Prolonged sitting proving to be painful for patient with SMA

A patient I work with who has spinal muscular atrophy, Michael, continues to experience pain in his right hip with prolonged sitting since moving to a new wheelchair earlier this year. He has continued to lose muscle mass in his hip, leading to increased pressure on his sciatic nerve and his coccyx, or tailbone.

Michael has to sit in his wheelchair when he is up for the day; he’s now sitting less and less due to pain in his right hip and sometimes down into his right leg. Michael used to be able to sit for most of the day, now he is limited to a few hours before having to transfer into his bed for the remainder of the day because of pain.

We have discussed getting a new cushion for his wheelchair to reduce the pressure on his hip, although we haven’t had success with the different cushions he’s tried so far. We have experimented with modifying hip flexion to change the pressure on his hip by increasing the height of his right foot. This didn’t change the feeling of pain in his hip and wasn’t able to be sustained in the long term.

We then looked at his back to try to modify his lumbar, or lower back, posture. Michael had a fusion of most of his thoracic and his entire lumbar spine several years ago, making it impossible to make any change there.

We continue to use techniques such as stretching his legs and hips while lying on the therapy table and sitting in his wheelchair to reduce his pain as well as soft tissue massages when applicable. We’ve recently tried other activities, such as dry needling around the coccyx region, to improve blood flow and promote healing properties to the area. Dry needling causes a localized twitch response and stimulates the body’s natural healing process. The dry needling also helps release the tension in the muscles and can improve the range of motion.

Michael’s coccyx is usually rightward deviated, therefore we have been performing coccyx mobilizations externally to reduce the tension in the attachments of the coccyx and improve the posture of the coccyx. When Michael first sat on his new cushion, his coccyx stayed more midline for several weeks, although the more he sits in the chair and as the cushion forms to his body, the rightward deviation has returned and increased his pain.

In a few weeks, we are scheduled for another session to perform internal release of the coccygeus muscles, muscles on the side of the coccyx, to reduce the rightward deviation. Due to the scoliosis, or curving, of his spine, he is forced to sit with his weight shifted to the side. Because of this, whenever we are able to reduce the deviation and reduce the pain, prolonged sitting causes the problem to repeat.

We are still looking for a better and more prolonged solution, although we will continue to perform the modalities and activities we know help reduce his pain for the time being. We will continue to collaborate with other professionals to discuss different options for prolonged relief and improved function for Michael.

Patient perspective

After sitting in a wheelchair for nearly 60 years, and after getting a new wheelchair with a different type of seat, changes needed to be made with my wheelchair cushion. I’ve tried numerous cushions, and while some are better than others, nothing has helped my tailbone.

After losing nearly 30 pounds over the past six years, this has also aggravated and exacerbated the problems with my sciatic nerve. Without enough fat and muscle in my buttocks, I’m sitting on bone and nerves. Emily and I met with a seating expert a few months ago, and will have another meeting with her to discuss a new cushion that may help my tailbone and sciatic nerve pain.

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