Pelvic Floor Physical Therapy Conference for Tailbone Pain (Coccyx Pain)

I spent this past weekend in Tampa, Florida, at a conference on Tailbone Pain (Coccyx Pain) for Physical Therapists who specialize in treating pelvic floor disorders.

I was honored to give them a lecture on Tailbone Pain (coccydynia) from my physician perspective.

I was also honored to learn lots about how a pelvic floor physical therapists (pelvic floor P.T.s) approach patients who are suffering from tailbone pain and other pelvic pain syndromes.

Some patients have diffuse pelvic floor pain and dysfunction in addition to their tailbone pain, and a pelvic floor physical therapist can often be very helpful at providing relief for those patients.

To see a VIDEO of Dr. Foye discussing the conference, click here:
https://www.facebook.com/TailbonePainCenter/videos/10154710842002982/

 

Photos from the event:

PT Coccyx Conference 2017

Patrick Foye, M.D., (center) with Pelvic Floor Physical Therapists, at conference on Tailbone Pain (coccyx pain, coccydynia). Tampa, Florida. March 2017.

 

Patrick Foye, M.D., gave a Lecture on Tailbone Pain (Coccyx Pain), to Pelvic Floor Physical Therapists. Tampa, Florida. March 26, 2017. Photo courtesy of: @LilaAbbate

 

 

How Big is that Coccyx Mass, Cyst, Tumor, or Cancer?

  • Sometimes I find that my patients with tailbone pain (coccyx pain, coccydynia) actually have a mass, cyst, tumor, or cancer either within the tailbone itself or in the nearby tissues.
  • Examples can include pilonidal cyst, retro-rectal hamartoma (tailgut cyst), chordoma (a type of bone cancer that tends to happen at the coccyx and is often deadly), and abscess (a collection of pus or infected tissue).
  • Within an MRI report, or CT scan report, the radiologist who reads the images will typically report the size of any such abnormal structure in centimeters (cm).
  • Patients often see the centimeters listed and they will ask me, “Well, how big is that?”
  • (Since the United States has not adopted the metric system, many people here are not familiar with thinking about things in centimeter size.)
  • I recently came across a medical blog post (link below*) that gives examples of common foods, based on size (as measured by centimeters in diameter).
  • This is a great way to visualize how big your mass is, compared to foods that you are already familiar with.
How Big is that Coccyx Mass, Cyst, Tumor, or Cancer?
  • Pea = 1 cm
  • Grape = 2 cm
  • Walnut = 3.5 cm
  • Plum = 5 cm
  • Tennis ball = 6.5 cm
  • Orange = 6.6 cm
  • Baseball = 7.5 cm
  • Grapefruit = 10 cm
  • Cantaloupe = 12 cm
  • Honeydew melon = 16 cm

 

*Reference: http://www.fibroidsecondopinion.com/2013/04/what-size-are-my-fibroids/
That excellent blog post was mostly about the size of uterine fibroids, but the same reference measurements would  of course apply for coccyx-related masses.

Predicting doctoring… since 1972.

Wow! A shocker from my childhood…
  • My parents’ home bathroom recently had the wall tiles removed to install grab bars for their safety.
  • They called me to come see the insides of the walls, which were covered in cartoon sketches drawn by my siblings and I the last time the bathroom was renovated.
  • That was 45 years ago, when I was just 5 years old!
  • I immediately spotted my own handwriting, but was surprised to see what I had written… “Pat Foye was here 1972. When I grow up I want to be a doctor.”
  • It’s funny because my recollection was that I was mid-way through college when I first decided to become a doctor. There were no doctors in my family (my parents were farmers who immigrated to the USA).
  • But apparently my 5-year-old self knew my career path way back in 1972, and left myself a note to remind the mid-life me!
  • #Predictions.
Dr Patrick Foye M.D. circa 1972

“Pat Foye was here 1792. When I grow up I want to be a doctor.”

Dr Patrick Foye M.D. predicted his Doctor career

Patrick Foye, M.D., pointing to his wall doodlings from 45 years ago. 

Tailbone X-Rays (Coccyx X-Rays), NOT Lumbar

The Tailbone (Coccyx) is NOT the Same as the Lumbar Spine.
  • Practically every day, patients with tailbone pain come to see me from around the country or from around the world. Many have faced a similar  challenge regarding imaging studies.
  • Specifically, it is unfortunately VERY common that the patient has tailbone pain (coccyx pain, coccydynia), but the have a difficult time getting medical imaging studies such as basic x-rays (radiographs) of the tailbone.
  • There are unfortunately multiple reasons why the coccyx x-rays fail to be done:
    • The treating physician  may not know much about  tailbone pain, and if they would not know what kinds of x-rays to order or what kinds of abnormalities to screen for on those x-rays, then they do not know the benefit of ordering  and obtaining the x-rays in the 1st place.
    • The treating physician may not know much about treatment of tailbone pain, and how modern treatments are based upon taking the imaging results into consideration. If the treating physician incorrectly thinks that  x-rays will not make a difference, then they will be unlikely to order those x-rays.
    • The ordering physician may have absentmindedly “checked off” the order box that said “lumbar” or “lumbosacral” x-rays. Because pain in those areas is probably thousands of times more common than tailbone pain, the template forms probably do not even have a box to check off for coccyx x-rays.
    • Even if the ordering physician correctly orders tailbone x-rays, the radiology technician may be so familiar with doing lumbar x-rays (and rarely does any coccyx x-rays), that the technician is on autopilot-mode and when you come in with some pain in the low back or buttock area they just automatically do the lumbar or lumbosacral x-rays.
    • An insurance company or health care system may deny authorization for the x-rays, because they incorrectly believe that the x-rays are unlikely to have any impact on the patient’s subsequent treatment.
    • The insurance company or health care system may  incorrectly use authorization/denial criteria regarding the Lumbar spine, and inappropriately apply those lumbar criteria  to the coccyx region.
  • Every week here at the Tailbone Pain Center, new patients come to see me with similar stories, having suffered through the situations described above. While they are here, we review the prior images (x-rays, MRI, etc.) and we assess whether the studies did or did not give an appropriate evaluation of the coccyx. We also can obtain additional imaging studies, including x-rays done while the patient is sitting.
  • When the appropriate imaging studies are done, the majority of patients with tailbone pain will have an accurate diagnosis that appropriately  explains  the reason for their symptoms. The diagnosis then also provides a basis for a personalized treatment plan, that specifically treats the specific cause of the pain in that specific patient.

Video: How Tailbone Pain Causes Suffering: work, home, friends, doctors

SHARE this page / video with others so they can better understand tailbone pain.
  • Recently, someone online asked me to do a video explaining how people with tailbone pain (coccyx pain) often face challenges that are not understood or appreciated by coworkers, family, partners, friends, or even their treating physicians.
  • She wanted a video that she could publicly share with family, friends, and coworkers, so that they could better understand what she was going through.
  • The video is by Patrick Foye, M.D., Founder and Director of the Tailbone Pain Center (Coccyx Pain Center) at www.TailboneDoctor.com

Here is the video:

 

Cycling Pain Article Ignores Tailbone Pain, Coccyx Pain

  • In this video, Patrick Foye, M.D., gives his initial reactions to a medical journal article that covers the topic of Cycling and Low Back Pain.
  • Dr. Foye points out that the article completely ignores the issue of tailbone pain (coccyx pain, coccydynia) in cyclists.
  • Sitting on a bicycle seat, or saddle, can put direct pressure on the tailbone (coccyx), resulting in tailbone pain.
  • Click the image to see the video:

How to Distinguish between Sacral Tarlov Cyst Pain and Tailbone Pain

A few months ago I wrote about “Do Tarlov Cysts cause Pain?”

Today’s question is:

How to Distinguish between Sacral Tarlov Cyst Pain and Tailbone Pain

Usually it is not difficult to tell these conditions apart. Here’s how:

  1. Location: The location of a sacral Tarlov Cyst is more than a few inches ABOVE the location of the coccyx. An experienced physician should usually be able to tell the difference from a careful physical examination of the patient.
  2. Pressing on the tailbone: Coccyx pain can typically be reproduced by direct palpation (pressing) on to the coccyx, reproducing the patient’s typical symptoms. If the pain was coming from a sacral Tarlov cyst, then pressing on the coccyx would not reproduce the patient’s symptoms.
  3. Anesthetic injection at the tailbone: If a patient has a local anesthetic injection at the coccyx, and the initial anesthetic response gives relief of the patient’s symptoms for an hour or two (while the anesthetic is working), this would be consistent with the pain having been coming from the coccyx in the first place. (A local anesthetic at the coccyx would not be expected to in any way relieve pain/symptoms that were coming from a sacral Tarlov cyst.)

 

Favorable But Variable Responses to Tailbone Injections for Coccyx Pain

Re: Response to coccyx injections.
Hi, Folks.

Overall, the specific type of coccyx injection varies from patient to patient, along with differences in how the injection is performed based upon an individual patient’s anatomy and an individual patient’s diagnosis.

For example, regarding anatomy, a ganglion par block would be perform differently in someone who had joint fusion between the sacrum and coccyx versus how it would be done in someone who had joint fusion between the first and second bone of the coccyx, and it would be done differently again if they had fusion of the entire coccyx.

Also, depending on the patient’s diagnosis, the ganglion Impar injection may or may not also include steroid injection (anti-inflammatory) either at the ganglion Impar, at or around an abnormal joint, or at/around a distal coccyx bone spur, etc.

While the majority of patient’s respond favorably to an appropriately selected injection, I will be the first to admit that unfortunately no treatment for coccyx pain is guaranteed to provide relief for all patients. Many patients do well with each of the different forms of treatments, such as cushions, medications by mouth, local icing, various injections, pelvic floor physical therapy, surgical removal of the coccyx (coccygectomy), etc., but unfortunately there is no single treatment that helps everyone. There are unfortunately times where the pain continues to worsen despite treatments, and even instances where a given treatment many exacerbate symptoms.

Ideally, we would be able to predict which patient would respond best to which type of injections. Several years ago, I analyzed responses to hundreds of injections in hundreds of patients, to see what factors might best predict how a given individual would respond to various types of injections. We looked at factors such as each patient’s age, gender, weight (body mass index), acute versus chronic pain (I’ve seen some patients with coccyx pain that started just hours before they were sent to me, and other patients who have had coccyx pain for almost 50 years before seeing me), diagnosis (fractures, dislocations, dynamic instability, bone spurs, etc.), previously tried treatments, etc..

The general outcome was that most patients responded well to injections regardless of any of the various factors mentioned above. Patients with the shortest duration of symptoms tended to respond most favorably and tended to obtain the most complete and long-lasting/permanent resolution of symptoms. (Meanwhile, many patients with years/decades of pain can still get relief, just that their success rates at doing so is not as great as it is for those with a shorter duration of symptoms.)

Unfortunately, for every category of patients there were unfortunately some who failed to obtain adequate relief despite all of our best efforts at providing nonsurgical care. In general, those patients become potential candidates for surgical treatment (coccygectomy) if these symptoms are severe enough to warrant that. As we know, coccygectomy comes with its own potential complications after surgery, and although the majority of appropriately-selected patients do indeed obtain partial relief of coccydynia, (and even some who get complete or nearly complete relief), unfortunately most coccydynia patients still have some degree of coccyx pain despite surgery and there are some patients who get little or no relief despite undergoing the surgery.

I guess the take-home message is that it usually makes sense to use a stepwise approach, starting with the least invasive, nonsurgical approaches first (cushions, injections, etc.). Then only progress up the treatment ladder if a given treatment fails to give adequate relief. Of course each person’s response is different, but the paragraphs above summarize the types of responses that are usually seen both in my practice and from what is published in the peer-reviewed medical literature.

Medical care is continually advancing, so hopefully in the near future we will be better able to provide more complete relief for more and more patients. I am eager to do so and I give you all my commitment that I am working towards those goals, not just for my own patients but for people worldwide who suffer with this. So, while I find it gratifying to have been able to help so many over the years, it deeply concerns me that not everyone gets adequate relief and I continue to strive to find solutions/relief for those who are still seeking it.

-Patrick Foye​, M.D.

Sit-ups and Tailbone Pain (Coccyx Pain)

I recently posted a video and blog about exercise and tailbone pain, but I forgot to mention sit-ups!

Doing traditional-style sit-ups are usually very problematic and painful for people suffering from coccydynia (coccyx pain, tailbone pain).

So here is my follow-up video specifically discussing sit-ups and tailbone pain:

 

Exercise and Tailbone Pain (Coccyx Pain)

What exercises should you avoid or modify if you have tailbone pain (coccyx pain, coccydynia)?

You may want to maintain their fitness, health, body weight, and well-being, without exacerbating (flaring up) your tailbone pain.

This video gives many tips and tricks for ways that you can exercise without making your tailbone pain worse.

The video covers tailbone pain and bicycling (cycling, spin class), rowing (canoeing, kayaking, rowing machines), weight lifting, etc.

Here’s the video:

coccyx-pain-and-excercise-tailbone-pain-patrick-foye-md-screen-shot

Click the image to see the video.

Exercise and Tailbone Pain (Coccyx Pain)

 

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