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Wednesday, 24 July 2013

Manual mobilisation of the coccyx

I just watched a video on YouTube, in Spanish, of a therapist, doing coccyx manipulation through the clothes. 

I am interested in coccyx manipulation. Mainly as, because it is a process that is not very appealing for a therapist, and it is not great to have done as a patient: probably often gets missed. This leaves an unfortunate sub group of patients who have a mechanical dysfunction of the coccyx: but are unable to find a therapist who deals with this area. 

Don't get me wrong: it is my least favourite body part to treat. It's ethically difficult ground.

But : it seems wrong to leave people in pain for years, when we are experts in manipulation of the rest if the body, to eliminate pain,  simply because its am awkward and undesirable area of the body to treat. 


Back to the SIJ?

I watched a YouTube video today by an orthopaedic surgeon on how 25% of back and hip pain may be from the SIJ. 

He noted that clinical and radiological tests are not reliable. 

The only reliable test is an anaesthetic injection to the SIJ. If the pain is gone then it was the source. 

He suggested manipulation and noted stabilisation belts as treatments. Also RF ablation and true fixation with a screw!  

It was good to do some independent CPD. The idea that some could have a true SIJ problem and do years of treatment with the wrong diagnosis is concerning. 

It will help me to think about the patients who do not get better and what could be going on for them. 

Thinking about it : I was in a similar place : treated for years for a facet or disc problem. When it was in fact stenosis. Something not diagnosable clinically. Needing an MRI and an advanced interpreter.

 Sacroiliac Joint pain, animation - Everything You Need To Know - Dr. Nabil Ebraheim, M.D.