Issue link: https://www.massageandbodyworkdigital.com/i/1439667
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 31 and ligaments. Muscles originating on the posterior coccyx include the gluteus maximus and strands of biceps femoris, which is often continuous with the sacrotuberous ligaments. Although multiple important ligaments attach to the coccyx, the ones I feel are most important for treating a hooked and sidebent coccyx are the sacrotuberous, sacrospinous, and lateral sacrococcygeal ligaments (Images 3 and 4). ASSESSMENT AND TREATMENT During the history intake for clients presenting with localized buttock pain, therapists can apply clinical reasoning to collect information by asking basic questions, such as: How do you think your pain began? Why do you think it continues to hurt? What kind of movements trigger the pain? When did you fi rst notice the pain? Where do you feel the discomfort, and can you reproduce the pain by pressing on a particular spot? Working through these questions in the intake interview not only helps pinpoint the injury site and possible tissues involved, but also reinforces that the client is being heard and that you will be working together as a team to help relieve their symptoms. Massage therapy can be used as a conservative treatment for a coccyx injury by aiming to restore fl exibility to surrounding buttock muscles. From there, the therapist can use ligaments as levers to help move the coccyx back to a more functional position. This can be done with the client prone or sidelying. In Image 5, I stand on the side toward which the coccyx is bent so I can hook my thumbs under the contralateral sacrotuberous and sacrospinous ligaments. The goal is to scoop up under the ligaments and gently traction the tissue posteriorly to reposition the hooked and sidebent sacrococcygeal joint. After holding for a period of 10–60 seconds, the tissues surrounding the coccyx should begin to release. If you do not feel the tissue easing, a movement enhancer such as slow pelvic tilting or deep inhalation and exhalation often does the trick. An important note to therapists treating coccyx dysfunction: Always ask the client's permission to perform this technique due to possible physical and emotional hypersensitivity in the area, and work through clothing or draping to better allow the client to relax. In addition, before performing any type of coccyx work, take time to clearly explain what you're doing and the desired outcome. Notes 1. L. S. Lirette et al., "Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain," Ochsner Journal 14, no. 1 (2014): 84–7. 2. F. Postacchini and M. Massobrio, "Idiopathic Coccygodynia. Analysis of Fifty-One Operative Cases and a Radiographic Study of the Normal Coccyx," Journal of Bone and Joint Surgery 65, no. 8 (1983): 1,116 –24; N. H. Kim and K. S. Suk, "Clinical and Radiological Differences Between Traumatic and Idiopathic Coccygodynia," Yonsei Medical Journal 40, no. 3 (1999): 215–20. 5 The therapist can use ligaments as levers to help move the coccyx back to a more functional position. Clients with coccyx pain may lean forward to relieve coccyx compression. 2 Ischial tuberosity No coccyx compression Compressed coccyx Coccyx 3 The sacrotuberous and sacrospinous ligament labels need to be switched. Coccyx Sacrotuberous ligament Sacrospinous ligament 4 SC Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfi ng, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit erikdalton.com. VIDEO: "COCCYX TREATMENT" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch! An injured sacrococcygeal ligament (SC) can drag the coccyx forward, fi xate the joint, and impact pelvic fl oor function.