The applicability of an integrated clinical approach in the management of a patient with chronic aspecific coccygodynia in association with chronic aspecific low back pain: A case report.
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Abstract
INTRODUCTION
Coccygodynia is a musculoskeletal disorder that reduces the quality of life of people in which it occurs. It affects about 1% of the general population with musculoskeletal disorders and it could be due to a multifactorial aetiology. Musculoskeletal disorders in other adjacent areas such as the sacroiliac and/or lumbo-sacral joints may also be associated in the physical examination. The current evidence for the diagnosis of coccygodynia is controversial both for the difficulty in the correlation between pain and structural factors and for the absence of evidence regarding the sensitivity and specificity of the clinical examination. Conservative treatment involves a series of passive interventions to reduce pain. The aim of this paper is to demonstrate how an integrated clinical reasoning could be used in the management of a patient with an aspecific musculoskeletal coccygodynia.
CASE PRESENTATION
The patient reports pain localized in the coccyx for about 3 years with worsening after activities in which there is an increase in load and/or long periods in standing position and/or when getting up from a prolonged sitting/supine position. The patient also refers pain in the lumbar spine. Both coccyx and lumbar pain decrease due to a partial limitation of daily life activities and an abstention from amateur football play. At physical examination the patient presents lumbar hyper-lordosis and hyper-activation of peri-vertebral muscles (static observation) with an alteration in lumbo-pelvic rhythm and during squat (dynamic observation). The palpation of the coccyx and the area adjacent to it causes coccygeal pain and refers to the sacroiliac joints. The functional diagnosis is ‘Chronic Aspecific Coccygodynia associated with Chronic Aspecific Low Back Pain’. A central mechanism of pain is prevalent in the maintenance of both musculoskeletal disorders. The reduction of functional and psychological impairments through desensitization, education and gradual increase in load is the tool of the treatment plan for a complete return to activity and participation. After five sessions the patient partially returns to daily life activities without any previously reported pain. At the follow-up at three, six, nine and twelve months there is a complete return to daily life activities and to playing football in the absence of coccygeal and lumbar pain.
CONCLUSIONS
This case report describes the success of pain functional and psychological management in a patient with ‘Chronic Aspecific Coccygodynia associated with Chronic Aspecific Low Back Pain’. The use of an integrated clinical approach in patients with coccygodynia could be a practical example to guide physiotherapists performing a functional diagnosis triage and to choose the correct treatment plan for each individual patient. Future studies could consider this decision-making process to validate it when a patient complains pain in the coccyx.
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Riferimenti bibliografici
[2] Awwad WM, Saadeddin M, Alsager JN, AlRashed FM. “Coccygodynia review: coccygectomy case series” Eur J Or-thop Surg Traumatol 2017. 27(2):961-965.
[3] Lirette LS, Chaiban G, Tolba R, Eissa H. “Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain” Ochsner J 2014. 14(1):84-87.
[4] Foye PM. “Coccydynia: Tailbone pain” Phys Med Rehabil Clin N Am 2017. 28:539-549.
[5] Nathan ST, Fisher BE, Roberts CS. “Coccydynia. A review of pathoanatomy, aetiology, treatment and outcome” J Bone Joint Surg Br 2010. 92(12):1622-1627.
[6] Howard PD, Dolan AN, Falco AN, Holland BM, Wilkinson CF, Aink AM. “A comparison of conservative interventions and their effectiveness for coccydynia: a systematic review” J Man Manip Ther 2013. 21(4):213-219.
[7] Sejer A, Sarikaya IA, Korkmaz O, Yalcin S, Malkoc M, Bulbul AM. “Management of persistent coccydynia with transrectal manipulation: results of a combined procedure” Eur Spine J 2018. 27(5):1166-1171.
[8] Emerson SS, Speece AJ. “Manipulation of the coccyx with anesthesia for the management of coccydynia” J Am Osteopath Assoc 2012. 112(12):805-807.
[9] Marinko LN, Pecci M. “Clinical decision making for the evaluation and management of coccydynia: 2 case re-ports” J Orthop Sports Phys Ther 2014. 44 (8):615-621.
[10] Wray CC, Easom S, Hoskinson J. “Coccydynia. Aetiology and treatment” J Bone Joint Surg Br 1991. 73(2):335-338.
[11] Woon JT, Perumal V, Maigne JY, Stringer MD. “CT morphology and morphometry of the normal adult coccyx” Eur Spine J 2013.22(4):863-870.
[12] Foye PM, Kumar S. “Letter to the editor concerning ‘CT Morphology and Morphometry of the normal adult coc-cyx’” [by Woon JT et al. (2013); Eur Spine J 22(4):863-870]. Eur Spine J 2014. 23(3):701.
[13] Woon JT, Stringer MD. “Authors' reply to the letter to the editor of P.M. Foye et al. concerning ‘CT Morphology and Morphometry of the normal adult coccyx’” by Woon JT et al. (2013); Eur Spine J 22(4):863-870.Eur Spine J 2014. 23 (3): 702.
[14] Woon JT, Maigne JY, Perumal V, Stringer MD. “Magnetic resonance imaging morphology and morphometry of the coccyx in coccydynia” Spine 2013. 38(23): E1437-1445.
[15] Ristori D, Miele S, Rossettini G, Monaldi E, Arceri D, Testa M. “Towards an integrated clinical framework for pa-tient with shoulder pain” Arch Physiother 2018. 8:7.
[16] Cook C, Brismée JM, Sizer PS Jr. “Subjective and objective descriptors of clinical lumbar spine instability: a Delphi study” Man Ther 2006. 11(1):11-21.
[17] Laslett M, Aprill CN, McDonald B, Young SB. “Diagnosis of sacroiliac joint pain: validity of individual provoca-tion tests and composites of tests” Man Ther 2005. 10(3):207-218.
[18] Testa M, Francini L, Maistrello LF. “Atlante delle tecniche di terapia manuale. Pelvi e rachide toraco-lombare” 9th ed. Savona: Università degli studi di Genova – Campus di Savona; 2019.
[19] O’Sullivan PB. “Lumbar segmental ‘instability’: clinical presentation and specific stabilizing exercise manage-ment” Man Ther 2000. 5(1):2-12
[20] Dankaerts W, O'Sullivan P, Burnett A, Straker L. “Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification” Spine 2006. 31(17):2017-2023
[21] O’Sullivan P. “Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism” Man Ther 2005. 242-255.
[22] Hagenaars LHA, Bernards ATM, Oostendorp RAB. “The Multidimensional load/Carriability Model” Nederlands Par-amedisch Institut.
[23] Butler DS, Moseley LG. “Explain pain” 1st ed. Adelaide:Noigroup Publications; 2003.
[24] Childs JD, Piva SR, Fritz JM. “Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005” 30(11):1331-1334.
[25] Monticone M, Giorgi I, Baiardi P, Barbieri M, Rocca B, Bonezzi C. Development of the Italian Version of the Tam-pa Scale of Kinesiophobia (TSK-I): Cross-Cultural Adaptation, Factor Analysis, reliability, and validity. Spine 2010. 35 (12): 1241-1246.
[26] Monticone M, Baiardi P, Ferrari S, Foti C, Mugnai R, Pillastrini P, Rocca B, Vanti C. “Development of the Italian version of the Pain Catastrophising Scale (PCS-I): cross-cultural adaptation, factor analysis, reliability, validity and sensitivity to change” Qual Life Res 2012. 21 (6): 1045-1050.27
[27] Carnes D, Mullinger B, Underwood M. “Defining adverse events in manual therapies: A modified Delphi consensus study” Man Ther 2010. 15(1):2-6.
[28] Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. “The mechanims of manual therapy in the treatment of musculoskeletal pain: a comprenshive model” Man Ther 2009. 14(5):531-538.
[29] Luomajoki H, KoolJ, de Bruin ED, Airaksinen O. “Reliability of movement control tests in the lumbar spine” BMC Musculoskelet Disord 2007. 8:90.
[30] Luomajoki H, Kool J, de Bruin ED, Airaksinen O. “Movement control tests of the low back; evaluation of the dif-ference between patients with low back pain and healthy controls” BMC Musculoskelet Disord 2008. 9:170.
[31] Luomajoki H, Kool J, de Bruin ED, Airaksinen O. “Improvement in low back movement control, decreased pain and disability, resulting from specific exercise intervention” Sports Med Arthrosc Rehabil Ther Technol 2010. 2:11.
[32] Lumajoski H, Moseley GL. “Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls” Br J Sports Med 2011. 45(5):437-440.
[33] Gagnier JJ, Kinele G, Altman DG, Moher D, Sox H, Riley D; “CARE Group. The CARE guidelines: consensus-based clinical case reporting guidelines development” J Med Case Rep 2013. 7:223.
[34] Gomes-Neto M, Lopes JM, Conceiçấo CS, Araujo A, Brasileiro A, Sousa C, Carvalho VO, Arcanjo FL. “Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: a systematic re-view and meta-analysis” PhysTher Sport 2017. 23:136-142.
[35] O’Sullivan PB, Beales DJ. “Diagnosis and classification of pelvic girdle pain disorders--Part 1: a mechanism-based approach within a biopsychosocial framework” Man Ther 2007. 12(2):86-97.
[36] Kangas J, Dankaerts W, Stars F. “New approach to the diagnosis and classification of chronic foot and ankle dis-orders: identifying motor control and movement impairments” Man Ther 2011. 16(6):522-530.