Disclosures: Mani Singh, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 13-year-old-female elite rower presenting with 4 weeks of lower back and coccygeal pain after recent increase in training intensity.

Case Description or Program Description: Pain was located in the low-back and coccyx. Described as sharp and stiff. Exacerbated by sitting, rowing, transitional movements, sneezing. She took a 3-4 week break from running, rowing on the ergometer, and biking with improvement in pain. However, even after this activity modification, pain returned with rowing. She denied neurologic symptoms, urinary incontinence, or painful defecation. Negative review of systems. Physical exam illustrated tenderness to palpation at the L5-S1 spinous processes, sacrococcygeal junction, and coccyx. Lumbar flexion and extension produced axial back pain. Neurologic examination was unremarkable.

Setting: Outpatient clinic

Assessment/Results: Sacrum and coccyx radiographs were negative for fracture but illustrated slightly anteverted distal coccygeal segments with increased space between segments, suggesting possible hypermobility. Magnetic resonance imaging was unremarkable in the lumbar spine and illustrated 5 coccygeal segments with a widened 2-mm space between Co3-Co4 with increase in bony and surrounding soft tissue edema. She was diagnosed with coccydynia secondary to segmental coccyx dysfunction and hypermobility presumed to be secondary from excessive ergometer training.

Discussion (relevance): Back pain is common and may affect up to 53% of rowers internationally. Typically, it is secondary to lumbar spine pathology. However, excessive rowing/ergometer use may result in coccygeal pain and hypermobility. Treatment should involve activity modification and evaluation of rowing biomechanics, particularly lumbopelvic movements in the catch and finish phases. Increased posterior pelvic rotation with lumbar flexion in the catch position followed by excess trunk extension in the finish position are risk factors for coccydynia.

Conclusions: Low back and coccyx pain in rowing athletes may be secondary to segmental coccyx dysfunction and is related to underlying anatomy, strength, and lumbopelvic biomechanics.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/coccydynia-secondary-to-segmental-coccyx-dysfunction-in-a-teenage-rower-a-case-report/