{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T19:12:17Z","timestamp":1773083537260,"version":"3.50.1"},"reference-count":24,"publisher":"Walter de Gruyter GmbH","issue":"2","license":[{"start":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jom-2023-0001_abs_001\">\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Pain of the coccyx, coccydynia, is a common condition with a substantial impact on the quality of life. Although most cases resolve with conservative care, 10\u202f% become chronic and are more debilitating. Treatment for chronic coccydynia is limited; surgery is not definitive. Osteopathic manipulative treatment (OMT) is the application of manually guided forces to areas of somatic dysfunction to improve physiologic function and support homeostasis including for coccydynia, but its use as a transrectal procedure for coccydynia in a primary care clinic setting is not well documented.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jom-2023-0001_abs_002\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We aimed to conduct a quality improvement (QI) study to explore the feasibility, acceptability, and clinical effects of transrectal OMT for chronic coccydynia in a primary care setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jom-2023-0001_abs_003\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This QI project prospectively treated and assessed 16 patients with chronic coccydynia in a primary care outpatient clinic. The intervention was transrectal OMT as typically practiced in our clinic, and included myofascial release and balanced ligamentous tension in combination with active patient movement of the head and neck. The outcome measures included: acceptance, as assessed by the response rate (yes\/no) to utilize OMT for coccydynia; acceptability, as assessed by satisfaction with treatment; and coccygeal pain, as assessed by self-report on a 0\u201310 numerical rating scale (NRS) for coccydynia while lying down, seated, standing, and walking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jom-2023-0001_abs_004\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Sixteen consecutive patients with coccydynia were offered and accepted OMT; six patients also received other procedural care. Ten patients (two males, eight females) received only OMT intervention for their coccydynia and were included in the per-protocol analysis. Posttreatment scores immediately after one procedure (acute model) and in follow-up were significantly improved compared with pretreatment scores. Follow-up pain scores provided by five of the 10 patients demonstrated significant improvement. The study supports transrectal OMT as a feasible and acceptable treatment option for coccydynia. Patients were satisfied with the procedure and reported improvement. There were no side effects or adverse events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jom-2023-0001_abs_005\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These data suggest that the use of transrectal OMT for chronic coccydynia is feasible and acceptable; self-reported improvement suggests utility in this clinic setting. Further evaluation in controlled studies is warranted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jom-2023-0001","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T14:35:59Z","timestamp":1700836559000},"page":"77-83","source":"Crossref","is-referenced-by-count":4,"title":["Transrectal osteopathic manipulation treatment for chronic coccydynia: feasibility, acceptability and patient-oriented outcomes in a quality improvement project"],"prefix":"10.1515","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7492-9053","authenticated-orcid":false,"given":"Bobby","family":"Nourani","sequence":"first","affiliation":[{"name":"Associate Professor, Department of Neuromusculoskeletal Medicine\/Osteopathic Manipulative Medicine (NMM\/OMM) , College of Osteopathic Medicine of the Pacific, Western University of Health Sciences , Pomona , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-4843","authenticated-orcid":false,"given":"Derek","family":"Norton","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Medical Informatics , University of Wisconsin\u00a0\u2013 Madison , Madison , WI , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Kuchera","sequence":"additional","affiliation":[{"name":"Green Bay , WI , USA (deceased)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1347-3603","authenticated-orcid":false,"given":"David","family":"Rabago","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine , Penn State College of Medicine , Hershey , PA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"2024012505512550190_j_jom-2023-0001_ref_001","unstructured":"Lirette, LS, Chaiban, G, Tolba, R, Eissa, H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J 2014;14:84\u20137."},{"key":"2024012505512550190_j_jom-2023-0001_ref_002","doi-asserted-by":"crossref","unstructured":"Howard, PD, Dolan, AN, Falco, AN, Holland, BM, Wilkinson, CF, Zink, AM. A comparison of conservative interventions and their effectiveness for coccydynia: a systematic review. J Man Manip Ther 2013;21:213\u201319. https:\/\/doi.org\/10.1179\/2042618613Y.0000000040.","DOI":"10.1179\/2042618613Y.0000000040"},{"key":"2024012505512550190_j_jom-2023-0001_ref_003","doi-asserted-by":"crossref","unstructured":"Park, PW, Dryer, RD, Hegeman-Dingle, R, Mardekian, J, Zlateva, G, Wolff, GG, et al.. Cost burden of chronic pain patients in a large integrated delivery system in the United States. Pain Pract 2016;16:1001\u201311. https:\/\/doi.org\/10.1111\/papr.12357.","DOI":"10.1111\/papr.12357"},{"key":"2024012505512550190_j_jom-2023-0001_ref_004","doi-asserted-by":"crossref","unstructured":"Pizzo, P, Clark, N, Carter-Pokras, O. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Mil Med 2016;181:397\u20139. https:\/\/doi.org\/10.7205\/MILMED-D-16-00012.","DOI":"10.7205\/MILMED-D-16-00012"},{"key":"2024012505512550190_j_jom-2023-0001_ref_005","unstructured":"Seffinger, M. Foundations of osteopathic medicine: philosophy, science, clinical applications, and research, 4th ed. Philadelphia: Wolters Kluwer; 2018."},{"key":"2024012505512550190_j_jom-2023-0001_ref_006","unstructured":"Barber, E. Osteopathy complete. Kansas City, MO: Hudson-Kimberly Publishing; 1898."},{"key":"2024012505512550190_j_jom-2023-0001_ref_007","doi-asserted-by":"crossref","unstructured":"Scott, KM, Fisher, LW, Bernstein, IH, Bradley, MH. The treatment of chronic coccydynia and postcoccygectomy pain with pelvic floor physical therapy. Pharm Manag R 2017;9:367\u201376. https:\/\/doi.org\/10.1016\/j.pmrj.2016.08.007.","DOI":"10.1016\/j.pmrj.2016.08.007"},{"key":"2024012505512550190_j_jom-2023-0001_ref_008","unstructured":"Nourani, B, Huff, R. Long lever techniques: an illustrated guide for practitioners to treat neuro-musculoskeletal pain, 1st ed. Berkeley, California: North Atlantic Books; 2022."},{"key":"2024012505512550190_j_jom-2023-0001_ref_009","doi-asserted-by":"crossref","unstructured":"Goodman, D, Ogrinc, G, Davies, L, Baker, GR, Barnsteiner, J, Foster, TC, et al.. Explanation and elaboration of the SQUIRE (standards for quality improvement reporting excellence) guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature. BMJ Qual Saf 2016;25:e7\u20137. https:\/\/doi.org\/10.1136\/bmjqs-2015-004480.","DOI":"10.1136\/bmjqs-2015-004480"},{"key":"2024012505512550190_j_jom-2023-0001_ref_010","doi-asserted-by":"crossref","unstructured":"Nourani, B, Gilbert, R, Rabago, D. The treatment of coccydynia and headache with transrectal OMT: a case report. Scholar: Pilot and Validation Studies 2020;1:14\u201318. https:\/\/doi.org\/10.32778\/spvs.71366.2020.4.","DOI":"10.32778\/SPVS.71366.2020.4"},{"key":"2024012505512550190_j_jom-2023-0001_ref_011","doi-asserted-by":"crossref","unstructured":"Manchikanti, L, Cash, KA, McManus, CD, Pampati, V, Fellows, B. Results\u00a0of 2-year follow-up of\u00a0a randomized, double-blind, controlled trial of fluoroscopic caudal epidural injections in central spinal stenosis. Pain Physician 2012;15:371\u201384. https:\/\/doi.org\/10.36076\/ppj.2012\/15\/371.","DOI":"10.36076\/ppj.2012\/15\/371"},{"key":"2024012505512550190_j_jom-2023-0001_ref_012","doi-asserted-by":"crossref","unstructured":"Ostelo, RW, Deyo, RA, Stratford, P, Waddell, G, Croft, P, Von Korff, M, et al.. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 2008;33:90-4. https:\/\/doi.org\/10.1097\/BRS.0b013e31815e3a10.","DOI":"10.1097\/BRS.0b013e31815e3a10"},{"key":"2024012505512550190_j_jom-2023-0001_ref_013","unstructured":"R Core Team. R: a language and environment for statistical computing [computer program]. Vienna, Austria: R Foundation for Statistical Computing; 2018."},{"key":"2024012505512550190_j_jom-2023-0001_ref_014","doi-asserted-by":"crossref","unstructured":"Bates, D, Maechler, M, Bolker, B, Walker, S. Fitting linear mixed-effects models using lme4. J Stat Software 2015;67:1\u201348. https:\/\/doi.org\/10.18637\/jss.v067.i01.","DOI":"10.18637\/jss.v067.i01"},{"key":"2024012505512550190_j_jom-2023-0001_ref_015","doi-asserted-by":"crossref","unstructured":"Efron, B, Tibshirani, R. An introduction to the bootstrap. New York: Chapman & Hall; 1993.","DOI":"10.1007\/978-1-4899-4541-9"},{"key":"2024012505512550190_j_jom-2023-0001_ref_016","doi-asserted-by":"crossref","unstructured":"Maigne, JY, Chatellier, G, Faou, ML, Archambeau, M. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine 2006;31:E621\u20137. https:\/\/doi.org\/10.1097\/01.brs.0000231895.72380.64.","DOI":"10.1097\/01.brs.0000231895.72380.64"},{"key":"2024012505512550190_j_jom-2023-0001_ref_017","unstructured":"Emerson, SS, Speece, AJ. Manipulation of the coccyx with anesthesia for the management of coccydynia. J Am Osteopath Assoc 2012;112:805\u20137."},{"key":"2024012505512550190_j_jom-2023-0001_ref_018","doi-asserted-by":"crossref","unstructured":"Wray, CC, Easom, S, Hoskinson, J. Coccydynia. Aetiology and treatment. J\u00a0Bone Joint Surg Br 1991;73:335\u20138. https:\/\/doi.org\/10.1302\/0301-620x.73b2.2005168.","DOI":"10.1302\/0301-620X.73B2.2005168"},{"key":"2024012505512550190_j_jom-2023-0001_ref_019","unstructured":"Khatri, S, Nitsure, P, Jatti, R. Effectiveness of coccygeal manipulation in coccydynia: a randomized control trial. Indian J Physiother Occup Ther 2011;5:110\u201312."},{"key":"2024012505512550190_j_jom-2023-0001_ref_020","doi-asserted-by":"crossref","unstructured":"Wu, CL, Yu, KL, Chuang, HY, Huang, MH, Chen, TW, Chen, CH. The application of infrared thermography in the assessment of patients with coccygodynia before and after manual therapy combined with diathermy. J Manip Physiol Ther 2009;32:287\u201393. https:\/\/doi.org\/10.1016\/j.jmpt.2009.03.002.","DOI":"10.1016\/j.jmpt.2009.03.002"},{"key":"2024012505512550190_j_jom-2023-0001_ref_021","doi-asserted-by":"crossref","unstructured":"Maigne, JY, Chatellier, G. Comparison of three manual coccydynia treatments: a pilot study. Spine 2001;26:E479\u2013484. https:\/\/doi.org\/10.1097\/00007632-200110150-00024.","DOI":"10.1097\/00007632-200110150-00024"},{"key":"2024012505512550190_j_jom-2023-0001_ref_022","doi-asserted-by":"crossref","unstructured":"Thiele, GH. Coccygodynia and pain in the superior gluteal region: and down the back of the thigh: causation by tonic spasm of the levator ani, coccygeus and piriformis muscles and relief by massage of these muscles. J Am Med Assoc 1937;109:1271\u20135. https:\/\/doi.org\/10.1001\/jama.1937.02780420031008.","DOI":"10.1001\/jama.1937.02780420031008"},{"key":"2024012505512550190_j_jom-2023-0001_ref_023","doi-asserted-by":"crossref","unstructured":"Maigne, JY, Maigne, R. Trigger point of the posterior iliac crest: painful iliolumbar ligament insertion or cutaneous dorsal ramus pain? An anatomic study. Arch Phys Med Rehabil 1991;72:734\u20137. https:\/\/doi.org\/10.5555\/uri:pii:000399939190260P.","DOI":"10.1097\/00042752-199207000-00019"},{"key":"2024012505512550190_j_jom-2023-0001_ref_024","doi-asserted-by":"crossref","unstructured":"Julious, SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceut Stat 2005;4:287\u201391.","DOI":"10.1002\/pst.185"}],"container-title":["Journal of Osteopathic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jom-2023-0001\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jom-2023-0001\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T05:52:34Z","timestamp":1706161954000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jom-2023-0001\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,24]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,9,20]]},"published-print":{"date-parts":[[2024,1,25]]}},"alternative-id":["10.1515\/jom-2023-0001"],"URL":"https:\/\/doi.org\/10.1515\/jom-2023-0001","relation":{},"ISSN":["2702-3648"],"issn-type":[{"value":"2702-3648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,24]]}}}