Coccydynia And Low Back Pain

Back pain due to coccydynia can be quite miserable – just ask anyone who has ever developed it after a fall on a slippery floor, a skid on the ice, or a bumpy landing while skiing or snowboarding.

Coccydynia is pain in the coccyx, or tailbone, the boney area at the end of the spine between the buttocks. Sometimes referred to in layman’s terms as a ‘butt ache’, it is a nagging pain, which can become excruciating, and increase with pressure from sitting or moving to stand up. It has been described as a pain similar to sitting on a sharp knife or a marble that rolls around or a feeling of being impaled on a cane or broomstick. The pain and discomfort may persist for months to eventually become chronic.

Causes
Falls On The Buttocks.
• This is the most common cause, often diagnosed as a fractured coccyx.

Unstable or Dislocating Coccyx
• The most common cause of pain is due to a coccyx which dislocates or moves more than normal when you sit down. This may develope after a fall, from childbirth or injury in a car accident. The actual cause is often unknown but this disorder is responsible for 55% of cases of coccyx pain.

Childbirth
• If the joints around the pelvis become more flexible in preparation for childbirth, sometimes the coccyx can be pushed out of position easily.

Repetitive Strain
• This is common after a great deal of rowing or bicycle riding

Misaligned Or Long Coccyx
• In this condition, the coccyx bone points forward or is angled forward about 70°, which is greater than normal and causes pain.

Boney Spur Or Spicule On Coccyx
• This has been the cause of pain in 14% of patients.

Muscle Spasms In The Gluteus Maximus Muscle Of The Buttocks
• These muscles help lower the body from a standing to a sitting position. Muscle spasms cause pressure where the glutueus is attached to the coccyx.

Piriformis Syndrome
• The piriformis muscle runs horizontally from the lower spine to the top of each femur (hip bone). It crosses the sciatic nerve and spasms in the muscle cause pain in the hips and down the leg. Sitting may aggravate it.

Pilonidal Cyst
• This is a birth defect in which an abscess develops at the end of the tailbone, causing pressure, swelling, inflammation, and pain in the coccyx area. The cyst is usually removed surgically.

Symptoms Of Coccydynia
• Pain during or after sitting
• Acute pain when moving to standing after sitting
• Deep ache around coccyx
• Shooting pains down both legs
• Pain during bowel movements
• Pain during intercourse
• Pain during menstruation

Coccydnia may clear up after a few months but in the case of persistent pain, it is wise to have a medical evaluation to determine the cause.

About the Author

Paul G Miller is a South Miami spinal decompression therapist who has worked with individuals with back pain problems for seven years.
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Latest Research on Elevator Shoe Lifts

The following articles report on research completed, in whole or in part, under a grant from ACFAOM. Thanks to all those whose voluntary contributions to ACFAOM’s Research Fund make such grants possible. Comparing Negative Casting Techniques: Foam versus Plaster of Paris Richard Berenter, DPM, FACFAOM Introduction: This study was undertaken to determine whether there was any difference in the clinical outcomes related to the type of negative casting technique utilized in the manufacture of functional foot orthoses. Those practitioners who favor foam casting blocks argue that the technique is cleaner, faster, more cost effective and just as reliable a method to produce functional foot orthoses versus the plaster of Paris technique. On the other hand, a number of practitioners have argued that the foam block technique is inferior because the foam is incapable of capturing the shape of the foot with the subtalar joint in neutral position and the midtarsal joint maximally pronated thereby leading to an inferior foot orthosis, which will be less effective at reducing patient symptoms. Materials and Methods: A total of 38 patients were enrolled in the study. All of the patients presented with lower extremity symptoms associated with abnormal lower extremity function as determined by gait evaluation. At the time of the initial visit, each patient signed a consent form and completed the top portion of the data sheet which included both personal information and the amount of pain in each extremity (patients were asked to circle the amount of pain on a scale from 0-10 with 0 being no pain and 10 being the worse pain ever felt). Upon completion of all paper work, both feet of each patient were casted via the semi-weight bearing foam block technique and by the non-weight bearing supine plaster of Paris method. Both sets of casts were sent to a professional orthotic laboratory with a prescription filled out for an orthotic shell with a medium amount of arch fill, average heel cup depth, normal orthotic width (to the lateral border of the 5th metatarsal and bisection of the 1st metatarsal shaft) and a thickness of polypropylene which would behave in a semi-rigid behavior for the patient’s stated weight. A laboratory technician was instructed to randomly select one of the two pairs of negative casts and keep track of which casts were used without the knowledge of the principal investigator. In this way, a double blind study was established since neither the principal investigator nor the patient knew which casts were used to construct the foot orthotics. Approximately 2-3 weeks following casting, the patient was dispensed a pair of functional foot orthoses and asked to walk around for a minimum of 10 minutes to gauge the comfort level of the orthotics. Each participant was asked to use one of 4 descriptive terms (very comfortable, comfortable, slightly uncomfortable or very uncomfortable) to describe the comfort level of 5 different regions on each foot orthosis corresponding to the heel region, medial arch, lateral arch, middle of the orthosis and distal edge. Patients were then sent home with standardized break-in instructions for the functional foot orthoses and returned to the clinic at intervals of 2 weeks and 4 weeks post-orthotic dispensal. At each follow-up visit, patients were asked to fill out a data sheet gauging the level of symptoms and comfort level of the orthoses. The data was then compiled and saved in a spread sheet format and upon completion of the study, the laboratory technician was contacted in order to identify which patients belonged to which study group, the foam box or plaster of Paris casting technique. Results: The data was compiled and the two study groups separated by casting technique. An independent investigator (non-podiatrist) was contacted and asked to analyze the data to answer the following questions: 1. Does the negative casting technique (foam vs. plaster) make a difference in the ability of the orthotic device to reduce symptoms? 2. Does the negative casting technique (foam vs. plaster) make a difference in how comfortable the orthotic device feels to the patient? The data was analyzed in a variety of methods such as the mean reduction of pain, Fischer exact test and Chi-square with T-tests. A simple comparison of the average reduction of pain after four weeks of orthotic therapy indicates that the plaster of Paris orthoses achieved a mean decrease of 82.43% of pain versus 61.14% reduction in pain with foam box cast orthoses, with a level of significance p

About the Author

Chris Maylor is the owner and operator of Serendipity Shoe Lifts at http://www.TallTall.com

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