Tailbone Pain (Coccydynia): Causes, Symptoms & Treatments

Dealing with pain is never an easy situation. However, when you deal with coccydynia, or tailbone pain, it can be difficult to do even the most normal daily tasks such as sitting at your desk. Tailbone pain can be caused by a variety of things and is more common in women than it is men. Here is a look at the symptoms of coccydynia, causes of the pain and how it can be treated to get you back to living life as normal.

Causes and Symptoms

A variety of things causes this type of pain such as a fall or trauma to the area, childbirth, and in some rare cases an infection or tumor in the area. As mentioned before this is more typical in women than men but men do suffer from it as well. The symptoms are usually pain that is worsened by sitting or putting pressure on the area itself. If it is tender to the touch or noticeably worse when sitting, it could be coccydynia. It may feel worse if you’re constipated or you may feel relief after having a bowel movement. You may also notice worse pain when you go from sitting to standing positions.

Treatment Options

Dealing with tailbone pain can be a difficult process but there are some things to try that will hopefully relieve the pain noninvasively. Your doctor may suggest to use NSAID’s to help with the inflammation and swelling in the area. They may also suggest to apply cold packs to the area several times every day to help reduce the swelling. You can also add heat later to help reduce the pain.

Making sure you stay off the area for prolonged periods of time can help reduce pain as well. Make sure not to sit in one position for too long, but get up and walk around to reduce the pressure on the tailbone area. You can also utilize a donut shaped pillow to help reduce the pressure applied on the coccyx area when you’re in a seated position. If you notice that constipation or a bowel movement causes or removes pain, then it’s important to be sure to get enough fluid and possibly take a stool softener to help reduce the pain during those times.

Other methods that are non-surgical include gentle stretches, chiropractic manipulation of the area, and injections to block the pain. There’s also physical therapy ultrasound techniques that can help to reduce the pain in the area. In severe cases where nothing else has helped after months of treatment, surgery may be required to fully get rid of pain.

Spinal Stenosis: Cause & Symptoms

Spinal stenosis is the result of the narrowing of free spaces in the spine. This will cause extra pressure to act onto the spinal cord and the nerves running through it. In majority of the cases, spinal stenosis affects the lumbar spine. This will eventually cause pain along the legs and make walking a difficult task to accomplish.

Causes

There are many different possible causes for spinal stenosis:

  • As we grow older, our soft connective tissues such as the tendons and ligaments will start to harden and thicken. When this happens, spurs will start to develop and some may make their way into the spinal canal. This will result in the damaging of the vertebrae and cause the facet joints to wear and tear. Eventually, this will cause the narrowing of the lower spine.
  • When one of the many vertebrae slips over another, this will cause congestion and narrow the spinal canal.
  • Spinal tumour. Spinal tumours are abnormal growth of soft tissues that will cause inflammation of the spinal canal. White blood cells will rush to the site and cause an overgrowth of new tissues. This will eventually result in the narrowing of the spinal canal.
  • Accidents especially high impact ones may shatter or dislocate the spine, causing small bones to impinge onto the canal.

Symptoms

Patients suffering from early stages of spinal stenosis often have no symptoms. Symptoms will develop slowly over time and may include:

  • Pain in the back
  • Burning pain at the buttocks
  • Numbness in the legs
  • Loss of feeling in the feet
  • Loss of sexual abilities
  • Loss of bowel or bladder control
  • Pain and weakness of legs

The pain in the legs are usually due to inefficient circulation of the blood. Leg pain will usually go away with rest but patients with spinal stenosis will get persistent leg pain despite resting. Narrowing of the spine will also cause nerve impingement, resulting in important nerves to be deprived of the abilities, leading to incontinence.

Spinal stenosis have no unique signs nor symptoms and will worsen over time. Although x-ray results look promising, there is still uncertainties. The best method to manage lumbar spinal stenosis is to understand the disease better and to strengthen the back by engaging in strengthening activities daily.

Spinal Cord Injury: Diagnosis & Prevention

Our spinal cord is the nerve centre of our body. It contains a bundle of nerves that runs down the back, transmitting signals to and fro the body and the brain. When a patient suffers from a spinal cord injury, this nerve centre is damaged and the signals will be disrupted. This could potentially create serious consequences and simple actions such as walking could not be done. Spinal cord injuries are usually due to direct trauma causing the vertebrae to dislocate. Most injuries however do not cut through the spinal cord. Instead, the bone fragments will impinge onto the nerves and result in the loss of bodily functions.

Spinal cord injuries can be partial or full. In a partial injury, movement below the injury will still be permitted. In a full injury however, the spinal cord is unable to communicate with nerves below that, thus causing in permanent loss of motion. Spinal cord injuries are medical emergencies and must be attended to immediately.

Diagnosis

Doctors are able to assess a spinal cord injury simply by testing for motor and sensory ability. If a patient is able to answer properly, it is not that serious. If symptoms are present, it may indicate a much more severe injury. X-rays are able to detect fractures and any problems with the vertebrae. CT scans are able to probe further into issues that were detected by x-rays. An MRI scan will scan and detect blood clots and herniated disks while myelography will identify damages to spinal nerves.

Prevention

There are many different ways a spinal cord injury can be prevented. When travelling in a motor vehicle, passengers should always use seat belts to secure themselves to the seat. This is to prevent trauma during a car accident. In senior citizens, the most common cause of spinal injuries are due to falls. In order to minimize this, anti-slip floor mats should be placed in wet areas such as the toilets and handle bars should be placed throughout the home for support.

Athletes are also at a higher risk and they should protect themselves by wearing the appropriate safety gears during training and games. During rugby, protective head helmets should be worn. Gymnasts should always use spotters during their training as well.

Spinal cord injuries can be life threatening and most people will need assistive devices such as wheelchairs to deal with the loss of mobility. In serious cases, patients might even be bedridden for the rest of their life.

Scoliosis: Symptoms & Treatments

Our spine is the structure that gives our body its shape and provide support to it. The entire spinal column consists of multiple small bones stacked together. The spine is designed to be curved naturally although it looks straight when it is viewed from the front. In fact, there are two S-curves at the spine. Scoliosis is a medical problem arising from the abnormal curvature of the spine. Patients who suffer from scoliosis have got spine that looks curved even when viewed from the front. Research has shown that scoliosis are more prevalent in females than males and affects 3 out of 1000 people.

As mentioned above, patients with scoliosis have an abnormal curvature of their spine. As such, this is the most common and obvious symptom. The curving of the spine occurs at an extremely slow pace and thus is easy to miss out until it really becomes severe. The easiest way to be spotted with it is during periodic medical examinations during primary and secondary school. In some patients, scoliosis may also cause their head to the slanted to one side or one of the shoulder to be slightly higher than the other side. In serious cases, the heart and lungs cannot work efficiently and this will lead to the shortness of breath and chest pains.

Treatment of scoliosis really depends on how severe it is towards the patient. Treatment is classified into 3 general groups: observation, bracing and surgery. In patients with mild symptom, they will only be observed for a period of time to spot any changes of the curve getting worse.

Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve stays below 25 degrees, no other treatment is needed. You may return to see the doctor every three to four months to check for any worsening of the curve. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. If the curve is between 25-40 degrees and you are still growing, a brace may be recommended. Bracing is not recommended for people who have finished growing. If the curve is greater than 40 degrees, then surgery may be recommended.

Although there is currently no cure for scoliosis, there are good treatment methods that are effective. As the saying goes, prevention is always better than cure.

Experienced Orthopaedic Specialists Onboard Our Clinic

We like to thank all our patients for the support so far and to better serve you, we now have 2 experienced orthopaedic specialists onboard.

Dr. Ambrose Yung who is a specialist orthopaedic consultant with experience in partial knee replacement, complex primary total knee replacement, revision knee replacement, minimal invasive knee and shoulder sports surgery.

Dr. Fong Shee Yan who is an experienced Spine-specialised Orthopaedic Consultant in Singapore practising Minimally Invasive Spine Surgery.

Join us in welcoming Dr. Ambrose & Dr. Fong and feel free to contact us if you’d like to understand more about our Clinic

 

Orthopaedic Conditions That Require Spine Surgery

Spine surgery is a major surgery that is often the last option for most surgeons due to the complexity and risks involved. Any slight mistakes or accidents can cause permanent paralysis of the body depending on the affected nerves in the spine. Surgeons will often recommend alternative treatments such as medication and physical therapy and when left with no other choices will they opt for spine surgery. With such high risks involved, what are some orthopaedic conditions that require spinal surgery to be carried out?

Herniated disc

A herniated disc occurs when one of the spinal disc in the vertebrae slips or ruptures, causing the soft disc materials to flow out of the disc. When the disc flows out, the movement and material can pinch on the surrounding nerves, causing pain and numbness. A discectomy will need to be carried out to remove this herniated disc that is pinching onto the nerve. A modern evolution is the microdiscectomy which uses high definition microscope to see better and is minimally invasive, reducing the risk.

Foraminotomy

Foraminotomy is performed to relieve pressure from an affected nerve in the spine. This pressure is caused either by bone fragments, scar tissues or excess ligament development in the spinal area, causing it to press against the spine and causing pain and numbness. Foraminotomy will open up the back where the nerve roots leave the spinal canal, reducing the chances of pinching.

Spinal fusion

As the name suggests, spinal fusion aims to join 2 or more vertebrae together to prevent excessive movement which may pinch onto the nerves. Loose vertebrae can press against the nerves during movement, causing pain and numbness. It will also prevent the surrounding soft tissues from stretching. Spinal fusion is based on the simple logic of “if it doesn’t move, it doesn’t hurt”. Similarly to welding in metals, spinal fusion will fuse the vertebrae together. This process however will reduce some flexibility in the spine but this is very minimal.

Artificial lumbar disc replacement

Artificial disc replacement is a new surgical process that uses man-made biomaterials to replace the affected intervertebral disc. The purpose of the spinal disc is to cushion the shock and distribute it evenly. Since the spinal discs do not regenerate as easily as our skin, biomaterials will need to be used to restore flexibility and motion.

Above are 4 orthopaedic conditions that warrant the usage of spinal surgery. Although the risks are there, medical advances have significantly reduced the risks and recovery time. Nonetheless, the risks are still present and serious considerations must be made before deciding on such major surgery as this.

Stiff Neck – An Underlying Spine Disorder?

Stiff neck causes pain and discomfort when attempting to move your neck. It is often due to injury to the soft tissues and ligaments at the neck region. It is usually accompanied by pain and soreness in the neck, shoulder and arm. Symptoms can last for quite a fair bit of time and it can be relieved using medication or a warm compress. For cases whereby the symptoms go away in a couple of days, there isn’t much of an underlying issue. Stiff neck can occur when you wake up after having slept in an awkward position for a long time. Sometimes, stiff neck can be an indication of an underlying spinal disorder.

We must first know the basic anatomy of our neck. Our neck is divided into 2 regions namely the anterior and posterior. There is a part of our spine that moves through our neck and that is the cervical spine which is effectively made up of 7 vertebrae. Any slight problems in our spine can ultimately lead to neck pain since they are interlinked. There are 2 common spinal disorders which are Cervical Herniated Disc and Neck Arthritis.

Cervical herniated disc is one of the leading causes for neck pain and indicates an injury to the cervical spine. Pain in the neck is caused by the disc pinching onto the cervical nerve, causing pain to flow down the nerve pathway down to the neck. Some patients may also experience numbness at the neck region.

Another common cause is due to cervical osteoarthritis which is a degenerative joint disease or otherwise known as neck arthritis. Cervical osteoarthritis are characterised by the presence of bone spurs which may impinge onto a nerve. When impingement happens, the pain will radiate down the nerve onto the neck region, creating in neck pain similar to the cervical herniated disc.

It can also be due to cervical spondylosis which is another degenerative disease that is increased by previous injuries. Cervical spondylosis can result in neck pain and stiffness and is due to the wear and tear of the cartilage and bones of the cervical vertebrae.

There are many causes for stiff neck and it could indicate an underlying spinal disorder due to the mechanism for both neck arthritis and cervical herniated disc. The best way would be to seek a doctor immediately if you frequently encounter a stiff neck.

4 Misconceptions About Epidural Steroid Injections

Epidural Steroid Injections (ESI) is commonly administered to patients suffering from lower back or leg pain. Lower back pain is due to the inflammation of spinal nerves, causing pain and discomfort to patients as the nerve passage is narrower compared to healthy patients. Corticosteroids are extremely strong pain relief medication that is injected directly into the area of concern, providing immediate relief. However, most patients undergo the procedure with the mentality that they will be “cured” from their lower back pain. This is a misconception of it and in fact, there are many more misconceptions out there about ESI.

ESI is extremely safe

Well, this is a misconception although it is true to a certain extent. Many people think that steroid injections are much safer than oral consumption of steroids. However, this really depends on the medication that is prescribed as the toxicity differs. While oral consumption of medication may cause irritation to the stomach and with the fact that it “travels” a longer distance down, there is a higher risk of allergy. However, ESI are injected directly into the affected area and when something bad occurs, it happens immediately without providing you much reaction time.

Repeated treatments are required for visible results

Many doctors tell their patients that a minimum of 3 ESI is required before they are effective. However, this is the average value comprising data from hundreds of thousands of patients worldwide. In fact, the exact amount of dosage required by each patient is never the same due to the differing genetics of each of us. Some patients get immediate relief after just a single injection while some may need a lot more to see results.

Multiple invasive sites are required

Most of us would have visited the hospital for one reason or another and a high percentage of us have had multiple needles injected into us. ESI are totally different from your usual invasive treatments. Only a single needle is required to be injected as ESI is done under the guidance of an X-Ray machine, providing the doctor with the exact spot to inject.

Immediate pain relief is obtained

While you may get immediate pain relief from the compressing of spinal nerves, you may suffer temporary pain in the form of bruises and tenderness due to the injection. Although the technique is conducted under the guide of an x-ray machine, human error is bound to happen. Bruising and swelling will go away on its own in just a couple of days.

Epidural Steroid Injections have been performed for a long time and it has a track record of being rather safe and successful. Since the procedure is an outpatient one, patients do not need to spend a night in the hospital, making it much more flexible and economical for them.

 

4 Most Common Gymnastics Injuries

Gymnastics is a full body and physically demanding sport meant for all gender. Due to its stressful and challenging nature, risk of injuries are extremely high. Although most injuries are minor ones, some can be serious and life threatening! This risk is amplified when risky stunts are attempted. I will discuss some common Gymnastics injuries in this article.

Wrist sprains

The wrist is the most heavily used part of the body in Gymnastics. With the extreme twisting speed and jumps, the force acting on the wrist can be double of that of our body’s weight. Thus, the wrist is the most prone to injuries. Wrist sprains are common and the immediate response would be to terminate all activities and get plenty of rest. The intensity of training in future would need to be toned down as the wrist will be more prone to future sprains. To protect and offer better support, a wrist brace should be worn prior to any strenuous activities.

Anterior Cruciate Ligament tear

ACL injuries are common and can happen if the gymnast lands in an awkward position. The ACL supports the knee and provides stability. However, it can rupture if it is twisted suddenly under high forces and that exact force is provided by an improper landing position following a stunt. A “pop” sound will be heard and this is followed by knee swelling. To prevent ACL injuries, a supportive knee brace should be worn. In addition, gymnasts should strengthen their leg muscles to better hold and support the ligaments together.

Foot injuries

Foot injuries are another type of common gymnastics injury. The more frequently occurring one is ankle sprain. Minor foot injuries only suffer from slight swelling while more serious cases will lead to severe swelling and a limit in mobility.  Wearing a protective brace is often required after foot injuries but this can hinder the flexibility of the gymnast.

Back injuries

Injuries to the back can be either a muscle strain, ligament sprain or even spinal disc disorder. Back pain will intensify based on the activity engaged and extension motions will cause the pain to increase. Back injuries are often referred to physiotherapists but they can be more serious underlying. Serious back injuries that are not easy to detect is the spinal disc disorder. The spinal discs will cushion our spine from shocks and if it is injured, the protective capabilities will be compromised.

Gymnastics is a physically demanding and challenging sport activity that is filled with lots of injury risks. There are strict requirements for the gymnast and training often starts young. Unlike most sports, injuries in gymnastics are hard to prevent due to the lack of protective equipment that are flexible and concealable.

Top 4 Most Injury Prone Activities for Youths

The period of youth is perhaps the most important part of our lives. Our body starts to mature and we have much more energy than before. We are also more motivated and have a higher desire to try new things, especially athletic activities. However, it is also during our youth that we suffer most injuries and due to that, many of us are unable to participate in competitive sports in the future. There are some activities which are especially prone to injuries and let’s take a look at some of them in this article.

Basketball

Basketball is a competitive high impact activity that is extremely popular with people of all ages. However, a large number of youth requires emergency response because of playing hoops. Common injuries associated with basketball include tears of the anterior cruciate ligament, responsible for the stabilisation of the knee. Being a high impact sport, basketball requires frequent sudden changes in direction and the ACL can tear if the foot is still fixed in a direction and the knee moves in another, causing the ligament to tear.

Skateboarding

Skateboarding is classified as an extreme sports and it is not termed like that for no reason. Skateboarding is an extremely dangerous sport that involves frequent falls from different heights on different parts of the body. Although protective gears such as skate shoes, helmets, knee and elbow padding are strongly recommended, many skateboarders ignore those as they find it not so cool.

Cheerleading

Cheerleading is a popular sporting activity that involves a lot of tossing, flips and catching. All of these motion uses the arms heavily and this is very taxing on the joints and shoulder blade. As such, the risk of injury is very high. An incorrect flipping technique can potentially cause further injury to the spinal cord.

Rugby

Rugby is an intensive and exciting full contact sport that is one of the most dangerous activity out there. Shoulder charging, take downs and sudden twisting actions are common throughout the game. Also, studs on the rugby boots are much longer and thicker than soccer boots in order to provide better grip. However, these studs can sink deep into the mud and during sudden twisting actions will cause the foot to be firmly planted in the ground while the knee changes directions, tearing the ACL, MCL and meniscus.

Discussed above are 4 most injury prone activities for youth. In fact, most activities out there carries a certain risk to them but these risk can be mitigated by wearing protective equipment which aims to prevent injury but this is not foolproof. Injuries are inevitable at some point in time but which the correct preventive measures in place, the risk is significantly lowered.