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M. Bowman1, K. Smith1, S. Anderson1, R. Clay1, A. Collins1, A. Yates1
1Tennessee State University, Physical Therapy, Nashville, United States
Background: Female patients with coccydynia often complain of pain in the coccyx with prolonged sitting, defecation, and sexual intercourse which often has a negative impact in their quality of life. Traditional therapies include invasive interventions such as coccygectomy and pain injections. There is a need for conservative treatments that restore musculoskeletal, neuromuscular, and muscular performance to alleviate deficits and restore normal pelvic floor and pelvic girdle function for the treatment of coccydynia and prevention of recurrence.
Purpose: The purpose of this review is to evaluate the available literature related to the effectiveness of pelvic physical therapy when compared with pharmacological and surgical interventions to alleviate coccydynia.
Methods: Peer-reviewed journal articles of traditional, conservative, and pelvic physical therapy approaches to coccydynia were sourced via online searches of keywords that were systematically obtained, reviewed, and data extracted independently by five reviewers. One final reviewer applied an analysis of the process and data retrieved. The following search engines were utilized: EBSCO, CINAHL Complete, Pub Med, Science Direct, PLOS ONE, Academic OneFile, and the Cochrane Library. Sackett's Levels of Evidence were used to classify the strength of the literature reported.
Results: Thirty-two articles met inclusion criteria and were reviewed. Three systematic reviews, eight randomized control trials, three cohort studies, eight case-controlled studies, three literature reviews, and four case studies were reviewed. Five studies specifically addressed surgical approaches. Seven studies addressed pharmacological approaches, two studies compared pelvic floor physical therapy to other approaches, five studies addressed various interventions and related outcomes.
Conclusion(s): The current literature demonstrates that the benefits of pelvic physical therapy provide effective, conservative treatment and management of coccydynia. While the surgical intervention was found to have the highest percentage improvement in pain, there was not a significant difference between surgery and physical therapy. Regarding the average percent of pain improvement, surgical intervention was found to be the most successful (65.94%) followed by physical therapy interventions (57.99%) and pharmacological (44.59%).
Implications: Physical therapy is a viable treatment option that eliminates the potential risks and adverse effects associated with invasive procedures. Physical therapy should be considered as the primary conservative treatment option of choice. Physical therapy interventions that have been found effective include joint mobilizations, stretching, soft tissue mobilization such as massage, postural adjustments, coccygeal cushions, muscle energy techniques, and therapeutic exercise.
Funding, acknowledgements: No funding sources.
Keywords: coccyx pain, physiotherapy, treatment
Topic: Pelvic, sexual and reproductive health
Did this work require ethics approval? No
Institution: Tennessee State University
Committee: Tennessee State University Research Committee
Reason: systematic review
All authors, affiliations and abstracts have been published as submitted.
