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Coccydynia and Painful Sitting

Herman & Wallace Pelvic Rehabilitation Institute

Objectives

Upon completion of this continuing education seminar, participants will be able to:
1. Identify the structures of the coccyx and understand the anatomy and nerve innervation to the coccyx and its adjacent structures.
2. Explain the basic function of the coccyx and the role of the coccyx relating to the sacrum, inominates and lumbar spine during sitting, standing and walking.
3. Understand normal coccyx placement, displacement, and deviation.
4. Explain the function of the coccyx and how it relates to sitting, bowel function and the birthing process.
5. Review of the literature regarding coccyx pain and medical testing, medical treatments, medications and surgical techniques.
6. Apply the principles of joint mobilization, muscle energy techniques, Hesch Method, Strain-Counterstrain and Theile’s massage to change coccyx position.
7. Effectively apply an up- or downtraining program for patients with coccyx dysfunction.
8. Effective use of modalities and taping techniques for neuromuscular re-education.
9. Create an appropriate plan of care relating to a patient’s symptoms and physical examination.
10. Select the most appropriate physical findings and use of validated questionnaires to determine a treatment plan.
11. Learn basic treatment options to relieve the patient of coccyx pain during defecation and sitting.

Target Audience

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by indivuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Confirmation Notes

Lab Attire:
Participants are encouraged to bring a loose fitting shorts, SI belt and McConnell taping to the course. There is external palpation and internal palpation and treatment labs.

Agenda

Day One:
8:00 Introduction/Course Objectives 8:45 Anatomy and Biomechanics of the Coccyx & Pelvic Girdle 10:00 Break 11:15 Medical Treatment of Coccydynia: Review of the Literature 12:00 Lunch 1:00 Physical Therapy Treatment of Coccydynia: Review of the Literature 2:00 External palpation lab of pelvis and its relationship to the coccyx position. Introduction to Hesch Method in treating coccyx pain 3:00 Break 3:15 External Strain-Counter Strain external techniques for lower quarter muscles and their relationship to the coccyx 5:00 Adjourn

Day Two:
8:00 Review 8:30 Internal rectal lab: internal treatment palpation and mobilization of the coccyx including Strain-Counter Strain, Theile’s massage 9:45 Break 10:00 Internal vaginal lab: internal treatment palpation and mobilization of the coccyx 12:00 Lunch 1:00 External coccyx neuromuscular taping lab 2:15 Break 2:30 Seating Options 2:45 Home Exercise Program and Case Studies 4:00 Adjourn

Description

Coccyx pain is a common, frustrating condition for the patient who often has difficulty sitting, one of the most important tasks necessary for daily activity. Patients who find help from a pelvic rehabilitation provider have often experienced pain near the tailbone for long periods of time, leading to chronic pain in addition to neuromusculoskeletal dysfunctions. This two-day continuing education course allows the therapist to focus on this vital, sensitive area to learn and refine skills in assessment and treatment. Anatomy, pathology, and detailed palpation skills of the coccyx region is instructed. Evidence is utilized to provide a solid foundation in current evaluation and interventions for coccyx pain. Tools ranging from manual (both external and internal) therapies, taping, therapeutic exercise, sitting modifications, modalities, and outcomes surveys will be included in the course.

In addition to learning local evaluation and treatment of the coccyx, participants will learn how to apply principles of biomechanics to the pelvis as they relate to the trunk, spine, and lower extremities. Sacral dysfunction, which can also be a main contributor to coccydynia, will be addressed with various mechanical approaches. The coccyx has a critical relationship to the pelvic floor muscles, and coccygeal pain can create or perpetuate pelvic floor dysfunction such as painful voiding or defecation and difficulty emptying the bladder or bowels. This course instructs the attendee in the functional movement patterns of the coccyx.

Medical testing and medical interventions including pharmacology and surgical approaches are discussed. At the conclusion of this training a therapist will have the ability to communicate with a provider about clinical findings and perform appropriate examination skills and treatments for the patient who has coccyx pain. The class was written specifically for therapists who are interested in refining skills for treating coccydynia. Lila Abbate, course instructor, shares her extensive experience in clinical care and teaching so that therapists can help patients recovery effectively and efficiently.

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