Massage & Bodywork

SEPTEMBER | OCTOBER 2017

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Using modalities such as massage, manual manipulation, psychotherapy, and pelvic fl oor rehabilitation, pain management researchers at the Ochsner Clinic Foundation discovered that conservative treatment was successful in 90 percent of coccydynia cases. 1 In some people with coccyx dysfunction, the brain's alarm system is triggered, warning of the possibility of tissue damage, whereas others with the same condition feel no pain. In the extreme, a person's nervous system "volume" may be turned up due to prolonged exposure to painful stimuli. This sensitization process causes buttock and pelvic pain to linger long after the problem has been resolved. Researchers are uncertain why some people with coccyx dysfunction are symptomatic and others are not, but it's likely linked to pain-gating malfunction and coccyx hypersensitivity. Here, we'll focus on assessing and correcting the most commonly seen coccyx disorders: sacrococcygeal joint misalignment and accompanying pelvic fl oor muscle spasm (Image 1). To begin, let's review possible causes and symptoms in clients suffering coccydynia pain. CAUSES OF COCCYDYNIA Pratfalls and direct blows to the coccyx from contact sports are obvious culprits, but what about the strenuous compressive forces cyclists, rowers, and desk jockeys place on the tailbone? In this "overuse and abuse" population, spastic pelvic fl oor muscles overengage and bind down the coccyx and surrounding neural structures. When noxious input from strained connective tissues overloads the spinal cord's neuronal pool, the brain gets involved and may decide to splint the area with protective muscle spasm. Thus begins the vicious cycle of muscle overuse causing brain irritation causing more layering of protective spasm. Overuse injuries and direct blows are not the only contributors to coccyx pain— consider the potential insult the coccyx experiences during pregnancy. At the end of the third trimester, hormonal changes 90 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 7 technique MYOSKELETAL ALIGNMENT TECHNIQUES Coccydynia and Pelvic Floor Spasm Working with a Sensitized Nervous System By Erik Dalton, PhD 3 The therapist's thumb hooks and lifts soft- tissue attachments at the coccyx. Image courtesy William E. Morgan. 1 Sidebent coccyx and pelvic fl oor. Sacrococcygeal joint Coccyx 2 Coccydynia clients fl ex at the hips to shift weight to sits bones. Coccyx Ischial tuberosity No pressure on coccyx Pressure on coccyx Pelvic fl oor Sacrococcygeal Pelvic fl oor

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