Massage & Bodywork

SEPTEMBER | OCTOBER 2017

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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 91 enable the synchondrosis between the sacrum and the coccyx (sacrococcygeal joint) to soften and become more mobile. This increases coccygeal segmental mobility, allowing for more sidebending, flexion, and extension, which is a good thing. However, in some mothers, the resting tension of surrounding musculoligamentous connective tissues is altered as secretion of the hormone relaxin decreases. Unlike fractures, which can remodel, sacrococcygeal joint injuries can last indefinitely if an inflamed joint is repeatedly forced from its normal position. In cases where inflammatory waste products trigger chemoreceptors and altered sacrococcygeal joint alignment hyperexcites mechanoreceptors, the brain often decides to lock up the area to prevent further insult. This is where myoskeletal therapy may help. SYMPTOMS AND CORRECTIONS In a fully functioning body, the coccyx acts as a shock absorber by flexing forward during sitting. Together, the coccyx and bilateral ischial tuberosities form a weight- bearing tripod that houses the pelvic floor muscles and ligaments. The coccyx bears more weight when a seated person leans back, so we often see coccydynia clients flex at the hips to shift more weight to the sits bones (Image 2). They usually report dull, aching pain emanating from the gluteal cleft just superior of the anus, and sometimes stabbing pain when rising from prolonged sitting. Physical examination through underwear, sports shorts, or a sheet includes gentle palpation of the coccyx and surrounding connective tissues for tenderness (Image 3). Hypertonus and protective guarding may be felt when palpating adjacent pelvic floor muscles, such as the coccygeus and levator ani. The sacrococcygeal, sacrotuberous, and sacrospinous ligaments must also be individually evaluated for tenderness. Ask the client to report any palpation maneuver that reproduces the tailbone pain. In true coccydynia cases, the coccygeal region is typically very sensitive, so first seek permission, and then carefully explain what you intend to do. Always keep an open dialog with the client, as this can be an emotionally charged area, and err on the side of modesty when working the buttock and hip areas. Myoskeletal techniques such as those demonstrated in Images 4 and 5 may be helpful as a conservative treatment for sacrococcygeal dysfunction. Once alignment and mobility are restored to the pelvic bowl, the therapist uses ligaments as levers to help decompress hooked and sidebent coccyges. This can be performed with the client seated, sidelying, or prone. As pain decreases, home exercise assignments, such as diaphragmatic breathing and mini-trampoline rebounding, can help restore optimal pelvic floor function. 4 The therapist's thumbs hook and lift the contralateral sacrotuberus ligament. DISCUSSION Pain is a symptom all healthy human beings experience at some point in their lives. In fact, pain sensation is necessary for survival—without it, we would not know if we were injured or unwell. However, in our sensitized clients, the degree of pain does not always match the degree of injury, and this is where proper manual therapy and corrective exercise can help. Working together in a comfortable, safe environment, we can identify specific movements that reduce a client's coccydynia symptoms and help eliminate areas of bind. Getting the client moving and exercising is always a great strategy for easing the pain of coccyx dysfunction. Note 1. L. S. Lirette, et al., "Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain," Ochsner Journal 14, no. 1 (Spring 2014): 84–7. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com. 5 The therapist's forearm gently scrubs the adductor fascial attachments to the pelvic floor.

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