Pain in the lt. tail bone region

[sanagupta]

Hi!
I have a client presenting with the pain in the taill bone region and pain radiating to lateral and anterior thigh region going upto the lateral leg.this pain manifests after walking just two steps and sitting for 5 minutes and subsides within 2 minutes ones she lies down since 2 and a half months.she presents wirh lateral disc protrusion on the same side..and one of the ortho has diagnosed her with evolving connective tissue disorder of the hip.
she too has spondolysthesis of l4 over L5.she has atender point somewhere in the vicinity of sacral vertebra2.
i m treating her with contrast fermentatuion to relief the spasm at her back Tens for pain relief and burnong sensation...and sacral mobilisation in flexion...but it has not helped her much..
Please Help...
Sana

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[arjunh]

hi Sana
Could you be a bit more clear on where is the pain exactly...is it exactly over the coccyx and hence it aggrevates on sitting?
also could you tell me the level of the disc prolapse?

Best of Luck

[sanagupta]

Hi..
she has pain on the left side of tail bone...not exactly on the bone.She too get that pain only on walking and sitting
as far as level of prolapse is concerned it is L4 -L5 lt. posterolateral..
Regards
sana

[sanagupta]

Hello everybody!
Just want to update the symptomsof the patient
Now she has pain L4-L5 ...PA and Unilateral PA at same level.She is experiencing pain in the tail bone region left..with pain still radiating to her left les..though now she can stit comfortably longer....
Please Help....I m stuck
Regards
sana

[Physiobase]

Can you assess her pelvic symmetry, in standing and sitting and lying as well as her leg length descrepancy/or not, in supine and sitting and get back to us. Also note the internal rotation of the hip with the leg fully extended in supine and with the hip at 90 degrees flexion. We will await the results.

p.s. If you see an assymetry there, then you can start to correct it.

p.p.s

A useful text is:

The Pelvic Girdle, 3rd edition
An Approach to the Examination and Treatment of the Lumbopelvic-Hip Region

By Diane Lee, BSR, MCPA, FCAMP, Instructor/Examiner for the Orthopaedic Division of the Canadian Physiotherapy Association

ISBN 0443073732 · Paperback · 280 Pages · 392 Illustrations
Churchill Livingstone · Published June 2004

[sanagupta]

Hello!
Thanx for the reply
There was pelvic assymetry
Lying None
Sitting None
Standing ASIS level towards left one inch above
No leg lengh assymetry in lying or sitting
IR in lying with leg straight end range restricted towards left
With flexed knee painful
PSIS assymetry was also visible in forward bending

She went to a pain clinic where she was diagnosed as L4-L5 radiculopathy and Suggesred IMS
What is IMS
Any further assesment u want me to carry do tell
Thanx for ur kind intrest..i m really stuck badly
Regards
Sana

[Physiobase]

OK sounds like the pelvis is out of place, perhaps drive a little by the Lx due to no assymmetry in sitting or lying..but this might not be quite accurate. Now you should look for trendelenbergs sign and stork tests on both legs, and look for any in flare or ourflare of the pelvic bones. Draw a midline down from the belly button (naval) and eyeball the distance of the ASIS's from this line. Then give some more feedback. I will try to find some text for these tests that I can copy and paste.

For now though get into releaseing his psoas, illiacus, and piriformis to give the pelvis an opportunity to move. Hold/relax and contract/relax techniques through range of the hip for prriformis and psoas might well help here.

[sanagupta]

Hello!
Thanx for the prompt reply.
I 'll check the things mentioned. tomorrow.
I was working on piriformiis and iliacus from day one...but that is the peculiar thing happened ....her piriformis cleared but from last 6 days has become painful...
PA L4-L5 central and unilateral has increased since that time.
L5-S1 is slightly painful..Is this any way pointer to the centralisation phenomena...point pain on buttock has also diffused
Waiting fot ur reply
Regards
Sana
thanx once again

[Oceantan]

Pain over buttock area radiating to front and lateral side of thigh. Does not go beyond knee. Pain increases with hip IR in neutral or 90deg Hip flexion. Some stiffness felt. Pain aggravate when sitting and walking.. You treated piriformis. I presumed hip flexion / adduction maneuvers because this was also positive with pain.

I would put the hip joint as high up in my hypothesis list.

I would confirm with additional tests such as hip extension and abduction ROM (Active and Passive). If hip, these ROM would be painful as well (less so than IR).