Playing sports with sinus pilonidalis?

Treatment coccygeal fistula and sports

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Are athletes more susceptible to coccyx fistula?

Sports and other injuries

Friction, sweating and bruising do not play a crucial role in the development of a pilonidal sinus. This condition, also known as Pilonidal Sinus , is usually caused by the ingrowth of hair in the coccyx area. Although external factors such as friction or bruising can aggravate the condition, they are not the main cause of the development of a Pilonidal Sinus. Nevertheless, proper care and hygiene of the coccyx area is important to relieve discomfort and prevent recurrence.

Sweating

Although it is repeatedly claimed, there is no evidence that sweat plays a role in the development of pilonidal sinus.

Sweating is a vital mechanism of the human body to regulate body temperature and remove excess heat. Sweat production is regulated by various factors such as physical activity, ambient temperature, emotions and general health.

Sweat consists mainly of water, electrolytes such as sodium and potassium as well as small amounts of urea, lactic acid and immunoglobulin A.

IgA serves to protect the skin and mucous membranes from microorganisms. It has the ability to bind toxins and, in combination with lysozyme, develops antibacterial and antiviral properties.

And what about wound healing? Well, science does not yet have a clear answer. An acidic pH value and IgA in our sweat could actually protect wounds from infection. Research is currently even being carried out into whether synthetic sweat can improve wound healing.

Sweating also stimulates blood circulation and gives the healing process the necessary kick-start.

Friction and textile fibers

There is a theory that textile fibers can also penetrate the skin pores through friction and pressure. These penetrated hairs and fibers could trigger a foreign body reaction that leads to inflammation and ultimately to the formation of a pilonidal sinus. However, there are no systematic studies to date that support this assumption. Furthermore, in the almost 7000 pilonidal fistulas that we have operated on so far, I have never been able to identify textile particles that would have been visible to the naked eye or using magnifying glasses. So dust and lint do not seem to be the culprits.

Is it allowed to do sports with Pilonidal Sinus ?

Can athletic stress worsen a Pilonidal Sinus ?

Despite a Pilonidal Sinus , it is possible to play sports in many cases as long as certain precautions are observed. The choice of sport plays a crucial role. Sports that generate little pressure and friction in the coccyx area, such as swimming or cycling, are often better tolerated. However, it is advisable to always consult with a physician before continuing or starting any sports activity to ensure that there are no risks or concerns in your individual case. Proper care and hygiene of the affected area and wearing loose, non-restrictive clothing can also help minimize discomfort during exercise. In any case, it is important to listen to your body and consult a physician immediately if you experience pain or problems.

Sport after coccygeal fistula surgery

When is it allowed to return to physical work, sports and sex after the operation?

Sport is a real health booster - even for patients after an operation! The fast-track concept of surgical rehabilitation builds on precisely this.

We have learned that bed rest, plaster casts and food restriction are not beneficial, but can actually be detrimental (keyword: inactive atrophy and catabolic metabolic states).

But how great is the risk of the wound opening up again in everyday life or during sport?

To find out, we need to understand the two types of wound healing. In primary wound healing, which is the aim after surgical procedures with wound closure, the wound edges are initially joined by suturing, stapling or gluing.

The wound then goes through four phases:

Coagulation phase (day 1): This is when blood platelets and coagulation factors stick the wound together. The resulting fibrin is the body's own superglue. Antibodies and white blood cells are active in the defense against infection. Stability is ensured primarily by the skin sutures, so strain should be avoided.

Inflammation phase (day 1 - 4): Messenger substances are released that cause vasodilation, increased blood flow, new blood vessel formation and the attraction of connective tissue cells (fibroblasts). These fibroblasts are true masters in the production of stabilizing fibres. The increased blood circulation can be recognized by the reddish or purple color of the scar. The mechanical strength is still low.

Proliferation phase (day 5-14): The fibroblasts multiply and form procollagen. This protein transforms into tropocollagen and contains larger amounts of the amino acids lysine, glycine and proline. By cross-linking these proteins, collagen fibrils are formed, which gradually stabilize the resulting scar.

Contraction phase (day 15 -): In this phase, the build-up and breakdown of collagen fibrils balance each other out and the fibers rearrange themselves. The mechanical strength of the scar continues to increase and the color of the scar gradually approaches the normal skin tone. In addition, the scar slowly begins to shrink as the tissue contracts and takes on a more compact structure. The scar is now fully resilient again.

In the "butcher's method" and in pit picking, the process of secondary wound healing is used, which corresponds to the natural mechanism of healing an injury.

Here, the wound slowly fills with granulation tissue to eventually reach the skin level. The skin then gradually begins to grow over the wound from both sides at a rate of about 1 mm per week. Only when the wound is completely closed will it stop weeping. It does not "air dry." With this type of wound healing, the progress achieved remains stable at all times, and physical rest does not provide any additional benefits.

However, if secondary wound healing is disturbed, usually caused by hair in the context of coccygeal fistulas, the granulation tissue remains unstable, proliferates beyond the boundaries of the wound ("wild flesh") and may bleed at the slightest touch. Normally, even in this case, a delicate skin layer forms over this tissue. Nevertheless, the scar remains unstable, regardless of how much you take it easy. Only when the disturbing factor, namely the hair, is removed, a firm and bleeding-free scar can develop.

Green = recommended

Open wound treatment: sport allowed without restrictions Closed wound treatment: Sport after 2 weeks

Which sports are problematic? Which are recommended?

When choosing sports with regard to possible relief or stress on the coccyx region, it is important to distinguish between activities that can exert pressure or impact loads on the coccyx and those that avoid this. Here are some considerations:

Sports that can strain the coccyx:

Cycling: Sitting on a narrow saddle for long periods can put pressure on the coccyx.
Riding: The movements and pressure of the saddle when riding can put strain on the coccyx.
Rowing: The sitting position when rowing can put pressure on the coccyx, especially during intensive or prolonged exercise.
Contact sports: sports such as soccer, rugby or martial arts carry the risk of a direct impact or injury to the coccyx

Unproblematic sports:

Swimming: Swimming is generally very easy on the joints and does not place any direct strain on the coccyx.
Hiking: Hiking or brisk walking is a low-impact activity that does not put direct stress on the coccyx.
Yoga: Many yoga exercises can help to strengthen and stretch the muscles around the coccyx without putting pressure on the coccyx. However, certain positions that put pressure on the coccyx should be avoided.
Pilates: Similar to yoga, Pilates can help to strengthen the core muscles and improve flexibility without putting strain on the coccyx.
Cross trainer: Cardio training on a cross trainer minimizes the strain on the coccyx and other joints.
Fitness - training on strength equipment: Strength training on machines leads to a selective load on individual muscle groups and can therefore be used in a very targeted manner.

It is important to listen to your body and avoid or adjust activities if you experience pain or discomfort in the coccyx area. In general, shear forces and frictional stresses under pressure, i.e. when sitting or lying down, seem to be a decisive factor.

Literature: Coccygeal fistula and sports

What science says

Diao, J., Liu, J., Wang, S., Chang, M., Wang, X., Guo, B., Yu, Q., Yan, F., Su, Y., & Wang, Y. (2019). Sweat gland organoids contribute to cutaneous wound healing and sweat gland regeneration. Cell death & disease, 10(3), 238

Doll, D., Brengelmann, I., Schober, P., Ommer, A., Bosche, F., Papalois, A., Petersen, S., Wilhelm, D., Jongen, J., & Luedi, M. (2021). Rethinking the causes of pilonidal sinus disease: a matched cohort study. Scientific Reports, 11(1)

Karydakis,G.E. (1992). Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust. N. Z. J. Surg. 62, 385-389 .

Kawanishi, M., Kami, K., Nishimura, Y., Minami, K., Senba, E., Umemoto, Y., Kinoshita, T., & Tajima, F. (2022). Exercise-induced increase in M2 macrophages accelerates wound healing in young mice. Physiological Reports, 10(19)

Pinho, E., Soares, G., Henriques, M., & Grootveld, M. (2015). Antibacterial Activity of Textiles for Wound Treatment. The AATCC Journal of Research (AJOR), 2(5), 1

Yndriago, L., & Izeta, A. (2017). Shh... Sweat gland in progress! Experimental Dermatology, 26(6), 548-549.