Pelvic Pain Lecture by Stephanie Stamas, Pelvic Floor Physical Therapist in NYC

I attended a fantastic lecture on Pelvic Pain this week in NYC by pelvic floor physical therapist Stephanie Stamas, PT, DPT, at Beyond Basics Physical Therapy in NYC.

They have upcoming lectures on related topics over the next few weeks.

I definitely recommend attending these if you are in the NYC area and interested in P.T. insights and treatments for issues in the pelvic, bladder, bowel, genital regions.

Stephanie Stamas PT with Patrick Foye MD, after her Pelvic Pain lecture, 3-19-18

Stephanie Stamas PT with Patrick Foye MD, after her Pelvic Pain lecture, 3-19-18

Stephanie Stamas PT, Title Slide from her Pelvic Pain lecture, 3-19-18

Stephanie Stamas PT, Title Slide from her Pelvic Pain lecture, 3-19-18

Pelvic Health 101, Lectures for 2019, Beyond Basics Physical Therapy, NYC

Pelvic Health 101, Lectures for 2019, Beyond Basics Physical Therapy, NYC


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Infection Rates after Coccygectomy, per Published Medical Research

Here is an excerpt from Dr. Foye’s book, Tailbone Pain Relief Now!

Chapter 25: Coccygectomy: Surgical Removal of the Tailbone.  Page 197:

“Published research by Dr. Wood (at Harvard Medical School) documented that after coccygectomy as high as 35 percent of patients have postoperative complications including wound problems (infection or persistent drainage). Meanwhile, Dr. Doursounian’s research team in Europe showed that 15 percent of coccygectomy patients required repeat surgery due to infection at the coccygectomy site. That means that more than approximately one out of every six patients requires a repeat surgery due to infection. This is an extremely high complication rate compared with most other elective surgeries.”

  • The publication by Dr. Wood at Harvard was: Journal of Spinal Disorders & Techniques. 17(6):511-515, Dec 2004.
  • The publication by Dr. Doursounian was: Coccygectomy for instability of the coccyx. Doursounian L, Maigne JY, Faure F, Chatellier G.Int Orthop. 2004 Jun; 28(3):176-9.
Infection after Coccygectomy, Quoting Dr Foye's book, Tailbone Pain Relief Now

Infection after Coccygectomy, Quoting Dr Foye’s book, Tailbone Pain Relief Now!

Note: There are many studies, some with higher or lower rates of success (relief of pain) and some with higher or lower rates of of infection and rates of repeat surgery being needed. This particular online article is not meant to be a list of every study ever published on infection after coccygectomy. Instead, it is explaining the published statistics that Dr. Foye was referring to in that chapter of his book.


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

 

Tailbone Pott's Disease: Coccyx Tuberculosis

What is Pott’s disease, or Pott disease?
  • Pott’s disease is a condition where tuberculosis infection occurs within the spinal vertebral bones.
  • “Pott’s disease” is also called “Pott disease.”
  • Tuberculosis is commonly called “TB.”
Tuberculosis infection usually involves the lungs.
  • Pott’s disease is different because the infection is within the vertebral bones of the spine.
Which spinal vertebral bones are usually infected in Pott’s Disease? 
  • In patients with Pott’s disease, usually the vertebral bodies infected with tuberculosis are the vertebral bones closest to the lungs, which are the vertebral bones of the thoracic spine. (These are the thoracic vertebral bodies.)
  • However, other locations in the spine may also be affected. In rare cases, this may include tuberculosis of the coccyx (tailbone).
Below is an excerpt from Chapter 14 of the book Tailbone Pain Relief Now!
INFECTION Causing Tailbone Pain, Chapter 14 in Dr. Foye's coccyx book

Infection Causing Tailbone Pain, Chapter 14 in Dr. Foye’s coccyx book

Tuberculosis (TB) Infection Causing Tailbone Pain

Tuberculosis (commonly referred to as TB) is a bacterial infection that typically involves the lungs. TB is more common in parts of Asia and Africa, as well as within certain populations in the United States, such as among prisoners.

Although TB typically starts as a lung infection, it can spread to the bones of the vertebral spine (called Pott’s disease). The vertebral bones most commonly infected are those of the thoracic spine, which are the spinal bones closest to the lungs. However, TB can instead spread to the spinal bones of the sacrum and coccyx.

Suspect possible TB infection of the coccyx region if you have a history of the following:

  • pulmonary (lung) TB infection,
  • a positive skin test (PPD test) for TB,
  • travel to areas where TB is common, or
  • an underlying condition that causes decreased ability of the immune system to fight infections.

The tuberculosis bacteria are often resistant to many antibiotics and thus treatment often requires giving multiple antibiotics to thepatient at the same time.

Here are some medical journal articles about Tuberculosis (TB) Infection Causing Tailbone Pain
  • Kim, Do Un et al. “Isolated coccygeal tuberculosis” Journal of Korean Neurosurgical Society vol. 52,5 (2012): 495-7.
  • Isolated Coccygeal Tuberculosis, 2012 article in the Journal of Korean Neurosurgical Society

    Isolated Coccygeal Tuberculosis, 2012 article in the Journal of Korean Neurosurgical Society

  • Osman, Walid et al. “A Rare Case of Tuberculosis with Sacrococcygeal Involvement Miming a Neoplasm” Case reports in orthopedics vol. 2016 (2016): 7286806.
  • Tuberculosis with Sacrococcygeal Involvement Miming a Neoplasm, 2016 article in Case Reports in Orthopedics

    Tuberculosis with Sacrococcygeal Involvement Miming a Neoplasm, 2016 article in Case Reports in Orthopedics

     

Other TB thoughts from Dr. Foye:
  • Lytic lesions: In the published medical literature, tuberculosis of the coccyx tends to be associated with “lytic” (destructive) appearance on imaging studies.
  • A clinical impression of tuberculosis of the coccyx would usually be based upon a history of tuberculosis (or at least tuberculosis exposure), increased likelihood if there are imaging findings suggesting tuberculosis within other areas of the spine (although, rarely, the spinal tuberculosis might occur only at the coccyx in a more isolated way), failure to respond to typical treatments for coccydynia.
  • Definitive diagnosis would usually require having a surgeon (or perhaps an infectious disease doctor, or interventional radiologists, or interventional musculoskeletal physician) place a needle into the site and obtain whatever fluid or tissue sample can be obtained, and then send that for special testing for tuberculosis. (This could include special cultures to look for acid fast bacilli, or even polymerase chain reaction [PCR] testing for Mycobacterium tuberculosis, etc.)
  • Sputum tests: theoretically a positive sputum test would confirm TB in the lungs and thus make it more likely that a spine lesion might also be TB (and, conversely, a negative sputum test for TB would suggest that there is not TB in the lungs, and thus making it less likely that a spine lesion is from TB). Still, those would be about determining how likely or unlikely it is that there is spine/coccyx TB. Meanwhile, “definitive” diagnosis of a spine lesion is due to TB would generally require obtaining a sample from the coccyx.
  • Coccygectomy testing for TB: in cases where the patient undergoes coccygectomy (surgical removal of the coccyx, tailbone), the coccyx and any other tissue removed can be sent to tthe pathology department for analysis. The surgeon would need to make a special order for the pathology department to test the tissue for tuberculosis (special cultures, etc., that are not routinely done if they are not specifically requested). While some people may think that such testing would be pointless since the coccyx would have been surgically removed anyway, I would beg to differ and say that if there was any question about tuberculosis at the coccygectomy site then it would typically be extremely helpful to know conclusively whether there was or was not tuberculosis there, since this could help the treating physicians and patient to figure out whether or not the patient should be given a course of medications to treat tuberculosis.

GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

 

Tailbone Anatomy and Imaging Questions-Answers on Facebook Live, with Jason Woon PhD and Patrick Foye MD, on Tailbone Pain, Coccyx Pain

Tailbone Anatomy and Imaging Questions-Answers on Facebook Live, with Jason Woon PhD and Patrick Foye MD, on Tailbone Pain, Coccyx Pain

On February 21, 2019, there was a Live Question-and-Answer session for more than an hour on the Tailbone Pain Center’s Facebook page.

People from around the world asked questions about coccyx pain (tailbone pain, coccydynia), including tailbone anatomy and coccyx imaging studies.

 The questions were answered by Dr. Woon and Dr. Foye.
  • Jason TK Woon, PhD, is from New Zealand, where he was published research on coccyx anatomy and imaging studies.
  • Patrick Foye, M.D., is Director of the Coccyx Pain Center (Tailbone Pain Center) in the United States.
Here is the video:

Or use this Link: https://www.youtube.com/watch?v=jQQSQPOayP8

Here is the screen-capture image from the video:
Jason Woon PhD and Patrick Foye MD, answering coccyx questions on Facebook Live, Feb-2019

Jason Woon PhD and Patrick Foye MD, answering coccyx questions on Facebook Live, Feb-2019


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Dr. Jason T.K. Woon PhD, MBChB, International Lecturer, Anatomy of the Coccyx and Implications on Reading a Standard X-ray

Please join the NJ Society of PM&R for a special event this Wednesday, February 20, 2019, at 6pm.

The special guest speaker from New Zealand will be Dr. Jason T.K. Woon PhD, MBChB.

Dr. Woon is an internationally known lecturer on the topic of coccyx anatomy and coccyx imaging studies. 

Dr. Woon will review the topic: “Anatomy of the coccyx and implications on reading a standard X-ray.”

Jason TK Woon, PhD

Jason TK Woon, PhD

Location:
Tailbone Pain Center,
90 Bergen Street, DOC Suite 3300 conference room,
Rutgers New Jersey Medical School,
Newark, NJ 07103

Free Lecture on Coccyx Anatomy, Jason TK Woon, PhD

Free Lecture on Coccyx Anatomy, Jason TK Woon, PhD

FREE Book on Tailbone Pain: 1-day only, New Year's Day 2019

  • FREE Book on Tailbone Pain: 1-day only, New Year’s Day 2019.
  • Go to Amazon. Get the eBook version (electronic version) for Free.
  • You do NOT need to have a Kindle.
  • You do NOT need to sign up for “Kindle Unlimited” (although Amazon tries to offer you that option).
  • Video explaining this:

Or use this link to the video: https://youtu.be/RN5X3w1PXA4

Screenshot from the video:

Free eBook for New Year's Day 2019, Tailbone Pain Relief Now, Coccyx Book

Free eBook for New Year’s Day 2019, Tailbone Pain Relief Now, Coccyx Book


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Can you Ride a Bicycle if you have Coccyx Pain, Tailbone Pain?

The 4 main factors for using a bicycle despite tailbone pain would be:
1) a coccyx cut out, so that the coccyx is not directly hitting into the bike seat.
2) a wider-than-usual bike seat, so that more of the body weight is on the other sit bones (on the ischial bones) rather than on the coccyx.
3) consider wearing cycling pants, which have padding over the coccyx/buttocks.
4) stay up on your feet, instead of sitting down on your coccyx/buttocks: If you are doing a spin class where you can be essentially standing up on the pedals while you are peddling, rather than having your coccyx/buttock onto the seat, that would be far less likely to exacerbate the tailbone pain.
Best brands and where to buy your bike seat:
Risk of flare-ups, exacerbations:
  • Even with making these modifications/adjustments, there is always the possibility that cycling will cause the tailbone pain to worsen or return in patients who have coccyx problems.

GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Periosteum of the Coccyx: Tailbone Periosteal Layer and Coccygectomy.

Periosteum of the Coccyx: Tailbone Periosteal Layer and Coccygectomy.

Recently I have received a lot of questions about the periosteum and whether  the periosteum  should be left in place when ppatient undergoes a coccygectomy (surgery to amputate  or removed the coccyx, or tailbone).

What is the periosteum?
  • The periosteum is a very thin layer of fibrous tissue that surrounds almost every bone throughout the body.
  • This periosteal layer is important for bone growth and bone healing.
Plastic food wrap comparison:
  • Plastic wrap is also called, shrink wrap, cling wrap, food wrap, plastic film, Saran wrap, etc.
  • The thin layer of periosteum is essentially like a thin wrapping around the length of each bone.
  • Imagine if you have a pencil and you were to wrap it with a layer or two of plastic food wrap. Your pencil would be the bone and the plastic food wrap would represent the layer of periosteum that surrounds the bone.
How thick is the periosteum?
  • The periosteum is very very thin.
  • 100 μm thin! That’s 100 microns.
    • “Total periosteal thickness is approximately 100 μm” for both the femur (thigh bone) and tibia (shin bone). (Source:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969058/ )
  • What is a micron?
  • A micron is also known as a micrometre or micrometer. A micron is represented by the symbol μm.
  • (Also, note that this 100 micron measurement is for the periosteum of the thigh bone, which is the largest bone in the body. The bones of the coccyx are much smaller than that, so the periosteal layer at the coccyx is probably even thinner than what we see at the thigh.)
How thin is 100 μm?
  • 100 μm = 0.004 inches. So, the periosteal thickness is 4 thousandths of an inch.
  • Ruler comparison:
    • One way to think of this is to look at a ruler.
    • Your ruler will typically show 10 short increments to make up one inch. So, the distance between each of those small increments is 1/10 of an inch, which can also be written as 0.1 inches.
    • Now imagine if each of those small increments were to be further broken down into 10 even-smaller increments. Those even-smaller increments would each be 0.01 inches.
    • Then if you took that even-smaller-increment of 0.01 inches and split it in half, you would get 0.005 inches. And the periosteum is thinner than that.
  • As thin as a hair: Another way to think about the periosteal thickness is to compare it to a common everyday item such as human hair.
    • The thickness of a human hair is also around 100 microns. (Source: https://en.wikipedia.org/wiki/Hair%27s_breadth)
    • As noted above, 100 microns is also the thickness of the periosteal layer.
    • So, look now at an individual hair on the back of your forearm and notice how thin it is. That hair is approximately the same thickness as the layer of periosteum that surrounds your bones.
 Coccygectomy surgery and the periosteum:
  • During amputation/removal of the coccyx (coccygectomy), the surgeon has a choice:
  • Option #1: some surgeons try to take out the entire coccyx along with its’ periosteum.
  • Option #2: other surgeons try to remove the coccyx while leaving the periosteum in place within the patient.
  • Either way, typically the surgeon starts the surgery from behind the coccyx (posteriorly).
Option #1: Removing the periosteum during coccygectomy:
  • If the surgeon is removing the coccyx and also removing the periosteum, then they will try to cut and separate the muscles, tendons, and ligaments that attach to the coccyx. This allows for the coccyx (and it’s periosteum which is stuck to the coccyx bones) to all be removed together.
Option #2: Leaving the periosteum in place during coccygectomy:
  • Alternatively, if the surgeon is removing the coccyx but trying to leave the periosteum in place, then they need to attempt to separate each of the coccygeal bones from its’ periosteal film/layer.
  • To do this, the surgeon does need to cut through the periosteum to get to the coccyx. This is typically done along the back wall of the coccyx, in the midline. Then they usually use electrical cauterization to burn through the layer between the bone and the periosteum to separate at that layer.
  • Note that the periosteum is very very thin. As thin as a human hair. So it would be very very difficult, if not impossible, for a surgeon to confidently guarantee that they left all of the periosteum in place. In reality, they do their best to dissect a target layer in between the bone and the periosteum. But the tools used by the surgeon may end up cutting through or burning through the periosteal layer, in a variable fashion. It is especially challenging for the surgeon to get to the front of the coccyx (since they are approaching it from behind) and this makes it tough to reliably peel off the periosteum at the front of the coccyx.
  • Variable success at peeling off the periosteum: so, some of the periosteum may still end up still stuck to the bone, while some of the periosteum may end up being destroyed as a normal byproduct of the surgery itself, and some of the periosteum may end up still “left in place” within the pelvis [in the periosteum that is “left in place” within the pelvis will presumably remain attached to the muscles, tendons, or ligaments that have been attached to it prior to the surgery]).
  • Each individual coccygeal bone will have its own individual periosteum. (There is NOT any single continuous periosteum for the entire coccyx, unless your entire coccyx is already naturally fused together, which does happen, although it is rare.) So this means that the surgeon would need to peel the periosteal layer off of each and every individual coccygeal bone, if the goal was to leave all of the periosteum in place within the pelvis.

 

Which option is better? One Publication on Coccygectomy and the Periosteum
  • In 2010, surgeons in Turkey published a study where they tried two different techniques for performing coccygectomy. Some of the patients had their coccyx removed along with the periosteum being removed. Other patients had their coccyx removed whilst leaving the periosteum in place. They had a total of 25 patients, split unevenly between the two groups.
  • Results: “Both surgical techniques resulted in a statistically similar clinical outcome. Overall, 84% of patients who underwent coccygectomy benefited from surgery.” But the likelihood of having infection at the surgical wound site was statistically less in patients who had their periosteum left in place within the pelvis.
  • Reference:  https://www.ncbi.nlm.nih.gov/pubmed/?term=19471931
  • So, at least from this one study, leaving the periosteum in place seems to decrease the chances of infection after the surgery, but does not improve long-term outcome.
  • There were some limitations to the study: 1) there were only 25 patients total, split unevenly between the two groups. Small sample sizes make it difficult to know how reliable the statistical differences are between the two groups. 2) It was a retrospective study, instead of a prospective study. 3) The groups were not randomized. The authors do not explain what factors determined which patients went into the periosteal-sparing group. This matters. If, for example, the first group were the first coccygectomy surgeries by this surgeon, and then the surgeon switched to a different technique a year or two later for the second group, then perhaps the decreased infection rate in the second group was due to the surgeon just having become a better, more experienced surgeon over the additional years of performing coccygectomies.

 

Where can we learn more about the periosteum in general (unrelated to the coccyx)?
  • Here is a good reference article about the periosteum in general (without reference to the coccyx):  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826636/

GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

 

 

Tailbone Book, Chapter 13: Cancer Causing Coccyx Pain, Tailbone Pain.

Tailbone Book, Chapter 13: Cancer (Malignancy) Causing Tailbone Pain, Coccyx Pain
  • Is your Tailbone Pain Caused by Cancer???
  • This is the next in a series of coccyx pain videos, giving you highlights from the chapters of Dr. Foye’s book, “Tailbone Pain Relief Now!”
The actual VIDEO is at the bottom of this page.
Here is the TEXT from the video: ….. PENDING…..  :-)
Here is the actual VIDEO:

Here is the screenshot thumbnail image for the video:
Chapter 13 of Tailbone Pain Book, CANCER Causing Tailbone Pain, Malignancy Causing Coccyx Pain

Chapter 13 of Tailbone Pain Book, CANCER Causing Tailbone Pain, Malignancy Causing Coccyx Pain


To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com
For more information on coccyx pain, or to be evaluated at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

Soft vs Hard Cushions for Tailbone Pain, Coccyx Pain. Which cushion is best?

How Hard Should your Cushion be for Coccyx Pain, Tailbone Pain?
Should your Tailbone Cushion be Softer or Harder? Which cushion is best?

Many patients ask me about what is the “best” cushion for them to sit on to help decrease their coccyx pain (tailbone pain, coccydynia).

In this video, I review a coccyx cushion that comes in 3 different levels of firmness: Soft, Medium, and Firm.

I comment on the pluses and minuses of each level of firmness.

Screenshot from the video:

How HARD should your CUSHION be for Tailbone Pain, Coccyx Pain?

How HARD should your CUSHION be for Tailbone Pain, Coccyx Pain?

 


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

 

Book Now Available! Click on the book to get it now:


Get the Book at www.TailbonePainBook.com