The coccyx, commonly known as the tailbone, is a small, triangular bone located at the base of the spine, typically composed of three to five partially or fully fused vertebral segments. This structure serves as an attachment point for numerous muscles, tendons, and ligaments of the pelvic floor. When this area becomes painful, the condition is referred to as coccydynia. This discomfort often prompts people to seek information about “adjusting” the bone, a specialized medical procedure intended to relieve pain and restore function.
Understanding Coccyx Misalignment
The primary cause of coccyx pain is often mechanical, resulting from trauma or cumulative strain that leads to abnormal movement or positioning. A sudden backward fall onto a hard surface is a frequent trigger, potentially causing a bruise, fracture, or joint dislocation at the sacrococcygeal junction. Internal trauma, such as a difficult vaginal childbirth, can also strain the ligaments and muscles attached to the coccyx, forcing it out of alignment.
Repetitive microtrauma from activities like prolonged sitting or cycling can also lead to chronic irritation and pain. Pain can arise from either hypermobility (excessive movement when sitting) or hypomobility (stiff and restrictive joint movement). This abnormal movement or fixation strains the surrounding ligaments and pelvic floor muscles, contributing to coccydynia.
Manual Manipulation Procedures
A professional assessment is necessary to determine if manual manipulation is appropriate. Physicians may use dynamic X-rays, taken while the patient is sitting and standing, to visualize the tailbone’s movement and confirm hypermobility or subluxation. This diagnostic imaging helps rule out other causes of pain, such as a fracture, tumor, or pilonidal cyst, before manipulation is attempted.
Coccyx manipulation is performed only by qualified medical professionals, including Doctors of Osteopathy (DOs), specialized physical therapists, or chiropractors with specific training. The goal is gentle mobilization to relieve tension and restore a normal range of motion to the sacrococcygeal joint, not a forceful “crack.” The technique can be categorized as either external or internal.
External manipulation involves applying gentle pressure through the skin just above the anus to pull the coccyx backward. This less invasive option is often used for a coccyx displaced forward. Non-Invasive Mobilization of the Coccyx (NIMOC) focuses on mobilizing the bone without internal contact.
However, an internal approach is often necessary for true realignment or to address deep muscle spasms. Internal manipulation involves the clinician inserting a gloved finger into the rectum to contact the front surface of the coccyx. Using the external thumb as counter-pressure, the practitioner gently mobilizes the bone into a corrected position.
This technique also allows for simultaneous massage and stretching of tight pelvic floor muscles, such as the levator ani. Self-adjustment is unsafe and ineffective due to the complex, internal nature of the joint. Attempting manipulation without professional expertise risks applying excessive force, which can overstretch supporting ligaments and cause joint instability. This can worsen the misalignment and lead to chronic pain.
Safety Considerations and Risks
Manual manipulation is associated with specific safety considerations and potential risks, particularly with the internal approach. Common side effects include temporary localized soreness, bruising, or a short-lived increase in pain following the procedure. These effects are typically managed with ice or brief rest.
More serious risks are primarily associated with the intrarectal nature of the technique. These can include a minor tear of the rectal lining or, rarely, an infection. Practitioners follow strict sterile protocols to minimize these risks.
Manipulation is contraindicated in patients with certain conditions to prevent serious complications. These include an acute coccyx fracture or dislocation, active infection (such as a pilonidal cyst), or suspicion of malignancy. Severe osteoporosis is also a relative contraindication, as mobilization forces could potentially cause a fracture in weakened bone.
Conservative and Alternative Treatments
For most patients, coccydynia is successfully managed through conservative, non-invasive treatments before manipulation is considered. Initial management often involves over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce local inflammation and pain. Applying localized heat or ice can also help manage acute discomfort.
Specialized coccyx cushions are an effective first-line treatment that mechanically alters weight distribution during sitting. These cushions feature a U-shaped or wedge-shaped cutout that allows the coccyx to “hover” above the sitting surface. This design removes direct pressure from the tailbone, shifting body weight onto the less sensitive ischial tuberosities, or “sit bones.”
Physical therapy is another established treatment, focusing on stretching and strengthening the muscles that attach to and surround the coccyx. A specialized pelvic floor physical therapist can teach exercises to relax hypertonic pelvic floor muscles and improve posture. This reduces the strain on the tailbone during movement and sitting.
When conservative measures fail, medical injections offer a targeted alternative. These procedures typically involve injecting a mixture of a long-acting corticosteroid and a local anesthetic directly into the sacrococcygeal joint or surrounding tissues. The corticosteroid acts as a potent anti-inflammatory agent to break the cycle of pain. In persistent cases, a Ganglion Impar block, which targets a cluster of sympathetic nerves, may be performed under fluoroscopy to interrupt chronic pain signals.