Most people spend their days alternating between sitting and standing, changing positions constantly. How many of us take the time to think about the position of our coccyx, ilia, or sacrum? The coccyx typically is minimally weight-bearing in sitting, about 10%, just like the fibula. However, it can become a major pain generator if the biomechanics of the ilia, sacrum, and femoral head positions are not quite right.
Coccydynia and Painful Sitting is a course that can be related to all populations that physical therapists treat. A lot of patients will state “my pain is worse with sitting” which can mean thoracic pain, low back/sacral pain, and even lower extremity radicular pain.
Coccyx pain patients often have more long-standing pain conditions than other patient types. For the most part, the medical community does not know what to do with this tiny bone that causes all types of havoc with patient pain levels. Lila shares that "Sometimes treating a traumatic coccydynia patient seems so simple and I am bewildered as to why patients are suffering so long - and other times, their story is so complex that I wonder if I can truly help."
Lila Abbate discussed this in her past blog, Case Studies in Coccyx Pain. She wrote that "The longer I am a physical therapist, the more important the initial evaluation has become. Our first visit with the patient is time together that really helps me to create a treatment hypothesis. This examination helps me to put together an algorithm for treatment.
I hear their story and repeat back their sequence of events in paraphrase. Then I ask if there is any other relevant information, no matter how small or simple, that they need to tell me? Some will say, I know it sounds weird, but it all started after I twisted my ankle or hurt my shoulder (or something like that). I assure them that we have the whole rest of the visit together and they can chime in with any relevant details."
Determining the onset of coccyx pain will help you gauge the level of improvement you can expect to achieve. Coccyx literature states that patients who have had coccyx pain for 6 months or greater will have less chance for resolution of their symptoms. However, none of the literature includes true osteopathic physical therapy treatment, so I am very biased and feel that this statement is untrue."
The remote course Coccydynia and Painful Sitting is very orthopedically-based which takes Lila Abbate's love of manual, osteopathic treatment and combines it with the women’s health internal treatment aspects so that practitioners are able to move more quickly to get patients back on the path to improved function and recovery. The course looks at patients from a holistic approach from the top of their heads down to their feet. In taking on this topic, the course hones basic observation skills, using some of Lila's favorite tools: the Hesch Method, the Integrated Systems Model, and traditional osteopathic and mobilization approaches.
This course is designed to spark your orthopedic mindset, encouraging the clinician to evaluate the coccyx more holistically.
Working through the basics and the obvious with failed results takes practitioners to the next step of critical thinking about how the patient presents, what seems to be lacking, and how to correct them biomechanically to achieve pain-free sitting?
This remote course provides 5.5 contact hours and the registration fee is $175. The 2022 scheduled course dates are:
Practitioners who have taken Sacroiliac Joint Current Concepts, Bowel Pathology, Sacral Nerve Manual Assessment and Treatment, Yoga for Pelvic Pain, or Ramona Horton's Mobilization of the Myofascial System courses may be interested in attending this course.
Lila Abbate PT, DPT, OCS, WCS, PRPC is the creator and instructor of Bowel Pathology, Function, & Dysfunction and Coccydynia and Painful Sitting. She also co-wrote the course Pudendal Neuralgia and Nerve Entrapment with fellow H&W faculty member Pamela Downey.
Often pelvic health physical therapists are nervous about treating patients with bowel dysfunction and constipation. Lila Abbate's mentor, Elise Stettner, is proud to be a PT who treats bowel conditions. “Any PT can treat urinary symptoms. The patients who are really suffering are those with bowel dysfunctions.” She passed this passion on to Lila, who is the creator and instructor of the Bowel Pathology, Function, & Dysfunction scheduled next on November 13-14, 2021.
Bowel dysfunctions and constipation are often embarrassing for those who suffer from them and thus are often under-reported, which may lead to statistical underrepresentation. The statistics that we do have show that the average prevalence of constipation worldwide in adults is 16%, and for adults over the age of 60 is over 33.5%. (1) Everyone has a different normal for bowel habits which makes it hard to define a normal frequency. Constipation can generally be defined as less than three bowel movements per week and can present as infrequent bowel movements or difficult passage of stools that lasts for several weeks.
There are many potential facets to pelvic floor muscle problems concerning constipation. Lila shares that she recommends that therapists provide a muscle activity assessment in a sitting position, and can even utilize computerized-biofeedback, with the patient's hip and knees at different heights can help determine the best position for muscle relaxation during defecation. At times, it can also be useful to incorporate abdominal massage in resolving a patient's constipation. Abdominal massage for bowel function is useful in motivating peristalsis in the gut, plus there are no known side effects. This is a safe and non-invasive way to manage constipation and can be taught to the patient for them to perform on their own as needed.
In the Bowel Pathology, Function, & Dysfunction Remote Course Lila focuses on teaching registrants about the details of normal gut motility, bowel function, medical tests, and medications relating to diagnosing and treating the medical side of bowel dysfunction. Some of the highlighted lectures are about fecal incontinence, chronic constipation, and abdominal pain and how they relate to pelvic floor muscle dysfunction and physical therapy interventions.
Also commonly encountered in pelvic rehabilitation practices are patients with coccyx pain. You may not think of constipation when treating coccydynia. However, defecation is one of the functional complaints that can be present. The coccyx can interfere with defecation as documented in a case study by Salar et al. They reported that the patient presented with an anteverted coccyx, and complained of "worsening rectal pain developing an hour before defecation and lasting for several hours afterward.” (2)
Lila Abbate also instructs the Coccydynia and Painful Sitting Remote Course. This course is a 1-day deep dive into treating patients who complain of coccyx pain with sitting and defecation. Lila shares that "The coccyx course is orthopedically-based and. I take my love of manual, osteopathic treatment, and combine it with the women’s health internal treatment aspects so that we can move more quickly to get patients back on the path to improved function and recovery."
When asked about the approach she took in creating the course, Lila explains, "this course looks at patients from a holistic approach from the top of their heads down to their feet. In taking on the topic of coccydynia, I focused on honing basic observation skills and using some of my favorite tools in my toolbox. These include the Hesch Method, integrated systems model, traditional osteopathic, and mobilization approaches mixed with internal vaginal and rectal muscle treatment skill sets."
Join faculty member Lila Abbate this November at her upcoming course Bowel Pathology, Function, & Dysfunction scheduled for November 13-14, 2021, or plan ahead and register for the Coccydynia and Painful Sitting Remote Course scheduled for February 4, 2022.