Comparative effects of radial and focused extracorporeal shock wave therapies in coccydynia

Management of coccygodynia: talking points from a systematic review of recent clinical trials

Background

Coccygodynia, characterised by localised pain in the coccyx and surrounding tissues, presents challenges in diagnosis and management given its low prevalence and varied aetiology. Traumatic injury, particularly backward falls, is commonly implicated, while non-traumatic causes include degenerative joint disease, overloading stress forces from obesity and morphological variations of the coccyx. Diagnostic evaluation involves medical history, physical examination, and radiographic imaging. While conservative management is often successful, refractory cases necessitate intervention. However, optimal treatment strategies still need to be clarified. The present systematic review discusses the clinical evidence on the management of coccygodynia.

Methods

In December 2024, a systematic review followed PRISMA guidelines, accessing PubMed, Web of Science, and Embase databases. Eligible studies included solely clinical trials investigating coccygodynia management. The risk of bias was assessed using Cochrane risk of bias assessment tool (RoB2) for randomized controlled trials (RCTs) and the Risk of Bias in nonrandomized Studies of Interventions (ROBINS-I) for non-RCTs. Data extraction and statistical analyses followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.

Results

Of 407 identified articles, 16 met inclusion criteria, comprising 858 patients, primarily women. Risk of bias assessment revealed varying methodological quality among included studies. Conservative treatments, including physiotherapy and shockwave therapy, showed promise in pain management. Interventional therapies, such as corticosteroid injections and ganglion-impair blockade, demonstrated efficacy in refractory cases. Surgical interventions, particularly coccygectomy, yielded moderate success rates but were associated with notable risks.

Conclusions

A multidisciplinary approach is advocated for managing coccygodynia, with conservative measures as initial strategies. Physical therapy-based interventions and interventional treatments, such as corticosteroid injections and ganglion impair blockade, offer viable options for refractory cases. Surgical intervention should be considered judiciously, weighing risks and benefits based on patient-specific factors and treatment response. Further research is needed to establish standardized guidelines for coccygodynia management based on high-quality evidence.

Effectiveness of physical therapy interventions for coccydynia: a systematic review with a narrative synthesis

Introduction

Various physical therapy interventions for coccydynia have been evaluated, but their effectiveness has not yet been comprehensively synthesized. This systematic review aims to evaluate the effectiveness of physical therapy interventions in adults with coccydynia.

Methods

A systematic search of relevant randomized controlled trials (RCTs) was conducted in PubMed/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro). Outcomes of interest included pain, function, mobility, and patient satisfaction. Due to the heterogeneity of the included studies, a narrative synthesis was performed.

Results

A total of 515 adults with coccydynia across 10 studies were included in the review. Physical therapy interventions, including extracorporeal shock wave therapy, kinesiotaping plus exercise, levator anus stretching or massage, manipulation alone or manipulation plus electrotherapy or exercise, and muscle energy technique, showed significant improvements in pain and function in the short term. Additionally, kinesiotaping plus exercise showed significant short-term improvement in trunk mobility. In the intermediate term, manipulation alone and levator anus stretching or massage were effective at reducing pain, whereas manipulation alone was effective at improving function. In the long term, levator anus stretching or massage showed sustained improvement in pain.

Conclusions

Overall, physical therapy interventions led to short-term improvements in pain and function for adults with coccydynia. However, there is a need for high-quality studies with long-term follow-ups to compare the efficacy of various physical therapy interventions, both in isolation and in combination.

Efficacy of radial shock wave therapy on rat models of adjuvant arthritis

BACKGROUND

Extracorporeal shock wave therapy (ESWT) is an effective treatment for musculoskeletal pain, tendinopathy, and fasciitis with an anti-inflammatory effect. ESWT can be categorized into two groups: radial pressure wave (RPW) and focused shock wave (FSW). Although there have been several studies on the inflammation and pain-improvement mechanisms of FSW, there are few studies on the pain-improvement mechanisms of RPW. This study aimed to elucidate the efficacy of RPW in a rat model of adjuvant arthritis.

METHODS

Ninety-six rats were randomly categorized into three groups: RPW, control, and sham as follows: (I) RPW group, which received RPW application after complete Freund's adjuvant (CFA) injection; (II) Control group, which received only CFA injection; and (III) Sham group, which received only saline injection. All rats were evaluated at 0, 4, 7, 14, 28, and 56 days post-RPW application based on foot circumference, von Frey test, and immunohistochemistry of nerve fibers for calcitonin gene-related peptide (CGRP) and protein gene product (PGP) 9.5 in plantar skins.

RESULTS

There were no significant differences in foot circumference between the RPW and control groups at any time point. The RPW group showed significant improvements in the von Frey test results on days 7 and 14. The total CGRP-immunoreactive (ir) and PGP9.5-ir nerve fiber lengths in the RPW group decreased on day 0; however, both were increased in the control group. The CGRP-ir and PGP9.5-ir nerve fibers in the RPW group were significantly shorter than those in the control group until day 14 after RPW.

CONCLUSIONS

RPW improved the mechanical hypersensitivity between days 7 and 14 after application. Like FSW, RPW also induced the degeneration of sensory nerve fibers in the skin in the early period after irradiation, and reinnervation occurred between 14 and 28 days. Thus, our results demonstrate one of the pain relief mechanisms after RPW application.

Effectiveness of focused extracorporeal shock wave versus manual therapy in postpartum patients with sacroiliac joint dysfunction: a prospective clinical trial

OBJECTIVE

To investigate the effectiveness of focused extracorporeal shock wave therapy (FESWT) in treating postpartum sacroiliac joint (SIJ) dysfunction.

METHODS

A total of 90 patients with SIJ dysfunction were included and randomly assigned to FESWT, manual therapy (MT), or combination therapy (CT) groups. Pain intensity and Oswestry Disability Index (ODI) score were measured upon admission, after 1 and 2 weeks of treatments. The treatment efficacy and adverse events of each group were also assessed.

RESULTS

There were no significant differences among three groups regarding clinical data, pain intensity, and ODI score on admission (all P > 0.05). After 1 week of treatment, FESWT exhibited similar pain intensity and lower ODI score (P < 0.001) compared to MT. After 2 weeks of treatment, the pain and ODI in FESWT were similar with MT. The pain in CT was lower than MT after 1 week, but lower than FESWT after 2 weeks. Furthermore, we identified interaction effects between treatment method and duration in relation to pain intensity (Fgroup*time = 5.352, P = 0.001) and ODI score (Fgroup*time = 5.902, P < 0.001). FESWT group exhibited the highest improvement rate of 66.7%, while CT group achieved the highest cure rate of 73.3%. No adverse events were observed in any of the patients during 2 months follow-up period.

CONCLUSIONS

Compared to MT, FESWT mainly reduced the ODI score rather than pain after 1 week of treatment. After 2 weeks, the effect of FESWT in relieving the pain was inferior to the MT.