A 42 year-old professional violinist presented to our clinic with complaints of coccyx pain that began after the birth of her daughter approximately one year ago. During her delivery she received an epidural and induction. Soon after, she began to experience pain in the region of her tailbone or coccyx which worsened with sitting on hard surfaces as well as the floor. During her physical therapy evaluation, she demonstrated sacroiliac (SI) joint and sacral torsion or misalignment as well as multi-level lumbar vertebral segmental dysfunction. Her coccyx was hyper-flexed or drawn under. Right pelvic floor musculature revealed myofascial restriction and tenderness. Her PT diagnoses included: SI joint dysfunction, lumbar spine dysfunction, coccydynia and pelvic floor muscle dysfunction (hypertonic or overactive). Treatment for this patient consisted of manual correction of her pelvic and lumbar misalignment, myofascial release to the related restricted soft tissue. She was instructed in appropriate therapeutic exercises to improve any muscoskeletal imbalances. During her physical therapy evaluation, the patient was asked to explain the regular, daily movements and postures assumed while being a professional violinist. She explained that her trunk was repetitively flexed, sidebent and rotated to the left. Interestingly, those very postures and movements were placing repetitive strain on her spine and pelvic floor musculature in all of the places where dysfunction was discovered and her symptoms presented. This posturing caused her pelvic floor musculature to overwork on leading to strain. Therefore, postural training and Feldenkrais© movement techniques were added to her home program to relieve strain and re-educate her body for improved balance of movement. She has found her treatment to be beneficial and is already on the road to recovery. The important point to note from this case is that although the trauma from her birth delivery may have triggered her coccyx pain, her underlying musculosketal imbalances from perpetual movements as a violinist made her vulnerable to injury. A thorough patient history often is the key to creating an effective and lasting treatment protocol.
Written by Luba Starostiak, PT, OCS
