Physiotherapy approaches for coccydynia: evaluating effectiveness and clinical outcomes.

Abstract

Background: Coccydynia, or tailbone pain, significantly impairs patients' quality of life, affecting daily activities such as sitting and transitioning between positions. It can arise from trauma, childbirth, repetitive strain, or idiopathic causes. Although conservative treatments like physiotherapy are widely employed, their clinical effectiveness remains uncertain due to inconsistent methodologies and varied outcomes reported in the literature.

Objective: To evaluate the effectiveness of physiotherapy interventions, in reducing pain and improving functional outcomes in patients with coccydynia.

Methods: A comprehensive search was conducted in PubMed, PEDro, Scopus, and Web of Science databases, including randomized controlled trials (RCTs) published between 1963 and 2024. The methodological quality was assessed using the PEDro scale and the Cochrane risk-of-bias tool. Inclusion criteria focused on studies evaluating conservative physiotherapy interventions in patients with coccydynia.

Results: Nine RCTs comprising 532 participants were included. The Cochrane risk-of-bias assessment indicated a moderate to high risk in several domains, particularly in allocation concealment and blinding. ESWT demonstrated significant reductions in pain and improvements in functional outcomes, with benefits sustained up to six months in some cases. Manual therapy was particularly effective in recent-onset coccydynia, although its efficacy diminished over time. kinesiotaping (KT) improved pain perception but showed limited impact on disability measures. Six studies were rated as moderate to high quality (PEDro scores 6-7), while three were low quality (scores ≤ 4). Despite promising results, heterogeneity in interventions, small sample sizes, and short follow-up periods limited definitive conclusions.

Conclusion: Physiotherapy interventions, particularly ESWT, are promising conservative treatment options for coccydynia. However, methodological variability and limited long-term follow-up hinder definitive conclusions. Future research should prioritize standardized protocols, larger sample sizes, and extended follow-up to strengthen the evidence base for clinical recommendations.