The coccyx, commonly known as the tailbone, is a small, triangular bone located at the base of the spine below the sacrum. It serves as an attachment point for various ligaments, tendons, and muscles of the pelvic floor, and supports weight when sitting. Pain localized to this area is medically termed coccydynia, a condition that can be debilitating and often worsens with pressure. An “adjustment” refers to a professional therapeutic intervention, typically manual manipulation, aimed at repositioning the coccyx or reducing surrounding muscle tension to alleviate chronic pain.
Understanding Tailbone Pain (Coccydynia)
Coccydynia arises from various factors that cause inflammation or abnormal movement in the sacrococcygeal joint. A direct fall onto the buttocks is a frequent cause, resulting in a bruise, fracture, or misalignment of the coccyx. Repetitive micro-trauma from activities like prolonged sitting, especially with poor posture, or from sports such as cycling and rowing can also strain the coccygeal tissues and surrounding ligaments.
Childbirth is another common trigger, as hormones increase ligament laxity and the coccyx can be stressed or dislocated during delivery. The pain often stems from either a hypermobility (too much movement) or hypomobility (too little movement) of the coccyx, or from spasms in the pelvic floor muscles attached to it. The discomfort is typically sharp or aching and is exacerbated when sitting, leaning back, or moving from a sitting to a standing position.
If tailbone pain is severe, lasts longer than a few days, or is accompanied by neurological symptoms like numbness or weakness, consulting a healthcare professional is necessary. Doctors can perform a physical examination and may use diagnostic tools like X-rays or MRI scans to rule out more serious issues such as fractures, tumors, or cysts. Conservative treatment is successful in approximately 90% of cases, often beginning with simple measures before escalating to more aggressive interventions.
Professional Manual Adjustment Techniques
When initial conservative steps fail, qualified practitioners, including physical therapists, osteopaths, and chiropractors, may utilize specific manual adjustment techniques. These methods are designed to mobilize the coccyx, reduce joint stiffness, or relieve tension in the muscles that pull the bone out of alignment. Manual manipulation is broadly categorized into external and internal approaches, depending on the severity and specific cause of the pain.
External Manipulation
External techniques involve applying mobilization pressure to the coccyx through the skin and soft tissues surrounding the tailbone. This is typically performed while the patient is lying on their side or stomach. The practitioner uses targeted, gentle pressure to assess the coccyx’s movement and attempt to correct minor positional faults or joint stiffness.
One method involves mobilizing the coccyx in a specific direction to increase its range of motion relative to the sacrum (NIMOC). External adjustments are often combined with massage and stretching of the external gluteal and piriformis muscles to restore normal biomechanics.
Internal Manipulation (Intra-rectal)
Internal manipulation is a more direct and sometimes necessary procedure performed by a trained professional, such as a physical therapist specializing in pelvic health or a physician. This technique involves the practitioner inserting a lubricated, gloved finger into the rectum while the patient is lying face down or on their side. The thumb is often placed externally over the coccyx to provide counter-pressure.
This intra-rectal approach allows for precise palpation and manipulation of the coccyx, providing direct access to deep pelvic floor muscles like the coccygeus and levator ani. The practitioner can gently massage these muscles to release spasms or apply specific pressure to move the coccyx back into alignment if it is subluxated or hyperflexed.
Non-Manipulative Treatment Options
Lifestyle modifications are often the first line of defense, primarily focusing on reducing pressure on the tailbone during sitting. Specialized seating cushions, such as those with a wedge shape or a cutout for the coccyx, are recommended to redistribute weight onto the thighs.
Physical therapy is a major component of non-manipulative care, focusing on strengthening and stretching the muscles that support the pelvis and spine. Therapists guide patients through exercises aimed at improving posture and correcting muscle imbalances. Pelvic floor relaxation techniques, which involve deep breathing to encourage the downward relaxation of the pelvic floor muscles, are particularly beneficial for relieving tension that can pull on the coccyx.
For pain resistant to conservative measures, medical interventions can provide relief. These include non-steroidal anti-inflammatory drugs (NSAIDs) to manage inflammation. When pain persists, a physician may administer targeted injections, such as a local anesthetic combined with a corticosteroid, directly into the painful area or the sacrococcygeal joint. In cases of chronic, severe pain, a nerve block procedure, such as a Ganglion Impar block, may be used to interrupt pain signals.
Safety Warnings and Self-Treatment Risks
Attempting to self-adjust the tailbone or asking an untrained person to perform manipulation is strongly discouraged due to the significant potential for harm. The coccyx is a delicate structure situated near critical nerves and the rectum, requiring precise diagnostic skill. Without proper training, forcing the bone could lead to further joint instability, soft tissue damage, or fracture.
Self-manipulation is nonspecific and unlikely to target the precise joint or muscle needing correction. This can cause overstretching of ligaments surrounding the unstable joint, potentially leading to chronic hypermobility and worsening pain. Furthermore, temporary relief may mask a more serious underlying condition, such as a pilonidal cyst or fracture, delaying necessary professional medical care. Only licensed physical therapists, chiropractors, or physicians should attempt manual coccyx adjustment.