2023-06-25 08:40:34
by Antonella Sparvoli
Coccygodynia is an inflammation often linked to ligament laxity. Among other causes, obesity and trauma. Women are affected five times more than men
About 1 percent of spine pain consultations are for coccyx pain, or coccygodynia, which mostly affects people in their 40s and 60s with a predilection for women.
What is coccydynia?
It is a symptom that depends on an inflammation of the osteo-ligamentous region of the coccyx – premised Marco Minetto, associate professor in physical and rehabilitation medicine at the University of Turin at the Molinette Hospital -. The female sex affected five times more than the male one, thanks to the greater posterior prominence of the coccyx compared to the man. Other factors that can contribute are also birth trauma and hormonal changes of pregnancy. These involve greater joint and ligament laxity of the structures that have to welcome the baby and “expel” him at the end of the nine months of waiting, so it can sometimes happen that after the birth a certain sacrococcygeal instability remains.
Are there other predisposing factors?
Visceral obesity, with the increase in the waistline, modifies posture, exposing the lumbosacral spine and the coccyx more to chronic biomechanical overload. Coccyx pain can also be favored by the classic fall on the bottom or by repeated microtraumas, as can happen in those who practice particular sports, for example cycling and rowing due to the continuous contact with a hard surface, or in those who sit for many hours a day, perhaps in an uncomfortable chair. Coccyx pain can sometimes also occur after surgery in which the patient has been immobile for several hours in a supine position with legs apart. In rare cases, coccygodynia can finally be the result of oncological problems, such as an intraosseous lipoma or skeletal metastases.
How is it diagnosed?
The diagnosis of coccygodynia is based on symptoms, i.e. very localized pain below the sacrum and above the anus, increased by palpation and postural changes, typically from sitting to standing. Sometimes the pain can also occur following the effort of defecation and during sexual intercourse. Diagnostic confirmation from a radiological point of view is obtained by resorting to the so-called dynamic radiography in lateral projection – Minetto specifies -: one radiography with the patient standing and another in a sitting position, always sideways. In this way it is possible to highlight signs of instability of the coccyx due to which, when the patient sits down, the coccyx moves. Magnetic resonance is another investigation that allows you to see the coccyx very well as well as the whole rachis, and is therefore especially useful for excluding other pathologies of the spine.
How can it be cured?
In the acute phase, the use of oral anti-inflammatory drugs is indicated. Furthermore, to reduce the pain when sitting down, donut or wedge cushions can be used which minimize postural micro-trauma. In general, the pain resolves within three months, but one in five patients relapses within a year, especially if no action is taken on the predisposing factors, replies the expert.
In some cases, if the pain is particularly insidious, it is possible to resort to infiltrations with cortisone in the coccyx area or to focused shock waves which favor an increase in the vascularisation of the district with very good results. Manual therapy can also be of great help. This can be done in the traditional way through vertebral micromanipulations and of the sacrococcygeal region which have the effect of restoring the postural structure and decontracting the paravertebral muscles.
In the event that the coccyx is subluxated, therefore displaced from the optimal position, intrarectal invasive manual therapy can also be considered, which mechanically stimulates a repositioning of the coccyx. Finally, in the presence of a hypermobile coccyx that tends to subluxate, stretching and strengthening exercises are recommended for the last part of the spine. The use of surgical removal therapy, partial or complete, of the coccyx is indicated only in extreme cases.
June 25, 2023 (change June 25, 2023 | 08:36)
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