Joined: March 1, 2003
When I was in my twenties, I slipped on icy stairs landing right on the coccyx and ended up in bed for two days. The thing ached pretty bad for about a year then no problem. Wasn't until I became pregnant that the MD asked me when did I fx. my coccyx, because it healed at an angle and I would probably be looking at forceps delivery. Guess my point would be, I agree with Drew, can't a person do an indirect technique? I can't picture myself doing that, and I used to be a nurse.
Joined: December 22, 2003
From: sherkston Ont Canada
taibone adjustment??a mdeical doctor sticks his gloved finger in there to check prostate with no lawsuits etc I asked my md about the cocyx internak and kow and behold I talked myself into a DRE along with my blood work, and he said thats as close as one gets to a tailbone adjustment in this clinic so question is whats the fuss all about, seems better to flick it back as opposed to surgery (comments) or am I just confused
Joined: May 9, 2004
From: West Palm Beach
I agree with Drew, why set yourself up for that. I have had 2 specific requests both for younger female athletes, and I told them no, go and seek someone likean FAAOMPT female and maybe they'll do it, otherwise too litigious of a society, I'd try MET, coccyx works in conjunction with L5, reciprocal to sacrum if I do recall..
Joined: March 12, 2004
Non-invasive coccyx mobilization:
Isolate the restriction in the dysfunctional plane, i.e. flexed, extended, rotated left/right while the patient is in the prone position. Then, have the patient flex one of their LEs (try each one and see which gets better movement of the coccyx) while simultaneously performing isometric contractions each direction until you feel the coccyx release. No luck? Keep providing the sustained isometric contraction in new directions with the LE until it does release.
Recheck the coccyx for the improved mobility. I've seen this performed before by one of my former instructors and it does work well. I've only used it a few times and have had success.
Joined: March 1, 2004
I think I posted something similar to this on a previous thread. I have treated two people successfully with just a lateral and P-A mobilization, Maitland technique. Both patients were females and I had them wear spandex shorts while I performed the mobs. One of the patients had complete resolution of symptoms, the other was about 60% better. Here is a picture of the technique.
You are close to the anus here but not inside it. Be sure to have a chaperone if possible, just in case. It also helps if the patient is not obese for obvious reasons and you may want to practice this on a spouse or close friend/collegue before trying on a patient.
In my opinion, this is something worth trying rather than "punting" the patient to someone else who is brave enough to go in.
Joined: March 1, 2003
Just my opinion, but ask yourself: Are you trained in pelvic/rectal examination? Are you able to rule out the the existance of tumors or is this a clear cut case of a traumatic event. I would be quite cautious in my approach and in close communication with the physician. My PT intervention would be lumbar support that would decrease pressure on coccyx when sitting (avoid sitting as much as possible and don't sit on soft cushion or pillow) mobilizing the sacrum or lumbar spine if indicated and perhaps give Army's technique a try. I did a search on one site that recommended Biofreeze but have never heard of anyone doing that.
Joined: February 14, 2003
From: Madison WI USA
Forgive me if my anatomical knowledge has slipped a bit, but are there actually joints in the coccyx? If not, what is being manipulated or mobilized? Will it stay there afterward? Seems to me that this is a stationary object. I am certainly not an expert in biomechanics of the coccyx, but I do know that there are no muscles that can make it move, therefore gaining "stabilization" is out of the question. Perhaps someone with a lot of experience in pelvic floor re-education can chime in here. Why is this supposed to "work"? Inquiring minds want to know.
Joined: January 25, 2003
If there is a radiographically confirmed coccyx injury, let the orthopod, sports med, or EM doc manipulate it. Its easy, one finger in, one thumb out...move. Please wear gloves. As for a litigious society, yep we are, that is why no PT in their right mind would want this WITHOUT signed consent and a chaparone. Noninvasive techniques around the anus need the same... I have too much experience worrying about lawsuits to not share some advice (too many pelvic exams to mention, rectals, catheters, etc etc.)
But remember, there ARE DC's who do pelvic exams in certain states, so when I say "PT in his right mind", it should be noted that there ARE exceptions to the "right mind"...as many practitioners are not in theirs.
Dr. Wagner DO Moderator of Medical Complexity Forum
I have performed the coccygeal mobilization technique as described by JV Maigne (Spine vol 26, # 20 2001) on multiple patients over the last several years, on the right patient these techniques can be extremely effective in reducing even chronic coccygodynia. We have the patient read and sign a very detailed informed consent prior to the eval, and then the technique is explicitly demonstrated on a pelvic model and verbal consent is again attained. I always have a chaperone in the room. For those patients suffering years of "tailbone pain" without any relief consent is usually not a problem and if the technique works they are extremely grateful.
I have seen mobilization or manipulations (if you want to use APTA approved verbage) of the coccyx be very effective. Most of the time, external manipulations grades I-III can be done and are effective. But with some coccyx injuries, soft tissue work to the pelvic floor musculature can also relieve pain and discomfort.
Joined: January 3, 2003
From: The Netherlands
There may be a noninvasive manual technique that might reposition the coccyx. I learned it from an osteopath who claimed that it was effective in case of uncomplicated coccyx luxation (I don't have any personal experience with it). I forgot to ask whether it has an official name, but I call it the Rebound Technique.
It's as follows:
* Patient prone. * Clinician puts the palm of his nondominant hand on the sacrum, and the middle finger over the coccyx. This finger acts as 'cushion'. * Clinician applies pressure with one or more fingers of the dominant hand, so that the coccyx is moved further (diagonally) anteriorly. * The pressure is applied up to the point where the patient says that the pain is getting (too) severe. * The clinician withdraws both hands in a sudden, jurky motion.
The idea behind it is that by pushing the coccyx further, the ligaments that keep (should have kept) it in place are stretched, and thus a reactional tension is created. With the sudden release of the 'actional' force, the reactional tension causes a reactional force, repositioning the coccyx in it physiological position.
Whether it works in practice? Beats me, really. But in my opinion the mechanism behind it sounds credible.
I would, however, even though this is a noninvasive technique, still have the patient sign a consent form.
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