Our bodies are not designed to sit all day long. We are designed to absorb shock through many different joints throughout the day, such as hips, knees, and ankles. When a patient is unable to use the lower half of their body and must sit all day, all that pressure ends up on their bottoms and at the base of the spine. This can easily and quickly equate to pain in the bottom area secondary to increased pressure. With Michael, who has SMA, and has been sitting in a wheelchair for the majority of the day for many years, he has become uncomfortable after sitting in his wheelchair for a while and has difficulty performing weight shifting independently to offload the pressure on the bones at the base of his spine and along his hips. Thankfully, he hasn’t had any pressure ulcers recently along these areas, but he has been very uncomfortable.
Recently, while performing our normal stretches with Michael, he has shown increased discomfort while laying in a reclined position. When asked what was bothering him, he told me it feels like more pressure has been on his tailbone when we move his legs in different directions to stretch out his lower extremities. Michael has significant scoliosis, so it isn’t always easy to figure out what area he is talking about unless I palpate it myself. After rolling him into a side-lying position, thinking it would be his ischial tuberosity, or sits bone that would be bothering him, I discovered it actually was his coccyx or his tailbone.
After transferring him into a sitting position, I began to investigate to see if there was anything I could do to help ease the pain. After sitting him up and finding his coccyx again, I began to try and perform a “stuck drawer” technique to see how the coccyx was moving. This technique is a bit challenging to perform on Michael due to the curve in his spine, but after finding the correct hand placement, it eased his pain quite a bit and he was able to sit without tailbone pain for an increased amount of time. The technique is usually done with the patient actively flexing and extending their spine by bending forward and extending backward at the hips while seated. Since Michael is unable to perform a full range of motion on his own, we had another therapist perform these motions for him while I performed the technique. When we leaned Michael into a forward flexed position, I applied gentle pressure to the coccyx and increase the amount of flexion, and then applied traction to the fascia over the coccyx while he was being put into extension to increase the extension of the sacrum.
The idea was to increase the mobility of the coccyx to allow for the coccyx to be in a more comfortable position when Michael is sitting in his wheelchair. To allow for even more comfort and the ability for Michael to perform weight shifting throughout the day, we are working on getting him in his new wheelchair, which has the capability to recline and change the pressure of the seat to allow for side-to-side weight shifting as well.
It is common to have patients complain of pain while sitting throughout the day, and a lot of times the solution is to increase their activity level and correct their posture, but with Michael and other patients who are in a wheelchair and unable to use their lower extremities, you may have to try different techniques to help them be more comfortable throughout their daily activities. Talk with your patients and ask them when they have pain and where. They may think the pain is something they have to deal with and there is nothing that can be done about it, but there may be something you can try to help them with, even if it’s a small amount.