Article

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. DESIGN:
Retrospective chart review. SETTING: The pelvic floor rehabilitation clinic of a
major university hospital. PATIENTS: 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 OR INTERVENTIONS: 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%). MAIN OUTCOME MEASURES: 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. LEVEL OF EVIDENCE:
III.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS