The Treatment of Chronic Coccydynia With Intrarectal Manipulation

In Brief Study Design. Randomized open study. Objective. To evaluate the efficacy of intrarectal manual treatment of chronic coccydynia; and to determine the factors predictive of a good outcome. Summary of Background Data. In 2 open uncontrolled studies, the success rate of intrarectal manipulation of the coccyx was around 25%. Methods. Patients were randomized into 2 groups of 51 patients each: 1 group received three sessions of coccygeal manipulation, and the other low-power external physiotherapy. The manual treatment was guided by the findings on stress radiographs. Patients were assessed, at 1 month and 6 months, using a VAS and (modified) McGill Pain, Paris (functional coccydynia impact), and (modified) Dallas Pain questionnaires. Results. At baseline, the 2 groups were similar regarding all parameters. At 1 month, all the median VAS and questionnaire values were modified by −34.7%, −36.0%, −20.0%, and −33.8%, respectively, in the manipulation group, versus −19.1%, −7.7%, 20.0%, and −15.7%, respectively, in the control (physiotherapy) group (P = 0.09 [borderline], 0.03, 0.02, and 0.02, respectively). Good results were twice as frequent in the manipulation group compared with the control group, at 1 month (36% vs. 20%, P = 0.075) and at 6 months (22% vs. 12%, P = 0.18). The main predictors of a good outcome were stable coccyx, shorter duration, traumatic etiology, and lower score in the affective parts of the McGill and Dallas questionnaires. Conclusions. We found a mild effectiveness of intrarectal manipulation in chronic coccydynia. Intrarectal coccygeal manipulation constituted a more effective treatment of chronic coccydynia than did the control treatment. The 6-month success rates were 22% and 12%, respectively. Manipulation was found to be more effective where the coccydynia was post-traumatic, of recent onset, and not associated with coccygeal instability or adverse psychosocial factors.