Coccyx

Question 1

Why do we directly assess and treat the coccyx early on?

Answer 1

It is the only lumbopelvic girdle structure whose dysfunctions are not improved through tx of other structural dysfunctions, and normalization of coccygeal dysfunction often resolves dysfx of other structures.

Question 2

What are some reasons the coccyx affects so much of the body?

Answer 2

dural connection through filum terminale means widespread bodily and neural effects
PF mm attachment site (placing them on slack or tension, affecting core mm activation; extension could create excessive tension, impact urination, etc)
Fascial connections
Biomechanical impacts
Visceral effects

Question 3

How do we assess the coccyx?

Answer 3

During weightshifting (in efficient state should not twist or SB and should be tension-free)
In prone at sacrococcygeal joint; assessing lipping and end feel, lateral shear, and compression. 
In prone or sidelying for sidebend/deviation, Flexion/ext dysfunction, and intersegmental dysfunction.

Question 4

what does unilateral or bilateral lipping at the sacrococcygeal joint mean?

Answer 4

Unilateral lipping w/ hard end feel = rotation.

Bilateral lipping or drop off = posterior or anterior shear

Question 5

A complex dysfunction at the coccyx means

Answer 5

It is sidebent and rotated in opposite directions.

Question 6

Treatment progression for coccyx (what do you treat first?)

Answer 6

1. STM
2. Decompression (distract from sacrum)
3. Correct Rotation
4. Correct Posterior shear
5. Correct extension
6. Correct deviation/SB
7. Correct flexion

Question 7

Functional mobilization of compressed sacrococcygeal joint

Answer 7

Same side or opposite LE rotation
bilateral knee extension (with self-resisted, lower shank crossed)
Same side praying mantis or basic training
Prone press up

Question 8

Treating coccygeal rotation

Answer 8

Localize with hip IR/ER

Use resistance and FMs to treat.

Question 9

FMs for tx of posterior shear of sacrococcygeal joint

Answer 9

basic training
bilateral knee extension
lower extremity rotation

Question 10

Best FM for mobilizing extended coccyx into flexion

Answer 10

Resisted bilateral knee extension.

Question 11

Positioning and strategies for treating sidebend of coccyx

Answer 11

in sidelying with deviated side up (deviated to L, pt in R sidelying)
localize directly and indirectly through planes of motion of the hip and then treat with FMs.
evaluate and treat neural tension with SLR as it may return the coccyx to deviated state if not addressed.

Question 12

FMs for treating coccyx SB

Answer 12

active/resisted flexion and extension of top leg
Resisted ER through heel
LE rotation
Basking seal (upper or lower trunk or both SB)

Question 13

Treating coccygeal flexion–positions

Answer 13

In quadruped, with pelvic ant/post tilt or forward/backward rocking
In sidelying, with hips and knees flexed, and resisting LE ER.

Question 14

Internal mobilization is useful for treating what dysfunctions and structures?

Answer 14

Treating anterior shear and flexion of coccyx
Structures: Sacrospinous and sacrotuberous ligaments, pudendal nerve, obturator internus, uterus, prostate gland, pubic symphysis, PF muscles.