Toolbox of Touch:
Coccyx Controversy
Erik Dalton, Ph.D.
Article as seen in Massage Today Magazine
October 2006
Many of
today’s medical texts tell us the coccyx fuses into one rigid
segment by adulthood in most people. However, several well-designed
studies have shown that a normal coccyx should have two or three
movable parts that gently curve forward and slightly flex as we sit.
Two medical papers (Postacchini and Massobrio1 and Kim
and Suk2) found that test subjects with fused coccyxes
that didn’t flex upon sitting were more likely to experience
tailbone pain than those with a normal coccyx. Postacchini and
Massobrio performed radiographic studies of 171 coccyxes, and found
less than 10 percent were fused into one piece…most had two or
three, and a few had four segments. The primary conditions they
found to be associated with coccyx pain were: coccyx angled sharply
forward; coccyx side-bending more to one side than the other; and
coccyx completely rigid (all segments fused together and fused to
the sacrum).
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Although none of the
abnormalities listed above always cause pain,
clients seem more likely to experience coccyx problems
when one or more of these conditions exist. Over the
years, I have noticed clients with particularly long
coccyxes also seem more likely to report local tenderness
and pain. Although not reported in the literature, it
seems obvious that a long coccyx would be more likely to
suffer damage than a shorter one.
Why some hurt and others don’t
is unclear. In the case of a misaligned coccyx, it might
be that the pain is caused by the coccyx pulling on
muscles, ligaments or overstretching the filamen terminale
(end of the dural tube). Connective tissues called the
filum durae spinalis enclose the end of the spinal cord
and attach it to the deep dorsal sacrococcygeal ligament. |
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Idiopathic head and
low back pain syndromes frequently manifest when a
distorted coccyx tugs on the dural tube, causing
reverberating tensional forces to travel all the
way up to the occiput.
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A major source of hip and back pain
occurs as fibrotic sacrococcygeal ligaments anteriorly flex (hook)
the coccyx and compress/overstretch the sensitive filum terminale (Fig.1).
In the case of a rigid coccyx, it might be that the tissues under
the inferior segments might create a pad of irritated tissue (like a
bunion) that can rub the dura raw. But the most common
pain-generator helped by manual therapists is neuroreceptor pain
from a misaligned sacrococcygeal joint.
Coccydynia (Coccyx Pain)
When sitting, the coccyx shifts forward
and acts as a shock absorber. However, falling on the tailbone or
events such as childbirth can lead to coccygeal pain, known as
coccydynia. In most cases, the pain is caused by an unstable coccyx,
resulting in chronic inflammation of the sacrococcygeal joint.
Coccydynia also can be attributed to a malformed or dislocated
coccyx and the growth of bony spurs on the coccyx. Resulting pain
often is resolved by performing specific soft tissue techniques to
release the levator ani muscle, anococcygeal, sacrotuberal and
sacrospinal ligaments, as well as the gluteus maximus muscles.
Another common etiology is childbirth.
The coccyx is considered by some to be in the way during childbirth.
At the end of the third trimester, certain hormonal changes enable
the synchondrosis between the sacrum and the coccyx to soften and
become more mobile. This increased mobility of three to five
coccygeal segments allows for more flexion and extension, which
might permanently change the resting tension of the surrounding
ligaments and muscles. Unlike fractures, which can remodel, injuries
to the sacrococcygeal junction often become inflamed as the joint is
repeatedly forced out of its normal position. Physical examination
should include direct palpation of the coccyx for tenderness. In
true coccydynia, the coccygeal region usually is markedly tender. If
the client reports coccygeal pain but is not tender upon palpation,
the therapist should refer out for an orthopedic workup to rule out
lumbar disk disease.
Hooked Coccyx
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Coccyx Release. Therapist
releases tight right pelvic ligaments by reaching across
the body and contacting the left ischial tuberosity with
his dominant thumb and sliding up and under attachments at
the inferior border of the sacrum. The therapist’s other
thumb braces on top, maintaining sustained “scooping”
pressure to release ligaments and gently lift the coccyx
from its hooked position |
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| Ida Rolf,
PhD, referring to the coccyx as the “seat of the soul,”
insisted on correcting hooked and side-bent coccyxes
during her famous session six of the Rolfing® series. When
this tiny group of bones “hooks” anteriorly or bends to
one side (typically the left), the dural tube tightens. In
reported cases, a hooked coccyx actually has shut down the
entire CNS by hindering cerebrospinal fluid flow. A hooked
coccyx also can lead to loss of psychological integrity.
Reported cases cite severe emotional disturbances in
people whose coccyx has been removed or broken off,
leaving no anchor for the dura mater. The coccyx has been
implicated in clients presenting with functional scoliotic
patterns. Through its connection with the sphenoid,
excessive dural tension stresses the eleventh cranial
accessory nerve, which, in turn, shortens the SCMs and
upper trapezius muscles. A modified version of Dr. Rolf’s
coccyx technique is demonstrated in Fig. 2
Coccyx pain often is caused
by falling backwards or by childbirth, although in many
cases, the exact etiology is unknown. There are various
treatment modalities available, and the great majority of
sufferers can be helped. Due to the vertebra’s direct
attachment to the dural membrane through the filum
terminale, coccyx work can cause a client to become very
emotional. Prior to treating coccyx dysfunction, always
ask the client’s permission to perform this technique due
to possible physical and emotional hypersensitivity in the
area. Before performing any type of coccyx work, take time
to clearly explain your therapeutic intent and the desired
outcome. All coccyx alignment techniques should be
performed through underwear or draping. |
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References
- Postacchini F, Massobrio M,
Idiopathic coccygodynia. Analysis of fifty-one operative cases and
a radiographic study of the normal coccyx. The Journal of Bone
and Joint Surgery. 1983 65(8): 1116-1124.
- Kim NH; Suk KS: Clinical and
radiological differences between traumatic and idiopathic
coccygodynia. Yonsei Med J, 1999 Jun, 40:3, 215-20.
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