title: The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy.
abstract: BACKGROUND
  Coccydynia is a challenging disorder that often is refractory to treatments such as medications and injections. Physical therapy for coccydynia rarely has been studied.
  
  
  OBJECTIVE
  To evaluate the efficacy of pelvic floor physical therapy for reducing pain levels in patients with coccydynia.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  The pelvic floor rehabilitation clinic of a major university hospital.
  
  
  METHODS
  A total of 124 consecutive patients over age 18 with a chief complaint of coccydynia between 2009 and 2012. A subgroup of 17 of the 124 patients had previously undergone coccygectomy with continued pain postoperatively.
  
  
  METHODS
  The primary treatment intervention was pelvic floor physical therapy aimed at pelvic floor muscle relaxation. Secondary treatment interventions included the prescription of baclofen for muscle relaxation (19% of patients), ganglion impar blocks (8%), or coccygeus trigger point injections (17%).
  
  
  METHODS
  Primary outcome measures included final minimum, average, and maximum pain numeric rating scales. A secondary outcome measure was the patient's subjective percent global improvement assessment. Baseline demographics were used to determine which pretreatment characteristics were correlated with treatment outcomes.
  
  
  RESULTS
  Of the 124 patients, 93 participated in pelvic floor physical therapy and were included in statistical analysis. For the 79 patients who completed treatment (with a mean of 9 physical therapy sessions), the mean average pain ratings decreased from 5.08 to 1.91 (P < .001) and mean highest pain ratings decreased from 8.81 to 4.75 (P < .001). The mean percent global improvement was 71.9%. Mean average pain ratings in postcoccygectomy patients improved from 6.64 to 3.27 (P < .001). Greater initial pain scores and a history of previous injections were correlated with P < .001 pain scores on completion of physical therapy. Pain duration and history of trauma did not affect treatment outcomes.
  
  
  CONCLUSIONS
  Pelvic floor physical therapy is a safe and effective method of treating coccydynia.
  
  
  METHODS
  III.
authors: Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9055(∗). Electronic address: kelly.scott@utsouthwestern.edu.
authors: Kelly M
authors: KM
authors: Scott
authors: Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX; Department of Physical Medicine and Rehabilitation, Providence St. Peter Medical Center, Olympia, WA(†).
authors: Lauren W
authors: LW
authors: Fisher
authors: Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX(‡).
authors: Ira H
authors: IH
authors: Bernstein
authors: Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX(§).
authors: Michelle H
authors: MH
authors: Bradley
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000534:rehabilitation; D003050:Coccyx / Q000293:injuries* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods / Q000534:rehabilitation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000534:rehabilitation*; D017773:Pelvic Floor / Q000503:physiopathology*; D026741:Physical Therapy Modalities; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome