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Coccygodynia, or, as it is sometimes called, coccydynia, is a painful
affection of the coccyx or bony end of the spinal column. It usually
results from trauma, as a fall on the buttocks on an icy pavement, or
particularly a fall in coming down stairs in which the main portion of
the impact is on the seat. Occasionally it follows horseback riding.
It is said to be on the increase among women who ride astride.
Occasionally it is reported after severe labor, particularly when the
head of the child was very large, or after first labor when the coccyx
has been beforehand bent inward somewhat abnormally and is pushed out
by the oncoming head. It seems to develop with special frequency in
nervous people who have to sit much, particularly if they sit on
unsuitable chairs. The chair seat with the ridge in the center which
has been introduced in recent years is sometimes blamed. Occasionally,
on the other hand, it is said to come from sitting on heavily
cushioned chairs, particularly leather chairs which do not allow of
much transpiration and cause a feeling of uncomfortable heat.

There are, indeed, so many different causes suggested, sometimes of
quite opposite or even contradictory effects, that it seems evident
that the main element in the disease is some predisposition to
sensitiveness in this region which is exaggerated and emphasized by
the cause that is blamed. It occurs particularly in women, though it
is occasionally seen in delicate or neurotic men. Sufferers from it
sometimes find it impossible to sit for any length of time. Even
lying down, especially if they lie on their backs, becomes a source of
pain. Various operations, such as the reposition in place of the bent
coccyx, or even the removal of the tip of the coccyx, have been
suggested. Some reported cures are to be found in the literature.
These are mainly surgical cures, however, that is to say, the patient
recovered from the operation, was seen for a month or two afterwards,
and was then on a fair way to complete recovery. Some of us who have
had to treat these cases afterwards for painful conditions apparently
due to the scar of the operation, or to a neurotic condition closely
corresponding to the old coccygodynia, are not so confident of the
value of an operation, though probably in purely traumatic cases
surgical intervention is of value.

In most cases the sufferers are women who have little to do, who have
much time on their hands to think about themselves, and who usually
receive abundant sympathy from friends and relatives. In one case
under my observation the death of a husband and the discovery that his
estate was much less than had been anticipated, so that his widow had
to take up a wage-earning occupation, did more in a short time than
all the treatment that had been employed before to relieve her
discomfort. She had been quite unable to move around at times,
especially in rainy weather, and was something of an invalid during
all the winter, but now she was able to go out to work every day and
had very little trouble. Her affection originally dated from a fall on
an icy sidewalk and her fear to go out in the winter seemed to be
dependent on the dread of another fall. She realizes now that
practically all her former trouble was due to over-attention to a
discomfort which is still present, but which she is now able to
forget, except at times when she is alone after there have been
worries and troubles that have reduced her power to control her
nerves. In young girls an injury to the coccyx by a fall on the
buttocks will often leave tenderness for months or even years, but if
attention is distracted from this and the patient is not allowed to
concentrate her mind on it and does not hear of the awful
possibilities of coccygodynia--a mouth-filling Greek name in which we
map out our ignorance, and which seems to carry with it such a weight
of pathology--she will probably recover completely.

Coccygodynia often resembles hysterical coxalgia or the hysterical
arthritises, and seems sometimes to be due to the fact that there is a
natural or traumatic abnormal mobility of the coccygeal vertebrae
which, owing to concentration of attention, has developed into a
neurosis analogous to the corresponding condition in a joint. There
are undoubtedly cases in which a real pathological lesion exists, but
these are comparatively few. In this, as in other joint and bone
affections with vague pains likely to be worse on rainy days, the word
rheumatism is often mentioned, but it has no proper place. Treatment
that will put the patients into good general condition--never local
unless there is objective indication--outdoor air and exercise with
reassurance of mind and distraction of the attention are the important
therapeutic agents. Patients with much time on their hands do not
readily get well, while those who are busily occupied seldom suffer
for long.

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