Manual treatments for coccyx pain
See also personal experiences of manual treatments
Warning: My own coccyx pain was made much worse by a physiotherapist who pressed hard on the coccyx from the outside, and this has also happened to others. So if you go for manual treatment, make sure it is gentle and is carried out by someone who knows what they are doing.
Manual treatment methods
Coccyx pain is often due to to a dislocation at one of the coccyx joints, or stiffness of one of the joints, or a spasm of the muscles attached to the coccyx. Manual treatment aims to reduce dislocations, mobilise stiff joints, or relax tense muscles. Most therapists also prescribe particular exercises. The method of treatment may vary greatly from one therapist to another.
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 manipulating.
External manipulation of the coccyx consists of pulling the tip of the coccyx backwards through the skin just above the anus. This should only be applied if the coccyx is displaced forwards.
These treatments may be carried out by physical therapists, chiropractors, osteopaths, massage therapists, or doctors.
Success rates
Manual treatments appear to be much more effective in the long term than corticosteroid injections. In postings in the 'Personal Experiences' section, improvement in pain at one year after treatment was a factor of 15 times higher for manual treatment than for corticosteroid injections (see Jon Miles's presentation at the Dordrecht Symposium on Coccyx Disorders).
George H. Thiele, an American doctor, reported on the treatment of 324 coccyx pain patients by massage, repeated 12 or more times. 42% were reported as cured, and another 19% were improved. Those who did not get relief with massage, Thiele treated for infections.
A British chiropractor, Michael Durtnall, treated 87 patients an average of 6.5 times, and reported that 41% had 90-100% improvement at the end of their course of treatment. The average reduction in pain among all patients was 73%.
A French doctor, Jean-Yves Maigne, and his colleagues, carried out a controlled trial of intrarectal manipulation for coccydynia, with 51 patients given manipulation and 51 given a placebo treatment. The success rate for the treatment was 25%. The lower success rate in this trial may be due to the fact that treatment was limited to three 5-minute manipulations for each patient.
Note: Practitioners with less experience in manual treatment of coccyx pain are likely to acheive lower success rates.
More information
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."
- Dr Marc Heller, a chiropractor, wrote an article in Dynamic Chiropractic (PDF) describing in detail the methods that he uses.
- 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.
- Dr Lila Abbate developed a taping technique which is used together with manual treatment (internal or external), to hold the coccyx in the correct position between treatments.
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. This method is known as NIMOC (Non-Invasive Mobilization of the Coccyx).
- 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).
Updated 2021-01-13
