Q: Kindly guide what Ankylosing Spondylitis is. Can physiotherapy help?

A: Primarily affecting the spine, axial spondyloarthritis induces inflammatory responses leading to discomfort, rigidity, and restricted mobility in the back. Notably, it commonly involves the sacroiliac, apophyseal, costovertebral, and intervertebral disc articulations, resulting in characteristic inflammatory back pain. This condition progressively stiffens and sensitizes the affected joints due to bone formation around the joint capsule and cartilage, eventually leading to decreased mobility and the development of a bamboo-like appearance in the spine.

Axial spondyloarthritis encompasses patients with both non-radiographic and radiographic manifestations. Unlike non-radiographic axial spondyloarthritis, which remains invisible on x-rays, MRI scans reveal discernible alterations. Radiographic axial spondyloarthritis, also termed ankylosing spondylitis (AS), falls under this category.

While peripheral joint pain, especially in the hips, knees, ankles, shoulders, and neck, is less recognized, it is also attributable to axial spondyloarthritis. This condition affects various joints, including synovial, cartilaginous, and sites of tendon and ligament attachment. Early identification and intervention are crucial in managing pain, stiffness, and preventing significant deformities associated with the disease. Sacroiliitis, enthesitis, and spondylitis contribute to the pain experienced in AS, with initial damage occurring in the sacroiliac joints and progression to entheses before involving the spine.

Symptoms indicative of AS often manifest in young adults aged 15-30 years, typically presenting with gradual onset lower back pain and stiffness. These symptoms may worsen at night or in the early morning, disrupting sleep. Additionally, AS may affect peripheral joints, eyes, skin, and other systems, leading to conditions such as iridocyclitis, conjunctivitis, and inflammatory arthritis. Reduced chest expansion, intermittent low-grade fever, fatigue, and weight loss are also associated features, often accompanied by complications like osteoporosis-related fractures, uveitis, and pulmonary function restrictions.

Physiotherapy plays a pivotal role in AS treatment, aiming to alleviate pain, enhance spinal mobility, correct posture, and improve functional capacity. Exercise programs, whether supervised or home-based, have shown efficacy in managing symptoms and enhancing overall well-being. During flare-ups, gentle stretching exercises and medication may provide relief, while joint protection strategies and patient education are vital for long-term management and self-care. Assistive devices and ergonomic adjustments can facilitate daily activities, ensuring better quality of life for individuals living with AS.

Q: Doctor I am a 31 years old male and I have severe tailbone pain, I am an office worker.

A: Coccygodynia, often interchangeably referred to as coccydynia, coccalgia, coccygeal neuralgia, or tailbone pain, manifests as a complex array of symptoms localized within the coccyx region. The discomfort typically arises during periods of sitting, yet transitions from sitting to standing can also trigger the pain. While a majority of cases tend to resolve within a span of a few weeks to several months, a subset of individuals endures the burden of chronic pain, which profoundly impacts their overall quality of life. The intricacies inherent in managing chronic coccygeal pain stem from its multifaceted nature, characterized by localized tenderness around the sacrococcygeal joint and described sensations such as "pulling" or "cutting."

A notable clinical feature observed in patients with coccygodynia is the adoption of a guarded seated posture, wherein one buttock is often elevated to alleviate pressure on the coccyx, thereby providing some measure of relief. Exacerbation of pain with prolonged sitting or positional changes is a common complaint among sufferers, although temporary respite can sometimes be found by assuming alternative sitting positions. Furthermore, individuals may report additional discomfort during activities such as defecation, coughing, or menstruation, suggesting a broader spectrum of symptomatology associated with coccygeal pain.

While coccygodynia isn't inherently linked with low back pain, morphological variations in coccyx shape and forward curvature may predispose affected individuals to such secondary symptoms. Although clinical diagnosis remains paramount, dynamic radiographs offer valuable insights into coccygeal displacement, particularly when obtained in both sitting and standing positions. However, the utility of single-position radiographs in distinguishing individuals with coccygodynia from those without remains limited. Typically, radiographic imaging is reserved for cases persisting beyond an eight-week duration, aiding in confirming the diagnosis and guiding subsequent treatment strategies.

Initial therapeutic interventions often focus on postural education, emphasizing the importance of maintaining proper sitting posture to redistribute weight away from the coccyx onto the ischial tuberosities and thighs, potentially alleviating undue pressure and associated discomfort. Additionally, physiotherapists may recommend specialized seating cushions, such as modified wedge-shaped or donut-shaped varieties, to provide targeted relief during prolonged sitting periods. However, the efficacy of these cushions over an extended period, spanning six to eight weeks, remains subject to further investigation, underscoring the need for additional research in this area.

In conjunction with postural correction and cushion utilization, manual therapy techniques, including massage, stretching, mobilization, and manipulation, may be employed to address muscular tension and improve overall mobility. These interventions, whether involving internal or external contact with the coccyx, offer potential avenues for symptom relief and functional improvement. Nevertheless, the therapeutic outcomes of such conservative measures warrant comprehensive evaluation to ascertain their long-term efficacy and clinical applicability in the management of coccygodynia.