Randall Braddom, M.D., Physical Medicine and Rehabilitation

It was great this week to spend time with Dr. Randy Braddom and hear him lecture for the New Jersey Society of PM&R.
Dr. Braddom is an icon within the field of Physical Medicine and Rehabilitation (PM&R).
  • He served as President of the American Academy of Physical Medicine and Rehabilitation (AAPM&R).
  • He also served as President of the Association of Academic Physiatrists (AAP).
  • He was Editor of one of the field’s major textbooks (Physical Medicine and Rehabilitation).
  • He has given hundreds of lectures.
  • Dr. Braddom is well known and highly respected nationally and internationally. It was a treat to see him.
Randall Braddom MD, photo with Patrick Foye MD, August-2-2018

Randall Braddom MD, photo with Patrick Foye MD, August-2-2018

Braddom's Physical Medicine and Rehabilitation textbook, book cover, 1st edition, 1996

Braddom’s Physical Medicine and Rehabilitation textbook, book cover, 1st edition, 1996

 

How often to Repeat Injections for Coccyx Pain, Tailbone Pain, Coccydynia

  • Many patients with coccyx pain (tailbone pain, coccydynia) get excellent relief and improved quality of life via various types of coccyx injections.
  • Prior to injections, it is important that the patient undergo a thoughtful, careful evaluation regarding the actual source of their pain.
  • Having an accurate diagnosis is important so that the physician can make a thoughtful and intelligent decision about what injection to do, if any. You can read more about that here: http://tailbonedoctor.com/whats-the-best-injection-for-tailbone-pain-coccyx-pain/

 

  • Regarding the specifics of exactly how often to repeat injections, this varies from patient to patient.
  • When I was in medical school back 25 years ago, doctors typically said that you could repeat a steroid injection at a given joint/site up to 3 times per year, and more recently many doctors will say that you could repeat a steroid injection up to 3 times within a six-month window.
  • I tend to be skeptical of repeating the injections quite that often, because if I had to do the same injection for someone 3 times every 6 months (meaning 6 times per year) that in my opinion the injection is not very helpful.

 

  • Sometimes an injection gives complete and sustained relief and the pain never comes back at all.
  • Very commonly we see patients who get excellent relief for several months or for a year or 2, or even for 3 years (or even longer depending on the type of injection).
  • So, some patients do very well with coming back for a repeat injection every year or 2, or once or twice a year. This varies from patient to patient.
  • If doing a repeat injection provides excellent quality of life and avoids the need for addictive opioid/narcotic painkillers or avoids the need for  invasive coccygectomy surgery (and thus avoids the risks of surgical side-effects such as post-operative infection and other surgical complications), then those injections can be repeated on that kind of an infrequent frequency on an ongoing basis.
  • In the small percentage of patients who may have difficulty tolerating the injections for whatever reason (e.g., in some diabetic patients the steroid component of the injection can make the blood sugars go higher) then that may limit how often the injections are repeated.
  • There is no treatment for coccydynia (coccyx pain) that is guaranteed to provide 100% relief for 100% of patients.  Every treatment has its pluses and minus (risks and benefits), which patients should discuss with their in-person physician. Meanwhile, overall, for those who do not get enough relief from cushions and such, various coccyx injections can often be an extremely helpful cornerstone of the overall treatment plan.

 

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.

Sacrospinous Ligament, External Palpation on Physical Exam, in Coccyx Pain, Tailbone Pain

Below is a very good video where a Pelvic Floor Physical Therapist explains palpation of the sacrospinous ligament on physical exam.

The sacrospinous ligament (SSL) is a connective tissue structure that spans from the sacrum to the ischial spine, hence the name sacrospinous (i.e., sacro – spinous).

However, despite being called the “sacrospinous” ligament,  this ligament also has attachments to the coccyx.

Here is the link to the video:

 

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

 

Videos of Standard X-rays of the Coccyx (Tailbone), AP and Lateral Views

Below are a couple of videos showing how standard x-rays are done at the coccyx (tailbone).

These are sometimes done for patients who have coccyx pain (coccydynia, tailbone pain).

In general, the best x-rays are the sitting-versus-standing x-rays, and you can read more about those here at this link: http://tailbonedoctor.com/sitting-versus-standing-coccyx-x-rays-for-tailbone-pain/

But unfortunately most radiology centers are not familiar with how to do the sitting-versus-standing x-rays. So, in the meantime, patients can at least have the “standard” x-rays done instead. These standard coccyx x-rays typically include lateral views and AP-views, which will be explained below.

The lateral view of the coccyx is typically the most important view when getting x-rays (radiographs) for a patient with tailbone pain.

The “Lateral” view is essentially looking at the coccyx from the side (side view).

Below is a video showing how to do the lateral view xrays of the coccyx: 

Below is another video describing how to do the lateral view coccyx x-rays:

And below shows how to do the “AP” view of the coccyx. “AP” stands for Anterior-to-Posterior, which means front-to-back. So, instead of the lateral view (which was the side view) the AP view looks at the coccyx from the front.

Video of the coccyx AP view: 

Note: although the demonstration videos show a “patient” wearing denim blue jeans, in reality if this was a real patient we would want her changed into a medical gown. Otherwise, the zippers and denim and grommets or buttons on her pants could block or obstruct or obscure our view of the tailbone.

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

Does local anesthetic relief predict response to coccygectomy?

  • I’d like to clarify… absolutely I do say that it is important to notice how much relief there is during the 1st hour or so after a local anesthetic injection.
  • If a local anesthetic injection at the coccyx is done under image guidance (such as fluoroscopy, thus confirming accurate/appropriate placement of the injection) and the patient does NOT have any relief AT ALL, this becomes highly suspicious for the pain coming from anatomical areas/structures OTHER than the coccyx (or at least OTHER than the area on the coccyx where the local anesthetic block was placed).
  • The vast majority of patients do well with injections, without the need for surgery.
  • But, unfortunately, yes, some patients do indeed require surgery. And, for those deciding about surgery, while there is of course never any guarantee of a good outcome (nor with cushions, oral medications, injections, etc., either), those who have no relief at all from the local anesthetic block of the coccyx are the individuals who I am most concerned that the pain may be coming from someplace OTHER than the coccyx, in which case surgically removing the coccyx of course would NOT be likely to help.
  • I know it is a subtle clarification from how I phrase it, but I am NOT saying that coccydynia patients who get relief from local anesthetic should get a coccygectomy. I don’t want people to get the wrong impression and think that anyone who gets a local anesthetic injection and has initial relief should then go on for surgery.
  • Rather, most people after injections will never need surgery. But for those who do end up failing to get adequate relief from injections and other nonsurgical treatments, and if someone is considering surgery… then… if someone does NOT get any relief from local anesthetic blockade of the coccyx, then they are LESS likely to get relief from surgical removal of the coccyx.

- Patrick Foye, M.D. www.TailboneDoctor.com

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

Viscosupplementation Injections (Hyaluronic Acid Injections) for Coccyx Pain, Tailbone Pain

Can viscosupplementation injections help relieve coccydynia (coccyx pain, tailbone pain)?
  • Viscosupplementation injections (hyaluronic acid injections) in the United States are currently only FDA-approved for osteoarthritis of the knee.
  • However, we certainly know that many patients have osteoarthritis (also called degenerative joint disease) at other joints, including at the coccyx.
  • So, theoretically, doing these types of viscosupplementation injections might be helpful for arthritic joints at locations other than the knee (specifically, potentially including the joints of the coccyx).
  • However, to my knowledge, no actual research study has been done looking at these injections at the coccyx.
  • So, insurance companies (in the United States at least) typically do not cover payment for injections at the coccyx.
  • But it’s an interesting area and I think it would most likely be helpful for those with osteoarthritis of the coccyx (and  this would be something that I would be willing to inject for my patients if the patient or their insurance company were able to provide the viscosupplementation to inject).
  • Examples of commercially available hyaluronic acid injections for viscosupplementation include: Hyalgan, Euflexa, Synvisc, Orthovisc, Hymovis.
  • - Patrick Foye, M.D.  www.TailboneDoctor.com
To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon
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

Patrick Foye, MD, is Board Certified since 1997

Patrick M. Foye, M.D., is a physician (medical doctor) who is board certified in Physical Medicine and Rehabilitation since 1997.

American Board of PM&R, Patrick M Foye, MD

American Board of PM&R, Patrick M Foye, MD

Dr. Foye is also Board Certified in Pain Medicine, since 2004.

Dr. Foye is the Founder and Director of the Coccyx Pain Center (Tailbone Pain Center) at Rutgers New Jersey Medical School.

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

Pelvic Floor Physical Therapists & Dr. Foye Discuss Coccyx Pain, Tailbone Pain, Coccydynia

It was great chatting today with Pelvic Floor Physical Therapists to discuss #TailbonePain #CoccyxPain #Coccydynia with Rivki Chudnoff (from Hamakom PT), along with Stacey Futterman Tauriello & Kara (both from @5pointPT)

http://tailbonedoctor.com/wp-content/uploads/2018/07/Pelvic-Floor-Physical-Therapy-Coccyx-Pain-Tailbone-Pain.png

Pelvic Floor Physical Therapy, Coccyx Pain, Tailbone Pain

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

Carrie Cushion for Coccyx Pain, Pelvic Pain. From the Netherlands.

Carrie Cushion for Coccyx Pain (Tailbone Pain), Pelvic Pain. From the Netherlands.

Patrick Foye, M.D., interviewed the creators of the “Carrie Cushion.”

The Carrie Cushion made its first public appearance at the 2nd International Coccyx Pain Symposium, in Dordrecht Museum, in the Netherlands.

Website: www.carriecushion.com

In this video, Dr. Foye interviews the following creators of the Carrie Cushion:

  • Fetske Hogen Esch, Owner of F-act Pelvic Pain Clinic BV
  • Sytske Lohof-Venema, Owner of pelvic (floor) practice ‘Overwinning’
  • Mimi and Roderick Lodewijks, Owners of EMTEK Ergonomics
  • Their motto: “Carrie your seat cushion”

Carrie Cushion, Interview with the Creators, for Coccyx Pain, Pelvic Pain, Netherlands

Carrie Cushion, Interview with the Creators, for Coccyx Pain, Pelvic Pain, the Netherlands

This video is not an official endorsement and there was no payment or sponsorship to Dr. Foye for making this video. Instead, this video is provided for public education about this new type of cushion. Designed and created in the Netherlands.


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

After the International Coccyx Pain Symposium, Summary Discussion

The video below is Patrick Foye, M.D., talking AFTER the 2nd International Coccyx Pain Symposium… Summary Discussion.

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

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


Get the Book at www.TailbonePainBook.com