Manual treatments for coccyx pain

See also personal experiences of manual treatments

First a word of warning: my coccyx pain was made worse by a physiotherapist who pressed hard on the coccyx from the outside, and I have heard of other cases where a doctor or another specialist made someone's pain a lot worse by doing this (or even caused the pain in the first place - see Physical therapist pushed too hard and dislodged my tailbone). So if you do decide to go for manual treatment, make sure it is gentle and is carried out by someone who knows what they are doing.

The idea behind manual treatment is that tense muscles can pull the coccyx out of position, causing pain. The treatment aims to relax and extend the muscles, so that the coccyx can return to its normal position.

Many people who have had manual treatment carried out by a skilled practitioner have reported success. People who had this treatment have suggested that you should allow a week or two between treatments, but that if it doesn't work first time, it probably won't work at all. Manual treatments of the coccyx may be carried out by physical therapists (also called physiotherapists), by chiropractors, osteopaths, or massage therapists.

Dr Marc Heller, a chiropractor, wrote an article in Dynamic Chiropractic (PDF) describing in detail the methods that he uses.

Dr Michael Durtnall, a chiropractor, presented results of a trial of Manipulation for coccydynia. He found that 73% of patients improved by 70-100% over an average of less than 7 treatments using specific manipulation, acupuncture, physical therapy and robust exercise.

There are two versions of manual treatment: external and internal. The details may vary from one therapist to another.

External manipulation of the coccyx consists of pulling the tip of the coccyx backwards through the skin just above the anus.

Meine Veldman, a physiotherapist, describes his method of external manipulation in this paper, with photographs: External correction of the coccyx bone.

Brenda was shown the external method of manipulation by a massage therapist, and went on to carry out external manipulation on herself. Note if you do this, it is essential to pull the coccyx backwards, not push it forwards, which could make the pain worse.

A physical therapist has found in his practice that external mobilization is usually effective, so that internal manipulation is not necessary in most cases.

Jerry Hesch has produced videos of treatment for a coccyx bent to one side and a hyperextended coccyx (see links at end of page).

Internal manipulation of the coccyx is carried out by the therapist placing a gloved finger into the anus of the patient, and gently massaging or stretching the muscles attached to the coccyx. Most therapists also gently pull the coccyx into its normal position, if it is out of position. Some also use the vagina of female patients to get access to the muscles, if the patient agrees.

The figure shows massage of the coccyx, from Gellhorn. He says "The bone is held between the forefinger in the rectum and the thumb on the [skin] outside; it is then moved backward and forward and the soft parts are moved about on the bone."

Susan St Claire wrote a paper in Journal of the American Chiropractic Association describing the methods she uses.

Dr Jean-Yves Maigne of the Hotel-Dieu hospital in Paris has carried out a study, and published the results in the journal Spine. Manual treatments worked best on patients who did not have an unstable coccyx, according to the sit/stand dynamic x-rays.

Dr Clemens Franzmayr (Musculoskeletal Medicine Clinic, 265 Papanui Road, Christchurch 5, New Zealand) wrote to me: The "manipulation" I carry out is actually a mobilisation (soft tissue relaxation, according to post isometric relaxation techniques) - this means we treat a muscle with minimal force and after it, it will relax better. Magnus Ericsson describes a gentle osteopathic treatment for coccyx pain which may be similar.

Lee described carrying out an internal manipulation on himself with success.

An anonymous graduate student of physical therapy describes what she was taught by a specialist in women's health. This included massage of the ligaments and muscles via the vagina as well as via the anus.

The Clear Passage Therapies website says that at this clinic they apply 'a gentle stretch for a sustained period of time to areas of your body where we feel abnormal tensions'.

Dr Lila Abbatte has developed a taping technique which is used together with manual treatment, to hold the coccyx in the correct position between treatments.

Five people have reported that they tried the Bowen technique, which is described as a series of gently rolling connective tissue moves, using a light touch and may be done through clothing. Two of these reported success, and three found no improvement. There are more details of the technique at www.bowtech.com.

There is a chiropractic treatment using an instrument called an Activator, which delivers a small controlled mechanical shock or "punch" to the area it is in contact with. It does not seem to be used much for coccyx problems. There is an abstract of a medical paper on the use of Activator technique in coccydynia (but only on one patient). Another patient reported rapid success with this treatment.

Julie has written about the success she had with a physical therapy designed to straighten out twists in her hips and shoulders.

Grace has had a programme of massage and exercise that has helped her greatly, though not directly related to the coccyx.

One type of therapy that is sometimes offered by physical therapists is ultrasound treatment. Very few people find this has any effect.

Updated 2014-01-05