back pain Archives - Hormones Matter

Often Injured, Rarely Treated: Tailbone Misalignment

Published on May 11, 2023

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Chronic lower back discomfort. Stiff neck. Pelvic floor dysfunction such as pain with intercourse or urinary incontinence. Inability to sit squarely or for long periods of time. Pain with bowel movements. These are symptoms I see commonly grouped together in patients coming for treatment. What is the connection?

The tailbone.

Although it is a common site of injury, often taking the brunt of our many childhood and adult slip and falls, the tailbone is unfortunately an under-evaluated source of pain and dysfunction in both men and women. Once injured it can cause pain in sitting, pain with bowel movements, pelvic floor dysfunction, such as pain with intercourse, or even cause reactions up the spine, all the way to the neck and head.

What Is the Tailbone?

The coccyx, or tailbone, is the last piece of the spine. It is shaped like a triangle, and attaches to the sacrum by ligaments that run front, back, and both sides. To find your tailbone, just feel down your back, between the buttocks, until just above the opening of the anus.

In a healthy alignment it is mobile (moves slightly when pressed upon), center line, pain free, and continuous with the sacrum. However in a dysfunctional alignment it may be painful to touch it or the tissue around it, immobile, and even noticeably off-center. It may feel like it “points” deep into the body, rather than continuous with the rest of the spine.

How Does Tailbone Injury Happen?

Some patients know the moment they injured their tailbone. It is often a slip and fall, resulting in pain in sitting, and requiring the use of a donut pillow for some time until the irritation subsides. Usually, though, patients arriving with tailbone dysfunction cannot pinpoint a particular time that it was severely injured. They recall a multitude of childhood falls, none of which were particularly notable. And yet the tailbone is out of alignment and causing dysfunction.

Because the tailbone is attached to the rest of the spine by ligaments, it can be sprained just like any other joint. It can also be moved out of alignment. In many cases, a fall to the buttocks jams the tailbone forward, spraining the ligaments surrounding. As they heal the ligaments may scar down around the misaligned tailbone, effectively holding it rigidly out of place. Whether the fall was 2 months ago or 20 years ago, the tailbone may still be out of alignment.

What Are the Problems Associated With Tailbone Misalignment?

The most obvious symptom is coccydynia, or pain at the tailbone. However often patients have no pain at the tailbone until it is directly touched, and occasionally have no pain around it at all. This symptom may manifest as an inability to be comfortable in sitting. Often patients find themselves shifting from buttock to buttock in search of a comfortable position.

Pelvic floor dysfunction is common, as the pelvic floor muscles attach around the tailbone. Their ability to function optimally is affected by the positioning of the bones around them. Problems may include pain with intercourse, sensation of “tightness,” or pain with bowel movements. Bladder leaking may be aggravated by the inability of the pelvic floor to contract optimally.

Pain or tightness further up the spine is often a secondary symptom that patients don’t realize is connected. Since the spine and its contents are continuous from the skull to the tailbone, a tailbone out of place can affect alignment all the way up to the head. The most common two places I see this are the lower back and the suboccipital region, or area just below the skull on the back of the neck. Chronic nagging pain or tightness in these areas that shifts but never resolves despite care may be traced down to misalignment of the tailbone.

Treatment

The only way to treat most tailbone dysfunction is to work internally to mobilize the soft tissue around it and the joint itself. This is most directly done rectally, but sometimes can be accomplished vaginally. Pelvic floor physical therapists can do this, and some chiropractors and osteopaths may be trained to do it as well.

Why does this only work internally? Since the most common dysfunction of the tailbone is to be pushed forward by a fall to the buttocks, it needs to be mobilized in a posterior direction. This involves putting pressure on the front of the tailbone to move it back into place. In most cases the only way to access this angle on the tailbone is internally.

The therapist treating you should have specialized training to work internally, and have worked with tailbone issues before. As with all internal treatment, it is important that you feel comfortable and informed about what is happening. The practitioner will use a gloved and lubricated finger to mobilize your tailbone. You should be in a private room, draped for your comfort, and educated on what is found during evaluation and being done during treatment. Many patients are very anxious about being treated at or around the rectum. A skilled practitioner will be able to make your treatment as comfortable possible.

Does It Stay Fixed?

Usually, yes! Once the tailbone is mobilized it will not scar itself back into the old position unless there is a new injury. However, it is important to treat the ligaments, muscles, and bones around it as well, which may be contributing the dysfunction. Without treatment, these areas might pull the coccyx back out of alignment over time. The same concept applies to areas such as the lower back and the neck. Once the pressure of the misaligned tailbone is resolved, it is important to also treat the rest of the spine as it may have become tight or weak over time.

Often patients describe a sensation of “lightness” and ability to stand taller after being treated for tailbone dysfunction, as if a pressure was released. If you suspect that you have tailbone dysfunction, it is worth it to have an evaluation. You may find a connection piece in the puzzle for other symptoms you didn’t think were related.

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This post was published originally on Hormones Matter on September 10, 2014.

Back Pain and B Vitamins: Notes from Personal Experience

by Derrick Lonsdale MD, FACN, CNS

Published on December 21, 2016

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Throughout the history of medicine, performing research on oneself has been time-honored. Before I describe the experiment on myself, I must digress. As many readers on this website know, I have written a great deal about thiamine and its use in therapy. In particular, I have long been interested in a derivative of this vitamin that is to be found naturally occurring in garlic. It has been synthesized and sold under various trade names. Its chemical name is complex, so I use the initials TTFD. Without going into details, its action is superior to that of the thiamine from which it is derived. I have used TTFD for the treatment of hundreds, if not thousands, of patients. Over the years, I became certain that there was no bad side to its use, whatever the dose. My experiment proved me wrong but in a way that I should have anticipated.

Vitamins Work Together

Vitamins work as a team and thiamine is a member of a group of vitamins known as the B complex that is vital to energy metabolism. We are however beginning to learn that vitamins, either singly or given in a group, can be used as drugs and it requires a great deal of research in order to understand completely these relationships if they are used therapeutically. As I have a particular condition that is precancerous, I have been attempting to find ways and means of preventing the possible onset of cancer by the daily use of a variety of nutrient supplements. We now know that thiamine is implicated in many conditions, including cancer.

For some time I had been taking 100 mg of TTFD a day and one tablet of B complex. I raised the dose of TTFD to 200 mg a day without raising the dose of B complex to see if I could perceive any difference in what I experienced. After about a month with this dose, I was getting into bed one evening and was suddenly afflicted with the worst pain in my left leg that I had ever experienced. It appeared to be muscular pain because any movement would sharply increase the pain and often cause me to cry out involuntarily. Sleep was of course impossible and at about 3 AM, one night last week, I remembered a manuscript that I had come across that purported to relieve pain by an injection of vitamins B1, B6, and B12, administered separately or in combination. I took three tablets of B complex (three times the previous daily dose) and about 15 minutes later I noticed some diminution in the pain. I waited a while before repeating the dose of B complex twice more and within about 45 minutes I was pretty well pain free. It was a shattering experience that demanded some form of explanation, if possible.

The Mechanics and Biochemistry of B Vitamins

My personal explanation is as follows. Each member of the B group of vitamins has a vital part to play in energy metabolism and I had produced an artificial balance between them that severely decreased the efficiency of their combined action. An analogy may help to explain what I am talking about. Imagine a machine that relies on cogwheels, such as a clock. The motor, whether it be clock-work or electric, passes the energy via the cog-wheels to the hands of the clock. The very first cogwheel in the series is the master, because without it nothing happens. The rest of the cogwheels are just as important but only function because of the first one.

The energy that our cells require is passed through a series of enzymes that are the equivalent of the cogwheels. Each enzyme requires one or more cofactors that can be thought of as a special lubricant that differs for each cogwheel. Imagine now that the first cogwheel is an enzyme that requires thiamine and you have added so much lubricant that it causes the meshing with the next cogwheel to slip. The motor keeps running but the transmission breaks down. Like all analogies, this is imperfect. Thiamine is known as the rate limiting factor in the enzyme complex that demands the presence of all the B vitamins. You can think of thiamine as being the dominant member but no less essential than the others.

Vitamins as Drugs

A drug is “a substance that, when ingested, alters physiological actions in the body”. That definition automatically excludes each vitamin and essential mineral, such as magnesium, as a drug under normal healthy circumstances because each is essential to normal human and animal physiology. However, we are completely dependent on appropriate nutrition in order to acquire the vitamins and essential minerals. Because we no longer obey the life rules of Mother Nature, it has become exceedingly easy to develop (non-caloric) nutrient deficiency. It particularly applies to the B complex because of its essential role in liberating energy from glucose. We know from studies of thiamine deficient diets in human subjects that the earliest symptoms are “emotional” in character and may be classified as “psychosomatic”. If the symptoms are not recognized and go on for years, we can assume that the structure of the enzymes deteriorates. If and when clinical and biochemical recognition occurs, it would seem logical to assume that the vitamin cofactor would have to be increased drastically in order to reconstitute the enzyme. The vitamin is therefore used under those circumstances as a drug until reconstitution is complete. When the normal activity of the enzyme is restored, the vitamin returns to its state as a nutrient and its therapeutic dose needs to be reduced.

Prevention Versus Recovery

In my case, the explanation may be different. I was taking a colossal dose of TTFD with insufficient concentrations of the B complex, perhaps causing an imbalance in the selective activities of each. If that is the mechanism, I can only guess that it interfered with oxidative metabolism. Also, I can no longer state that there is no “toxicity” from taking large doses of TTFD. It does seem to imply that the remainder of the B complex should always be used with TTFD. We know that beriberi patients required 100 mg of thiamine three times a day for months. If blood sugar was normal they always responded. If there was hyperglycemia the response was slower. If there was hypoglycemia, some did not respond at all. We can be sure that the thiamine dependent enzymes were sick and that they were being reconstituted by thiamine being used as a drug. Thus, my situation is quite different than treating a thiamine deficient patient. High doses are required only for sick thiamine dependent enzymes that have long been lacking sufficient concentrations of their cofactor(s). Preventive therapy is different than long-term deficiency.

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The Analgesic Effects of B Vitamins

by Derrick Lonsdale MD, FACN, CNS

Published on July 27, 2016

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It appears that high doses of vitamins B1, B6 and B12, administered separately or in combination, can alleviate acute pain by potentiating the analgesic effect of non-opioid analgesics such as diclofenac (an NSAID), sold under various trade names. These facts were published in a German paper. In addition, a randomized, double-blind, controlled clinical study was reported in 378 patients with lumbago. The term lumbago is a relatively old one and it is now often referred to as “back strain”.

The patients were divided into two groups, half of them receiving diclofenac together with very large doses of vitamins B1, B6 and B12. The other half received only diclofenac . The investigators concluded that the addition of the B vitamins did indeed enhance the analgesic effect of the drug. The primary mechanism for the anti-inflammatory, anti-pyretic and analgesic action of diclofenac is thought to be by a biochemical mechanism that is well known in the body and described in the paper.

When I read this, I became aware that the mechanism they were describing was the same mechanism that has been described for one of the actions of thiamine tetrahydrofurfuryl disulfide (TTFD, Allithiamine, Lipothiamine) a thiamine derivative that I have mentioned a number of times in posts on this website. When I further researched the mechanisms of action of diclofenac, I read that “diclofenac also appears to exhibit bacteriostatic activity by inhibiting bacterial DNA synthesis”. Could it be that the drug has an effect on mitochondrial DNA in people using it to relieve their pain? If so, this would be a serious indictment on its use.

Mitochondrial DNA

We now have reason to believe that our mitochondria (cellular energy producing organelles) have evolved from an original bacterium millions of years ago, and we now know that they have their own genes. These genes, inherited only from the mother, are completely separate from the cellular genes that we inherit from both parents. They are vitally important in the function of mitochondria that are responsible for synthesizing ATP, the energy currency used by the body. The interesting thing is that mitochondrial DNA is like bacterial DNA, has a different conformation from that of cellular DNA, and could be expected to be sensitive to the “DNA related bacteriostatic activity” reported to be one of the effects of diclofenac.

Side Effects of Diclofenac

There are 50 side effects of diclofenac recorded online. It may surprise you to know that 20 of the symptoms reported as side effects are identical to those that are well known in relationship to the thiamine (vitamin B1) deficiency disease, beriberi. Since thiamine is vital to the normal function of mitochondria, perhaps it suggests why three members of the vitamin B complex enhance the analgesic effect of the drug by protecting the patient from harm. This would enable it to be used with reduced dose, thus obviating the possible appearance of side effects.

Side Effects of Pharmaceuticals

It is always wise for a patient who is taking a drug to know what the potential side effects are. With this story of diclofenac, I was reminded of a drug that was produced in the 1930s in order to stimulate weight reduction. The chemical name is dinitrophenol (DNP). The side effects were so severe and occasionally caused sudden death, so it was withdrawn in 1938. Its present use is in experimental research in animals because it inhibits mitochondrial function and enables the researcher to study energy metabolism. Believe it or not, DNP is still available for weight reduction. There is no doubt that it works but it certainly offends the Hippocratic oath accepted by all physicians, “thou shalt do no harm”.

Genetic Susceptibility

We simply do not know the genetically determined susceptibility of an individual in the use of a foreign agent prescribed to relieve a given symptom. The body always recognizes a “foreigner” and sets about breaking it down and getting it out of the body as quickly as possible. If a vitamin is used in a much larger dose than merely replacing it as an essential nutrient, it may be thought of as a drug. This is really a new concept in medicine and has not yet reached the collective psyche of medical practice. Perhaps the body recognizes the huge dose, but uses what it needs and excretes the excess. The trouble with that is that the present concept is that vitamin replacement is thought to be confined to the tiny doses found in natural food that are required by a healthy individual. No thought has been given to the fact that a vitamin may have to be used in order to stimulate and restore the decayed effectiveness of the enzyme to which it must bind. It is as though the roles of the enzyme and the vitamin are reversed. In a sense, the enzyme becomes cofactor to its requisite vitamin rather than the normal enzyme/cofactor relationship.

Energy Metabolism is the Core Issue

What seems to be emerging from all this is that failure of energy metabolism, coupled with genetic risk and the imposition of individual life stresses, provides us with a new medical model for disease. Besides killing the “enemy”, the bacteria, viruses or cancer cells safely, the only real treatment possible is an educated use of nutritional components to coerce damaged cellular systems back into a state of functional efficiency. Healing takes energy and only the body knows how to do that. We should give it every possible assistance. There is much evidence that even cancer cells become maverick because of devious energy metabolism.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

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