title: The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study.
abstract: METHODS
  Randomized open study.
  
  
  OBJECTIVE
  To evaluate the efficacy of intrarectal manual treatment of chronic coccydynia; and to determine the factors predictive of a good outcome.
  
  
  BACKGROUND
  In 2 open uncontrolled studies, the success rate of intrarectal manipulation of the coccyx was around 25%.
  
  
  METHODS
  Patients were randomized into 2 groups of 51 patients each: 1 group received three sessions of coccygeal manipulation, and the other low-power external physiotherapy. The manual treatment was guided by the findings on stress radiographs. Patients were assessed, at 1 month and 6 months, using a VAS and (modified) McGill Pain, Paris (functional coccydynia impact), and (modified) Dallas Pain questionnaires.
  
  
  RESULTS
  At baseline, the 2 groups were similar regarding all parameters. At 1 month, all the median VAS and questionnaire values were modified by -34.7%, -36.0%, -20.0%, and -33.8%, respectively, in the manipulation group, versus -19.1%, -7.7%, 20.0%, and -15.7%, respectively, in the control (physiotherapy) group (P = 0.09 [borderline], 0.03, 0.02, and 0.02, respectively). Good results were twice as frequent in the manipulation group compared with the control group, at 1 month (36% vs. 20%, P = 0.075) and at 6 months (22% vs. 12%, P = 0.18). The main predictors of a good outcome were stable coccyx, shorter duration, traumatic etiology, and lower score in the affective parts of the McGill and Dallas questionnaires.
  
  
  CONCLUSIONS
  We found a mild effectiveness of intrarectal manipulation in chronic coccydynia.
authors.affiliation: Department of Physical Medicine, Hôpital Hôtel-Dieu, Paris, France. jy.maigne@htd.aphp.fr
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Maigne
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Michel Le
authors.initials: ML
authors.lastname: Faou
authors.forename: Marie
authors.initials: M
authors.lastname: Archambeau
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003050:Coccyx / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal; D008405:Massage; D008875:Middle Aged; D010146:Pain; D010147:Pain Measurement; D000078702:Radiofrequency Therapy; D011859:Radiography; D012447:Sacrum / Q000528:radiation effects; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome