SpinalColumnRadio

Episode 014 — A Pain in the Butt and Your Chiropractor

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SHOW NOTES

Title: A Pain in the Butt and Your Chiropractor

Episode Number: 014

Host: Dr. Thomas Lamar

Show Date: 06/11/2010

Run Time: 17:55

Description: Tailbone pain.  Coccydynia. Coccygeal pain.  Pain in the coccyx.  Or, simply, a pain in the butt.  Regardless of what you call it, it can be extremely painful and debilitating.  Fortunately there is hope, and it can be as simple as a visit to your friendly chiropractor.

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Does your podcast listening schedule need a little backbone? If so, it’s time to schedule an appointment with your podcast chiropractor, Dr. Thomas Lamar.

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Transcript:

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Spinal Column Radio, episode number fourteen.

Coming up next on Spinal Column Radio — A Pain in the Butt and Your Chiropractor.

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[intro theme music]

And welcome back to another exciting and information packed episode of Spinal Column Radio.  My name is Dr. Thomas Lamar, chiropractor and Dad of 6.   And this is the podcast that gets you to think.  To think about your health in a whole new way.  We’re the podcast for your backbone… the podcast with backbone.  Who knew that spinal education could be this much fun?

We’d like to invite you to visit our podcast website at spinalcolumnradio.com where you can learn more about us, check out our world-renown “What’s a Podcast?” page, and can access the show notes for this episode.  Also, we encourage you to leave comments and ask questions through our website, or, if you prefer, you can email me using DrLamar AT spinalcolumnradio DOT com.

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[transitional sound effect]

Well, we’re going to be talking about butt pain today… as my 10 year-old, audio engineer son, snickers by my side.

But, before we do… I wanted to say a big thank you to ChiroCat … our first comment on iTunes.com. [applause sfx] She writes (actually I’m assuming she’s a she)… anyway she writes:

“This is one of the best podcast stations I have ever heard! It’s so informative and gives me inspiration to become an awesome Chiropractor someday.  Thank you so much for everything Dr. Thomas Lamar!”

Well, thank you ChiroCat, and I’m glad you are listening.  And… I wish you luck with your chiropractic studies…. which of course should include a regular dose of Spinal Column Radio.

Folks, its no secret that iTunes.com is where the majority of people find the podcast content that they enjoy listening to.  And that is precisely why we are listed in the iTunes.com store.  But with, what, 137,000 podcasts currently listed in their store…. it’s a bit easy to get lost….. So one of the ways you can help get our show noticed by more people is to do what ChiroCat just did.  Leave us a comment or rating on our page in iTunes.com… assuming, of course, that you are finding value in our show.  Besides, when Logan and I get feedback, like that… we are encouraged and eager to push forward to produce more content for our listeners.

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[transitional sound effect]

Tailbone pain.  Coccydynia. Coccygeal pain.  Pain in the coccyx.  Or, simply, a pain in the butt.  Regardless of what you call it, for those that have it, it can be extremely painful and debilitating.  Fortunately there is hope, and it can be as simple as a visit to your friendly chiropractor.

We doctors refer to the tailbone as the “coccyx.”  This name originates from the Greek word meaning “cuckoo” because of its resemblance to the bill of a cuckoo bird.  [cuckoo clock sfx]

The coccyx is formed by 3 to 5 fused caudal (tail) vertebrae at the very end of the spinal column and forms a joint with the triangular sacrum bone just above.

While I don’t hold to the opinion that the coccyx is a remnant of what once used to be a long monkey tail…. [monkey sfx] It does have a purpose.  It together with the ischial tuberosities of the pelvis form a “tripod” of sorts that bear weight when we sit down.  It also serves for the attachment of important  regional muscles and ligaments that help form what they call the “pelvic floor.”  In addition there is a collection of nerves in the front of the coccyx called the “ganglion impar”… which is responsible, in part, for servicing the pelvic organs.  So, while it might not propel us forward like the tail of a whale, or express our emotions like that of a dog [dog barking sfx]…. it does have a purpose, and certainly should not be thought of as a vestigial, evolutionary, throwaway piece of human anatomy.  Because, I’ll tell you, when the tail bone stops functioning properly, pain is just the tip of the iceberg.   Many with this condition also suffer from bladder, bowel, and sexual problems.  And because the the ganglion impar is part of a chain of nerves that runs up and down the spine (known as the sympathetic ganglion — which is responsible for the “flight or fight” response) many other odd and seemingly “disconnected” symptoms can crop up.  In addition the meningeal tissues that envelope the brain and spinal cord, end and anchor themselves on the coccyx.  It’s called the “filum terminale.” ….And problems with the coccyx can cause this anchor point to exert abnormal tension on the meningeal tissues… causing all sorts of symptoms…. a big one being headaches.  It’s kind of funny when you think about it… headaches being treated at the opposite end.  No…. I think its safe to say that the coccyx, is very important and has a distinct, and definite purpose.

Which is one of the reasons I am so troubled when I hear about the radical measures that medicine will sometimes employ.  Its called a coccygectomy.  That’s when they basically lop off the tail bone.  Just like on a Cocker Spaniel. …Because after all, it’s not really needed. [pruning shears with man yelling sfx]

While the causes of a painful coccyx can be many, invariably the most common cause comes from a  trauma of some sort.  A fall on the butt or even occasionally a difficult childbirth are typical events which can cause the tailbone to jam or displace slightly at the joint with the sacrum.   A 1994 study out of the medical journal Spine, found that perhaps up to 70% of common coccyx pain can be attributed to a displacement or abnormal motion of the sacral-coccyx joint. This slight displacement or jamming of the joint is what we chiropractors refer to as a subluxation.  And this of course begins to affect the things that we just talked about.  The muscles that make up the pelvic floor… the nerves of the ganglion impar, and the meningeal tissues, called the filum terminale, that anchor there.

But here’s another thing to consider….  Causation might not always be so obvious.  Because of the meningeal connections via the filum terminale, the coccyx can literally be “pulled” out of alignment from such things as sudden whiplashes, or more of a slow, chronic tension build up on the dura matter from a disc herniation.

Typically a person with this condition will have trouble sitting, especially on hard surfaces, due to pain.  The tailbone area will be tender to the touch, [female ouch!! sfx] as well as the surrounding muscles and ligaments that aid in its support.  This can lead to all sorts of secondary symptoms such as…. and I’ll throw out some big doctor words here:  dysuria (painful urination) Dyspareunia (pain with sexual intercourse), and dyschesia (painful… how should I say this… painful pooping) [toilet flushing sfx].

Doctors may also find that those with coccyx problems also suffer from  chronic lower back pain, sacroiliac pain, or sciatica that has been unresponsive to care thus far.  Incidentally, the patient may also suffer from chronic bouts of hemorrhoids…. and I have a story I want to share with you regarding this… but I’ll do that a little later on.

So, if you want to know if your tailbone, or coccyx, is a problem, you need to palpate it.  You need to touch it.  And to do that go a head and reach down your backside… all way down… keep going… little more…. And you’ll start to feel the tailbone curve.  And what you want to do is get right under it at the very tip… and you know you’ve gone to far if — and I apologize in advance, but I’m going to have to be a bit blunt in this episode — you know you’ve gone too far if your finger is toughing your anus.

Okay… so now, you’ve located the tip of your coccyx… how does it feel?  If it is exquisitely tender? If it is, that’s a problem.  You might notice that it is more tender on one side versus the other…. that’s also a problem.  Then start to take inventory on some symptoms you might be having in the pelvic region… or perhaps ones that might seem related, and then take a trip to your chiropractor.

The chiropractic approach to this problem is aimed at realigning the coccyx in its proper relationship with the sacrum  and/or restoring its normal motion.   By doing this, the nervous irritation that was created can be reduced or eliminated, allowing proper natural healing to take place.  Typically a patient who is a candidate for this type of treatment will show improvement in their symptoms within the first few visits.

The chiropractor may opt to utilize X-rays to aid in his diagnosis and to assist in making his care more precise.  To facilitate healing in the initial phases, the chiropractor might recommend the use of ice to reduce inflammation and pain, as well as  the use of a donut seat cushion designed to reduce the pressure that is placed on the tailbone while sitting.  In my research, I even came across a corrective taping procedure which might prove helpful.

Okay… some of you may be wondering, “Just how does a chiropractor go about adjusting the coccyx?”  Well there are basically two methods: the internal method and the external method.  While the internal method can potentially be the most uncomfortable for the patient — given the circumstances involved, it can also be the most effective.

Now, I’m not going to describe the entire procedure, but typically the patient is side lying.  They’d be gowned appropriately, and there should be a female assistant in the room — especially if the doctor is male and the patient is female. And again,  I’m going to be a bit blunt here… The chiropractor, with a lubricated-gloved finger will insert his finger into the patient’s anus, reaching into the rectum until the finger is on the front side of the coccyx.  The adjustment itself is usually a slow pull on the coccyx in the direction of the restriction… but the doctor might opt to do a quick tug — it all depends on the chiropractor’s training and choice of technique for the situation.  The process can be quite uncomfortable but is usually not painful.  The good news is that usually once is all that is needed to bring the tailbone back into proper alignment.  Sometimes, in more stubborn cases, up to a few times may be needed.  But the internal coccyx adjustment can be extremely powerful and extremely effective.

The other method — the external method — works as well… but does not share in the high success rate of the internal method.  And while I’ve seen a variety of styles for this move, usually, what I do is have the patient lie face down.  I will then contact the skin just above their coccyx and slowly tug it head ward…  The patient is fully clothed… and usually I can have them loosen their belts or waistbands enough so I can reach down under their pants to make the contact… sometimes I am able to contact right over their clothing.   It just depends.  …..when this tissue is in tension, I will then impart a quick chiropractic thrust that literally uses the tissue tension I’ve just created to “pull” the forwardly displaced coccyx back into alignment.

Chiropractors will also usually address the tight ligaments and spastic muscles in the tailbone neighborhood (such as the sacrospinous ligament, the sacrotuberous ligament, and piriformis muscle to name a few)… And this helps to bring about pain reduction and balance to the region.  In addition, the neighboring joints of the pelvis, sacrum, and lumbar spine will also need to be assessed.

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[transitional sound effect]

Okay…. story time.  I’ve got a couple that I want to share with you to make this condition a little more human.

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[transitional sound effect]

I had a patient who came in for lower back pain about 12 years ago.  I started treating her and she was showing signs of improvement.  And for those of you who have been adjusted before — you might be aware of a pretty common manual, adjustive move that’s used on the lower back…. it’s called a “side posture adjustment.”  So I had her on her side, and I was preceding to adjust her sacroiliac joint… which is at the bottom part of the spine.  Well, as I went to adjust her sacrum, I inadvertently placed my hand a little lower than usual — not much… but a little lower — only to have the patient yelp in pain.  Well, this startled me of course, because all I had done was just barely touch her.  As turns out, she was suffering from chronic tailbone pain… and had done so for nearly half of her life from various falls of one sort or another — and in particular, a fall off of a horse.  Well, she had been sitting a lot that day and it was feeling a bit uncomfortable — which is probably why I didn’t find it on her initial exam.  The irony is, that she had never considered a chiropractor as being someone who could help her with this condition. And she had seen chiropractors in the past.  Remember, she had come to me for lower back pain.

Well, the long and the short of it was, that I started treating her coccyx with the external move, prescribed her a donut pillow to sit on, and the chronic tailbone pain that she had learned to live with for 20 plus years went away in a handful of visits over about a three week period.

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[transitional sound effect]

Now, this next story has to do with the “hemorrhoid issue” that I was referring to earlier.  Now, I wasn’t the chiropractor in this case, but this particular success story came out of chiropractic school.  You see, one of the students, a young woman, had suffered from chronic hemorrhoids for a good portion of her life. Her father, just so happened to be an ObGyn.  Her hemorrhoids were apparently so bad that she suffered through the utter embarrassment of have her father and his colleague surgically remove them… only to have them reappear.  Well… flash forward a bit.  She eventually enrolls in chiropractic college.  During one of her adjustive technique courses, the coccyx moves were discussed…. and I believe they were coaching the students in the external move that I was discussing.  Now, the student doctors actually did not deliver a full blown adjustment — at least they weren’t supposed to — but rather, they mastered the set up and then delivered a small, practice thrust — kind of like how a baseball player might deliver a “check swing.”  Well… guess what happened?  Her hemorrhoid problems went away.  And what’s more… is that it went away from the hand of a student who was merely learning this procedure for the first time and he didn’t even give her the full adjustment.  It turns out, in retrospect, she had suffered from a good fall on the butt earlier in her life.

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[transitional sound effect]

Most of us probably don’t think much about our tailbones, but for those who suffer from coccydynia — it truly is a “pain in the butt.”  For these people, a visit to their chiropractor may prove to be just what they need.

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[outro theme music]

Well, that’s going to wrap up this episode.  Hey if you are interested, I did author an article on this subject and you can find that on our SpinalColumnBlog.com website.  I’ll put a link in the show notes.  And of course, if you have questions or comments, drop me a line at drlamar AT spinalcolumnradio DOT com or leave it in the comments section of the show notes for this episode.

Spinal Column Radio would like to remind you that true health comes from the inside out — not outside in.  As such, the content of this podcast, along with the show notes and related links, is not intended to cure, diagnose, treat, or prevent any disease.  But, instead, is meant to inform and inspire you in asking better questions regarding your health.  Since the circumstances surrounding your particular situation are unique, you are encouraged to consult with a Doctor of Chiropractic — or other health care practitioner of your choosing.

Next time on Spinal Column Radio, world renown Animal Chiropractor, Dr. Daniel Kamen joins us on the show to talk about this very interesting chiropractic specialty. That’s in two weeks.  So, until then, for my son Logan, who’s tweaking the knobs on the mixer board, this is Dr. Thomas Lamar, your podcast chiropractor.

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Spinal Column Radio is a production of Spinal Column Communications in conjunction with AnchorChiropractic.net.  Copyright 2010.

Download a PDF version of these Show Notes

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