Most of us spend our day sitting and do not think about the position of our ilia, sacrum or coccyx during the change from standing to sitting. Weightbearing through a tripod of bilateral ischial tuberosities and a sacrum that should have normalized form closure should be easy and pain free. The coccyx typically has minimal weight bearing in sitting, about 10%, just like the fibula, however, it can be 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. Women’s health providers treat anything regarding the pelvis, so we are seeing a lot of complicated histories and symptoms.
Scanning the literature for coccyx treatment does not always yield the best results for physical therapists. Most literature states what the medical interventions can be, and physical therapy is never at the forefront. However, as we are musculoskeletal and neuromuscular specialists, this is no different on our thinking patterns relating to coccyx pain or painful sitting.
During sitting, the coccyx has a normal flexion and extension moments that will change or become dysfunctional once mechanics above and below that joint change. A simple ankle sprain from 2 years ago can result in chronic knee pain, sacroiliac pain, and can lead to coccyx pain over time. Even the patient who has long standing TMJ (temporomandibular joint) and cervical dysfunction, now has a thoracic rotation and your correction of their coccyx deviation cannot maintain correction.
This course sparks your orthopedic mindset, encouraging the clinician to evaluate the coccyx more holistically. What are the joints doing? How does it change from sitting to standing? Standing to sitting? What is the difference from sitting upright to slump activities? Working through the basics and the obvious with failed results, takes you to the next step of critical thinking within this course. How does the patient present, what seems to be lacking and how to correct them biomechanically to achieve pain free sitting?
Related coccyx musculature and nerve dysfunction can seem like the easiest to treat, but what happens when those techniques fail? This course looks at the entire body, from cranium to feet, to determine the driver of coccyx pain and dysfunction. A better understanding of ilial motion, with accompanied spring tests (Hesch Method), normalizing spinal mechanics and lower extremity function is highlighted in this course. Internal vaginal and rectal release of pelvic floor muscles can lead to normalized coccyx muscle tension that are supported via coccyx taping.
An interesting study aimed to objectively answer the following question: Does applying kinesiotape to promote a posterior pelvic tilt improve an active straight leg raise (ASLR) test in women who have sacroiliac joint pain and who habitually wear high-heeled shoes? To explain some of the rationale for the chosen technique and target population, the authors first describe prior research pointing out that use of high heels can lead to an anterior pelvic tilt position and increased lumbar lordosis. This position can slacken the sacrotuberous ligament and therefore reduce the ability of the ligament to create proper form closure, according to the article.
The research included 16 women with a mean age of 23.63. Inclusion criteria is as follows: having a habit of wearing high-heeled shoes (at least 4 times/week for 4 consecutive hours over at least 1 year), and having pain in both sacroiliac joints with the active straight leg raise test (ASLR). Additionally, having symptoms for at least 3 months, no proximal SIJ pain referral to the lumbar spine, and at least 3 of 5 positive SIJ tests (posterior shear test, pelvic torsion test, sacral thrust test, distraction and compression test) were needed for inclusion in the study.
Anterior pelvic tilt was measured using a palpation meter (PALM) before, immediately after application, 1 day after tape application, and immediately after removal of tape. ASLR was measured at same time points. The ASLR was self-scored on a 6-point scale ranging from “not difficult at all”” to unable to perform”. Kinesiotape was applied for a posterior pelvic tilt taping, and the tape was applied in the target position. I-type strips with ~50% of available tension were applied over the rectus abdominis and external oblique muscles. I-type strips with ~75% tension were placed from ASIS to PSIS aiming for mechanical correction of the anterior tilt.
Results of the study indicated a decrease inanterior pelvic tilt, both during and after tape application, and an improved active straight leg raise test. As this was a preliminary study, the results cannot be extrapolated to SIJ pain and dysfunction with other activities than the ASLR test. The degree of anterior pelvic tilt cannot also directly be correlated to sacroiliac joint pain and dysfunction, yet this research is very interesting, and demonstrates a simple method for affecting in the short term a patient’s mechanics as well as reports of function on the ASLR test, a very clinically simple and useful exam.
If you would like to learn more about evaluating and treating dysfunctions related to the sacroiliac joint, join Peter Philip at Sacroiliac Joint Evaluation and Treatment - New Orleans, LA this Sep 12, 2015 - Sep 13, 2015.