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.
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.
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)
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, 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.
After Day-1 of the 2nd International Coccyx Pain Symposium, the Netherlands
Patrick Foye, M.D. talks after giving lectures at the 2nd International Coccyx Pain Symposium, in the Dordrecht Museum, The Netherlands, on June 29, 2018.
Patrick Foye, M.D. is on his way to the 2nd International Coccyx Pain Symposium, in The Netherlands, in late June 2018.
This video was done in Amsterdam, at a Schiphol Airport hotel. Looking forward to traveling north by train to the conference city (Dordrecht, the Netherlands) and meeting with other worldwide experts regarding evaluation and treatment of coccydynia (also called coccygodynia, coccyx pain, tailbone pain).
Grietje Vander Mijnsbrugge, MD
works as a colorectal surgeon since 2011 at the Proctos Kliniek in the center of the Netherlands. After her studies at the Vrije Universiteit Bruxelles she followed her training in Gent in Belgium. During her training she also participated one year in cardial surgery in the Sint Antonius Ziekenhuis in Nieuwegein. After finishing her studies as abdominal surgeon in Belgium she returned to the Netherlands. She had multiple experience in abdominal laparoscopic and proctological surgery. She specialized in complexe sphincter surgery (dynamic gracilis plastic). On behalf of the Proctoskliniek she is an international trainer in anorectal and pelvic floor dynamic ultrasound.
Dr. Marijke Slieker -ten Hove
is a pelvic physiotherapist and director of the ProFundum Institute for diagnosis, therapy and education in Dordrecht, Hendrik Ido Ambacht and Rotterdam. She studied innovation management in healthcare. She was responsible for the development and execution of the first master education of pelvic physiotherapy during 20 years in the Netherlands and obtained her PhD in 2009 on the Erasmus University Rotterdam studying the pelvic floor function and disfunction of the pelvic floor in a general female population aged 45-85 years. She has been active in international committees for many years in ICS and IUGA, is a member of honour in the Dutch Pelvic Physiotherapy Association. She is a wellknown (inter)national speaker and trainer and organizes many courses, congresses and symposia. She developed the Dutch pelvic floor app for patients and is author of the Dutch pelvic floor book for women (Verborgen Vrouwenleed).
Dr Jean-Yves Maigne, MD
is specialized in Physical and Manual Medicine, Rheumatology and Human Anatomy. He is currently Head of the department of Physical Medicine in the Hôtel-Dieu Hospital of Paris. His research has focused on the anatomy of the dorsal primary rami, the natural history of disc herniations, low back pain, the indications, contra-indications, complications and safety rules of spinal manipulations, sacroiliac joint pain and coccydynia, of which he was a major contributor.He has authored more than one hundred scientific studies, chapters of books and articles. He is the author of five books (for medical or general audience). He has been for 18 years the Editor-in-Chief of the “Revue de Médecine Manuelle Ostéopathie”, the French quarterly for manual medicine.He is a member of the International Society for the Study of the Lumbar Spine (1995), the European Spine Society (1997) and the French societies of Rheumatology (SFR), Physical Medicine (SOFMER) and Manual Medicine (SOFMMOO, being a past president of it). He manages, and is a teacher in the diploma of Manual Medicine of the Paris Descartes University since 1990. He has been awarded by the European Academy of Rehabilitation (1988), the International Federation of Manual Medicine (FIMM, 1993) and Sanofi International (1994) for his research. Department of Physical Medicine, Hôtel-Dieu Hospital, 75181 Paris Cedex 04 France, email: jy.maigne@aphp.fr, maigne@wanadoo.fr
Dr Levon Doursounian
started with an internship of surgery in Paris France from 1979 to 1983, followed by a fellowship of orthopaedic surgery in Paris from 1983 to 1987. He was consultant of orthopaedic surgery in Hotel Dieu Hospital of Parisfrom 1987 to 1996 and became professor of orthopaedic surgery in 1996 – Georges Pompidou Hospital – Paris. He was head of Orthopaedic departement of Saint Antoine hospital of Paris from 2003 until 2017 with orientation toward Shoulder and Spine surgery. At Hotel Dieu hospital started in 1987 a collaboration with Doctor Jean Yves Maigne on Low Back Pain and on Coccygodynia. This collaboration have lasted 30 years and has resulted in the publication of 6 papers in peer review International Orthopaedic journals. In 2016, in collaboration with Dr Jean Yves Maigne, organization of the first International Symposim on Coccyx Disorders in Paris.
Jason A.T. Woon
as a highly-motivated medical researcher, I have multiple publications on the coccygeal anatomy. A recent doctoral graduate from the University of Otago, with a thesis awarded an exceptional grade (top 10%) titled ‘Clinical Anatomy of the Human Coccyx’, a detailed investigation into the anatomy of the coccyx using dissection, radiography, and histology was reported. The results have been published in several high-quality journals and aims to fill gaps in the existing knowledge of the coccyx, particularly in relation to the coccygeal plexus, sacrococcygeal intercornual region, and the bony morphology and morphometry of the coccyx. As a senior medical student, my hope is to continue to develop my research skills, explore new avenues and contribute to the scientific community.
Dr. Patrick Foye
is Founder and Director of the Coccyx Pain Center (Tailbone Pain Center), located in the United States, just outside of New York City. He is a Professor of Physical Medicine and Rehabilitation (PM&R) at Rutgers New Jersey Medical School.In addition to publishing in peer-reviewed medical journals and textbooks, Dr. Foye also extensively publishes educational materials directly for people suffering from coccydynia (coccyx pain), which you can find on his website www.TailboneDoctor.com, on his YouTube channel TailbonePainDoctor, on Facebook.com/TailbonePainCenter, and on Twitter @TailboneDoctor. Dr. Foye authored a 272-page book titled, “Tailbone Pain Relief Now!” Dr. Foye has received many teaching awards and has given over 500 local, regional and national lectures regarding musculoskeletal pain, rehabilitation, and especially coccydynia.USA Today newspaper named Dr. Foye on their list of “Most Influential Doctors”. The American Academy of PM&R (AAPM&R) honored him with their national “Distinguished Clinician Award”. Clinically, Dr. Foye is sub-specialty board-certified in Pain Medicine, and his niche area of therapeutic injections for coccyx pain has drawn thousands of patient visits from all across the country and internationally.
Fetske Hogen Esch, MSPT
Owner and Managing Director of F-act Pelvic Pain Clinic BV has specialised in the prevention, diagnosis and treatment of pain in the abdomen, lower back and pelvic area since 1991. She is one of the pioneers in pelvic physiotherapy and, for more than 25 years, has been treating people with chronic pelvic pain. She was the first pelvic physiotherapist in Europe that was trained in the Wise-Anderson protocol. She is known as the ‘Sherlock Holmes’ of CPPS and regularly lectures on the topic both in the Netherlands and abroad. In addition to her work in the F-act clinic, she is also owner of Bekkenfysiotherapie Hogen Esch and has spent more than 20 years training pelvic physiotherapy students. For many years she was responsible for the content of the Masters Course in Pelvic Physiotherapy at the SOMT University in Amersfoort.
Annick van de Walle
is a Dutch osteopath and studied in Gent in Belgium. Annick had her own private clinic and chose for the multidisciplinairy approach. She is specialized in women, babies and topsport especially tennis players. She did a special training in the pelvis minor in Women, urogenital manipulaties and lumboradical problems. Furthermore she is trainen in clinical neurodynamixs and integratie technics based on the knowledge of embryology. In a multidisciplinair team Annick is working with gynecological oncology patients.
Dr Michael Durtnall DC MSc FRCC
is specialised in spinal manipulation and computed digital x-ray diagnosis for neuromusculoskeletal back pain, coccyx, sacroiliac, pelvic and pudendal neuralgia, costochondritis, scoliosis and postural rehabilitation. He has an MSc in Performing Arts Medicine UCL. He is conducting PhD research at Great Ormond Street Institute of Child Health (GOSICH), University College London (UCL)He is founder and chairman of Sayer Clinics: London in Kensington W8, Mayfair W1 and City EC2 for specialist spinal manipulation, radiology, acupuncture, chiropractic, osteopathy, specialist pelvic physiotherapy.Michael practises at Sayer Clinic: Kensington, 8 Sunningdale Gardens, London W8 6PX +44 207 937 8978 mail@sayerclinics.com www.sayerclinics.comHe is a member of the British Medical Acupuncture Society (BMAS), International Pelvic Pain Society (IPPS), Fellow of the Royal Society of Medicine and Fellow Royal College of Chiropractors FRCC (Orthopaedics and Rehabilitation)
He has presented on Coccyx and Neuromusculoskeletal Pelvic Pain at the 8th World Congress of Low Back and Pelvic Pain in Dubai 2013 and presented Manual Treatment of Coccydynia at the Paris Coccyx Symposium in July 2016. He is listed with www.coccyx.org for specialist diagnosis and manipulation for coccydynia, www.pudendalhope.info as neuromusculoskeletal pelvic pain specialist and www.pelvicpain.org as pelvic pain specialist.
Elif Gürkan, MD, Istanbul
As a Physical Medicine and Rehabilitation specialist in my country, I am mostly practising treatment modalities for pain due to spinal disorders. In the year of 2000, I visited the clinic of Dr. Jean Yves Maigne in Paris for learning manual medicine. In the meanwhile, he mentioned me about dynamic x-rays and intradiscal injections for coccydynia. Then I was very interested in this complex pain syndrome in musculoskeletal medicine. After then, I had the chance to meet more than 1000 patients with coccydynia. In most of the cases dynamic x-rays and magnetic resonance imaging were showing the pain source. What really interesting was that a very small number of patients had a psychosomatic basis as believed for many years. I think dynamic x-rays have been a very helpful answer to understand the reason underlying coccydynia in %75 of patients and treating patients with intradiscal injections have been really successful. However, this region keeps to be mysterious in terms of cause of the pain and the cause of recurrence of the pain after treatment in a certain group of patients. So I would like to work more on anatomy, cause, manual treatment options, different medical alternatives and injections for coccydynia.
Dr. Thibault Riant
Former anaesthetist. Pain physician for 15 years: Consultations, CT-guided and US infiltrations including coccyx, IMPAR ganglia…I work in a pain unit which contributes to the Nantes Federative Pelvic Pain Centre. This centre regroups two pain units: public and private. There are also private physiotherapists and osteopaths.During a long time, our main topic was only perineal neuralgia (pudendal, cluneal, obturator). For few years now, we have driven this experience further enlarging our practice with new modalities including coccygodynia, vestibulodynia, pelvic hypersensitization and chronic post-operative pain.We see around 1500 new patients each year who are suffering from the “pelvic” area. We organize three multidisciplinary consultations by month. The professionals invited are: pain physicians, gynaecologists, urologists, psychologists, physiotherapists, osteopaths. The first consultation includes patients with perineal neuralgia, coccygodynia. The second one is for patients with pelvic pain and urologic diseases. Finally, the last one is open to patients with pelvic pain and gynaecologic diseases.
Dr. Eric Bautrant
Pelvi-Perineal Rehabilitation Department. Private Medical Centre « L’Avancée »44 avenue du Maréchal de Lattre de Tassigny. 13090 Aix-en-Provence France ebautrant@l-avancee.fr Initial Surgical training for General Surgery. Specialist in Obstetrics and Gynaecology. Specialist Certificate in Gynaecological, Pelvic and perineal Surgery. Assistant Professor, Marseilles Hospitals. Senior Clinical Lecturer, Aix-Marseilles II University. Dr. Bautrant began his clinical and anatomical works on Pudendal neuralgia in 1994 and worked on the description of the Pudendal nerve surgical decompression with the trans-ischio-rectal (TIR) technique under endoscopic guidance in1998 and validation of the results in 2000 and 2003. From this period, the interest for the Pudendal neuralgia leads to a better knowledge of the other causes of chronic pelvic and perineal pain : endometriosis, adenomyosis, other pelvic and perineal neuralgias, interstitial cystitis, vulvodynias and vestibulitis, uretrals and ano-rectals syndromes, myo-fascial syndromes. The other main working pole is the treatment and surgical repair of the post-trauma, post-operative, post-pelvic cancer treatments and post-delivery, pelvi-perineal lesions. And specially, pelvi-périneal reconstruction techniques, prolapse, urinary and fecal incontinences treatments. In charge of the developing and head of a multi-disciplinary unit for the diagnostic and the treatment of pelvi-perineal chronic pain and dysfunction in Aix-en-Provence, France.Surgical demonstration, teaching and skill transfer in the field of chronic pelvic pain, laparoscopic, vaginal and perineal surgeries for prolapses, incontinences and other perineal dysfunctions. Main publication of the Pelvi-Perineal Rehabilitation unit in the review « Pain », in march 2009. We make the cover of the review with the TIR procedure for Pudendal nerve decompression : Mollo M, Bautrant E, Rossi AK, Collet S, Boyer R and Thiers-Bautrant D. Evaluation of diagnostic accuracy of Colour Duplex Scanning, compared to electroneuromyography, diagnostic score and surgical outcomes, in Pudendal Neuralgia by entrapment : A prospective study on 96 patients. Pain. 2009 ; 142 : 159-163.
Sytske Lohof -Venema, MSPT
is a pelvic physiotherapist. She obtained her master in 2013 and developed the Non Invasive Mobilization of the Os Coccyx (NIMOC). At ProFundum Educatie she is the trainer of this technique for the pelvic physiotherapist and has been training in Belgium, Germay and UK too. She presented her poster at the 8th World Congress on controversions in Neurology min 2014 in Berlin. On the post ICS-IUGA congress in the Netherlands she won the best abstract price.
Dr. Moein Tavakkoli Zadeh MD, FRCA, EDIC, EDRA, FFPMRCA
is consultant in Pain medicine and Neuromodulation, working in the National Hospital for Neurology and Neurosurgery, UCLH and in St. George’s University Hospital in London. He is an experienced anaesthetic trained and fellowship trained pain specialist. He has a huge experience of managing patients with pain, often of spinal origin and undertakes pain procedures including spinal injections and neuromodulation. Also workin in the London Spine Clinic. Running the pain clinic, Moein manages the medication profiles of patients, intervening with other therapeutic options where necessary. Jointly with other colleagues in the team, he undertakes spinal cord stimulation, to treat chronic pain states.
Jon Miles
was a physicist working for the UK National Radiological Protection Board until he retired in 2009.
In 1993 he injured his coccyx in an accident. After various unsuccessful treatments, he had his coccyx removed in 1999. In the same year he started the website www.coccyx.org to provide information about coccydynia, to allow patients to post their personal experiences, and to help patients find specialists able to treat them. Since then about 3,000 patients and over 100 medical professionals have contributed to the site.
Ante M. Kalstad, MD
is a specialist in orthopaedic surgery at St. Olav’s University Hospital, Trondheim, Norway, subspecialized in orthopaedic traumatology, and working clinically at the Orthopaedic Trauma Department. He is a PhD candidate at the Norwegian University of Science and Technology, researching the treatment of coccyx disorders, with a focus on corticosteroid injections and surgical treatment. Ante Kalstad is currently evaluating the results of several hundred patients who have undergone this type of treatment over the last seven years.
Rainer Günter Knobloch, MD
started his surgical training with an internship in Germany before moving to Norway in 1987. After training as a general surgeon in various hospitals in northern and southern Norway, he started to work at St. Olav’s University Hospital in Trondheim in 1994 and qualified as an orthopedic surgeon in 1997. After this, he specialized in spinal surgery, becoming a senior consultant in this subspecialty. Since 2009 he has taken a special interest in tailbone patients together with his tutor Prof. Vilhjalmur Finsen. Since then he has treated around 500 patients with injections and performed over 200 coccygectomies. St. Olav’s University Hospital in Trondheim is now the leading center in Norway for the treatment of tailbone pain.
Vincent van Pelt, MD
(1957) graduated as a medical doctor on Rotterdam Erasmus University in 1984. Since then he has been treating musculoskeletal painproblems in his Postural Medical Centre making use of several therapies ( Manual Medicine, Neural therapy, Ear Acupuncture and Podo-Postural therapy). He is a specialist in the podo-postural approach that links musculoskeletal ailments through posture to the position and form of the feet.
