Coccydynia in Taiwanese women: biomechanical and physiological study

Abstract

Coccydynia is a form of back pain and occurs more commonly in women than in men, and is a particular clinical problem seen in Taiwan. Understanding of the condition is limited and it cannot be isolated from other dysfunctions in the lumbopelvic region. It is proposed that neuromuscular alterations that occur in low back pain (LBP) could also occur in coccydynia and forms the topic of this thesis. The aims of this study were to explore neuromuscular and musculoskeletal changes in Taiwanese women with coccydynia. A total of 55 Taiwanese women, aged 23-65 years were studied in three groups: healthy young participants in Southampton (n=18, aged 23-35 years); patients with coccydynia in Taiwan (n=20 aged 23-65 years) and healthy older women in Taiwan (n=17, aged 35-65 years). Three techniques were used to investigate musculoskeletal changes in coccydynia: rehabilitative ultrasound imaging (RUSI), 3-dimensional motion analysis (using the VICON system) and surface electromyography (sEMG).The reliability of the developed experimental protocols was first established at the University of Southampton and then the protocols were replicated for he main study in Taiwan.

Patients had thicker resting transversus abdominis (TrA) muscles than healthy participants but showed less thickness change during a functional task, indicating reduced ability to contract the muscle. Differences between patients and healthy groups from motion analysis and EMG studies were found and indicate that neuromuscular alterations occur in coccydynia. In six case studies, a six week intervention using a pelvic belt, patients reported improvements in symptoms and function but there were no changes in the objective tests of musculoskeletal function.

The contributions of this preliminary work to knowledge include: (1) provision of normal reference data of muscle morphology in Taiwanese women of different ages; (2) a possible effect of age on muscle contractile ability; (3) objective evidence of changes in musculoskeletal function in patients with coccydynia, specifically muscle morphology, motor control and biomechanical changes; (4) evidence of the feasibility of using RUSI as an appropriate tool to detect differences in the lumbopelvic muscles between patients with coccydynia and healthy participants; (5) Reliability of inter-recti distance measurement on RUSI at rest and during contractions in patients with coccydynia and healthy participants; (6) the pelvic belt may be a potentially effective intervention in the management of pain in coccydynia.

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Identifiers

ORCID for M. Stokes: orcid.org/0000-0002-4204-0890

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