Manual therapy + movement for the masses

Coccydynia and DTM-CASE STUDY

Coccydynia and DTM-CASE STUDY
January 29, 2018 Phillip Snell

Coccydynia is truly a pain in the a$$! This is a quick case study of a patient just seen in our office that responded well to dermal traction method (DTM) targeting a neural structure we’ve not previously discussed here…the coccygeal nerve.

The 45 y.o. female patient was referred to our clinic by another DC and she drove for 2 hours to arrive at our clinic. That is no small feat because prolonged sitting was one of the provocative activities.

Symptoms arose insidiously 2 years before with only correlation being initiation of a new yoga routine. She reliably felt 7/10 pain in the area when sitting in a slumped fashion with weight on the sacrum. She could also reliably reproduce the pain performing a quadruped “fire hydrant” exercise using the left leg.

Past medical history was notable for absence of trauma over the area as well as a total hysterectomy in 2011 which successfully managed uterine fibroids.

To screen the area, we first considered the spinal level of the neuro in the area affected and performed prone press ups to as an intervention to see if they ameliorated symptoms. No significant benefit was appreciated.

We queried the peripheral neuro using slump and SLR but symptoms were equivocal owing to the position of the tests placing some pressure over the sensitive area.

Palpation localized the discomfort to the tip of the coccyx and somewhat on the bilateral sacrotuberous ligaments. Dermal traction over the coccyx to theoretically affect the coccygeal nerve offered 30% reduction in pain with the “fire hydrant” movement. A silicon cup placed on that area was similarly effective and after performing 10 reps of the movement, her pain was improved by 70%. Additional skin rolling over the area allowed for 90% improvement. Given the upcoming 2 hour drive home, she received RockTape over the area, after which she was unable to reproduce the pain.

She was given instructions to apply dermal traction over the sacrum and coccyx 4-5X daily while moving or performing the previously painful movement. Some here know my bias about discogenic back pain, and I suggested she remove forward folds from her yoga class temporarily and perform prone press ups 3-5X daily for 10 reps.

Patient was quite happy with the results and will return in several weeks if symptoms don’t continue to improve.

Be well,

Dr. Phillip Snell

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