were found immediately lateral to the coccyx on both sides.

I diagnosed this patient with a posteriorly subluxated coccyx with concurrent sprain/strain of the coccyx. Originally, I had thought the coccyx would be fixated in a flexed (anterior) position. However, the X-rays showed that she likely fell on the sacro-coccygeal joint and somehow caused the coccyx to fixate posteriorly.

I treated this patient 2 times a week for the next 4 weeks using chiropractic care. I used ice therapy pre and post treatment to help with swelling and to numb the area of treatment. I used trigger point therapy to help with myofascial release. Initially, this was very painful for the patient. Following trigger point therapy, I used external traction and pressure to encourage the coccyx anteriorly. I used the assistance of the chiropractic table (drop piece).

After the first treatment, she reported an increase in soreness, which was expected.

On her next visit, I taught her the use of Kegal exercises (pelvic contraction) and encouraged the use of a towel roll to further encourage proper positioning. I used the above treatment again.

On the next visit, the patient reported that she was pain-free following my treatment for the rest of that day, until the next morning, when the pain returned. During today's treatment, I felt that coccyx was still quite fixated. So I explained the internal gloved technique to the patient. Following normal office procedure, she expressed and signed a consent form. An office assistant was present during this procedure.

On the next visit, she expressed that the pain was decreasing, and she was able to perform more activities. However, she still had pain. Internal gloved technique was performed a 2nd time to the coccyx.

On the next visit, she reported a decrease in overall pain. However, she still had pain going to the bathroom and when performing her Kegal exercises. I treated her using the external traction technique.

Over the next 2 weeks, I continued to see her 2 times a week using the trigger point therapy and external technique, with the pain decreasing. After a total of 8 visits, she only had minimal pain remaining. I treated this patient for another 4 visits, reducing her visits to 1x a week, with an emphasis on home exercise. On her last visit, she reported being pain-free without any symptoms. She was able to sit, go up and down stairs, crouch, etc without any problems.

In summary, I treated this patient for a total of 12 visits, over a period of 2 months. In her situation, the pain completely resolved.

Brian Chan, DC, Chiropractic Physician.

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