Oh sit down!!

As I detailed in my previous posting on the treatments I have had, it took me 2 years before I had a seated X Ray. The first image below is not the seated one (it is the one from where Dr Maigne did the guided injection). However, the seated one (the second on, also done in Paris), clearly shows the dislocation between C1 and C2 (i.e. between the last vertical segment and the horizontal segment).

  

It baffles me why the NHS is so reluctant to give even a standing X-ray, let alone a seated one, when someone has unexplained pain for more than 8 weeks or so and is not responding to physio etc. I know it is because of their guidelines regarding radiation to parts of the pelvis, but I think most people would take that very minor downside if it were to help them get some kind of diagnosis on their pain!!! If more GPs (as referall points) and other health professionals were educated on this, my sense is that a lot of people would shortcut their pain duration and be able to seek more appropriate treatment sooner rather than later - through getting dynamic standing/sitting X-rays. This would save the NHS lots of money in MRI scans, physio sessions, GP follow ups, and of course, everyone's favourite, more drugs.

Having had, at least in part, some of my strange coccyx explained following a standing X-ray by chiropractor and coccyx expert, Michael Durtnall, I know the benefits of finally having someone that knows what they are looking at, actually explaining an image that shows the coccyx is clearly not 'normal'. At the time this was a major breakthrough. Indeed, Michael's knowledge and advice were invaluable to me. However, even he does not do seated X-rays, not as protocol, but also seemingly not at all. I find this a little strange, particularly when dealing with cases such as mine that had not really responded to lots of treatment - probably something like 50 plus separate manipulation on me. To explain further, his opinion on mine was that both the sacroccygeal joint and the next one down (C1:C2) were like concrete. The aim was to get the sacroccygeal joint mobilised so that it could flex forward rather than being in the slightly extended and fixed position. This in his opinion would make the C1:C2 joint largely irrelevant as the 90 degree angle as seen above would be less and less pressure on the joint. All very logical in theory but after a year of bashing we were not really making any progress and insitinctively I knew this was heading nowhere and wasting lots of money and yet time. What he got wrong was that upon sitting C1:C2 was actually hypermobile not like concrete as he suggested and it was completely dislocating upon sitting - as seen in the X-ray if you look carefully. Yes, it may have been like concrete in being moved one way (down and back) but it floated up very willingly when I sat. And the sacroccygeal joint that slightly extends backwards is ossified so unfortunately was never going to move forward in the first place despite all the bashing.

This is not meant to be overly critical of his approach as without him I may not have found my way to Dr Maigne, and I am sure based on his experience this works in the majority of cases (his testimonials are evidence of this). However, it did not work for me and a seated X-ray right at the start may have given a heads up on this before going to see Dr Maigne a year or so later. Michael was completely supportive of the decision to proceed with surgery and offered me invaluable guidance on what to speak to Dr Maigne and Pr Doursouninan about prior to the surgery. I must add he still thought he could fix it though! However, I knew he couldn't. 

The bigger point is that the NHS or equivalent in other countries should be providing this as a standard protocol. As a result of them not, I was a couple of years further down the line and no better off (and significantly worse off financially!). I would like to think that my case, and numerous others like mine that I am aware of, should provide strong evidence to change the protocol, but I do not think it will. The lady who Professor Doursounian operated on on the same day as me would also have benefitted for starters! And I have read many similar stories of woe on coccyx.org.  If I knew what I know now that is the only thing I would change about the process I have gone through - where I have taken the advice and done everything everyone has suggested every step of the way. Hindsight is a great thing so hopefully some people will benefit from having read this. Clearly every case is different and it is a case of finding what works for you, but surely the first step should be to get in front of the X-ray machine and just sit down!

For more info see Dr Maigne's personal website which has links to several articles and images: http://www.sofmmoo.com/english_section/7_coccyx/coccyx_photos/accueil_coccyx.htm