The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy. Issue 4 (24th August 2016)

• Record Type: Journal Article
• Authors: Scott, Kelly M.; Fisher, Lauren W.; Bernstein, Ira H.; Bradley, Michelle H.
• Is Part Of: PM&R. Volume 9:Issue 4(2017)
• Page Start: 367
• Page End: 376
• Publication Date: 2016-08-24
• Subjects: Medical rehabilitation -- Periodicals; Physical therapy -- Periodicals; Physical Therapy Modalities -- Periodicals; 615.5
• DOI: 10.1016/j.pmrj.2016.08.007
• Languages: English
• ISSNs: 1934-1482

Abstract

Abstract: Background: Coccydynia is a challenging disorder that often is refractory to treatments such as medications and injections. Physical therapy for coccydynia rarely has been studied. Objective: To evaluate the efficacy of pelvic floor physical therapy for reducing pain levels in patients with coccydynia. Design: Retrospective chart review. Setting: The pelvic floor rehabilitation clinic of a major university hospital. Patients: A total of 124 consecutive patients over age 18 with a chief complaint of coccydynia between 2009 and 2012. A subgroup of 17 of the 124 patients had previously undergone coccygectomy with continued pain postoperatively. Methods or Interventions: The primary treatment intervention was pelvic floor physical therapy aimed at pelvic floor muscle relaxation. Secondary treatment interventions included the prescription of baclofen for muscle relaxation (19% of patients), ganglion impar blocks (8%), or coccygeus trigger point injections (17%). Main Outcome Measures: Primary outcome measures included final minimum, average, and maximum pain numeric rating scales. A secondary outcome measure was the patient's subjective percent global improvement assessment. Baseline demographics were used to determine which pretreatment characteristics were correlated with treatment outcomes. Results: Of the 124 patients, 93 participated in pelvic floor physical therapy and were included in statistical analysis. For the 79 patients who completed treatment (with a mean of 9 physical therapy sessions), the mean average pain ratings decreased from 5.08 to 1.91 ( P < .001) and mean highest pain ratings decreased from 8.81 to 4.75 ( P < .001). The mean percent global improvement was 71.9%. Mean average pain ratings in postcoccygectomy patients improved from 6.64 to 3.27 ( P < .001). Greater initial pain scores and a history of previous injections were correlated with P < .001 pain scores on completion of physical therapy. Pain duration and history of trauma did not affect treatment outcomes. Conclusions: Pelvic floor physical therapy is a safe and effective method of treating coccydynia. Level of Evidence: III