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30 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 2 Pain while sitting is a common client complaint, but massage therapists often disregard the coccyx as a possible pain generator. This is due to a lack of biomechanical knowledge about the coccyx, as well as concerns about how to safely assess and treat this structure. When seated, the coccyx and bilateral ischial tuberosities form an elegant weight- bearing tripod. Although the coccyx bears minimal weight when sitting—about 10 percent, like the fi bula—it can be a major pain generator. Events such as childbirth or falling on the tailbone can lead to coccygeal pain, known as coccydynia. In most cases, the pain is caused by an unstable coccyx, resulting in chronic infl ammation of the sacrococcygeal joint, along with protective guarding in associated muscles (Image 1). Don't Disregard the Coccyx Addressing Localized Buttock Pain Coccydynia can also be attributed to a malformed or dislocated coccyx and the growth of bony spurs at this joint. Unlike fractures, which can remodel, sacrococcygeal joint pain can last indefi nitely if the infl amed joint is repeatedly forced from its normal position. In cases where infl ammatory waste products trigger chemoreceptors and altered sacrococcygeal joint alignment stimulates mechanoreceptors, the brain often locks the area up with reactive muscle spasm to prevent further insult. This is where myoskeletal therapy may help. I encourage you to spark your biomechanical mindset and gain the knowledge necessary to evaluate and treat coccyx pain more thoroughly and confi dently. An infl amed coccyx may cause spasm in pelvic fl oor muscles. 1 Pelvic fl oor Sacrococcygeal joint Coccyx ANATOMICAL CONSIDERATIONS Many of us have been taught that the three or four bones of the coccyx fuse into one rigid segment by adulthood. However, several well-designed studies have shown there should be two or three movable parts within the coccyx that gently curve forward and slightly fl ex as we sit. 1 In fact, the authors of two medical papers found that people with fused coccyges who were unable to fl ex upon sitting were more likely to experience tailbone pain than those with a normal coccyx. 2 The primary conditions associated with coccyx pain in these studies were coccyges that were angled sharply forward (hooked coccyx) and bent more to one side. As for symptoms, the study participants reported dull, aching pain emanating from the gluteal cleft just superior to the anus and sometimes stabbing pain when rising from prolonged sitting. They also complained of localized pain after long periods of driving, biking, and sitting on hard surfaces, and many found that shifting weight from buttock to buttock temporarily relieved their symptoms. Because the coccyx bears more weight when a seated person leans back, we often see clients with coccyx pain fl exing at the hips to shift more weight to their sitz bones (Image 2). In humans, the coccyx serves important biomechanical functions and is an attachment site for various muscles, tendons, TECHNIQUE By Erik Dalton, PhD KEY POINTS • Coccydynia, or coccygeal pain, is often caused by an unstable coccyx, resulting in chronic infl ammation of the sacrococcygeal joint, along with protective muscle guarding. • Massage therapy can be used as a conservative treatment by restoring fl exibility to surrounding muscles; from there, use ligaments as levers to help move the coccyx back to a functional position. MYOSKELETAL ALIGNMENT TECHNIQUES