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Case Studies in Coccyx Pain

Herman & Wallace faculty member Lila Abbate instructs several courses in pelvic rehabilitation, including "Coccyx Pain, Evaluation and Treatment". Join Lila this October in Bay Shore, NY in order to learn evaluation and treatment skills for patients with coccyx conditions.

Case studies are relevant reading for physical therapists. Reviewing case studies puts you into the writer’s brain allowing you to synthesize your current knowledge of a particular diagnosis taking you through some atypical twists and turns in treating this particular patient type. In JOSPT, August 2014, Marinko & Pecci presented a very well-written case study of two patients with coccyx pain. By then, I had already written my Coccyx course and couldn’t wait to see what the authors had written. I eagerly downloaded the article to see another’s perspective of coccyx pain and their treatment algorithms, if any, were presented in the article. How were the author’s patients different than mine? What exciting relevant information can I add to my Coccyx course?

I believe that coccyx pain patients have more long-standing pain conditions than other patient types. For the most part, the medical community does not know what to do with this tiny bone that causes all types of havoc in patients’ pain levels. Sometimes treating a traumatic coccydynia patient seems so simple and I am bewildered as to why patients are suffering so long - and other times, their story is so complex that I wonder if I can truly help.

The longer I am a physical therapist, the more important has the initial evaluation become. Our first visit with the patient is time together that really helps me to create a treatment hypothesis. This examination helps me to put together an algorithm for treatment. I now hear their story, repeat back their sequence of events in paraphrase and then I ask: do you think there is any other relevant information, no matter how small or simple, that you think you need to tell me? Some will say, I know it sounds weird, but it all started after I twisted my ankle or hurt my shoulder or something like that. I assure them that we have the whole rest of the visit together and they can chime in with any relevant details. Determining the onset of coccyx pain will help you gauge the level of improvement you can expect to achieve. Coccyx literature states that patients who have coccyx pain for 6 months or greater will have less chance for resolution of their symptoms. However, none of the literature includes true osteopathic physical therapy treatment, so I am very bias and feel that this statement is untrue.

The coccyx course is a very orthopedically-based which takes my love of manual, osteopathic treatment and combines it with the women’s health internal treatment aspects so that we are able to move more quickly to get patient’s back on the path to improved function and recovery. The course looks at patients from a holistic approach from the top of their head down to their feet. In taking on this topic, I couldn’t do it without honing into our basic observation skills, using some of my favorite tools in my toolbox: Hesch Method, Integrated Systems Model, and traditional osteopathic and mobilization approaches mixing it with our internal vaginal and rectal muscle treatment skill set.


Marinko LN, Pecci M. Clinical decision making for the evaluation and management of coccydynia: 2 case reports. J Orthop Sports Phys Ther. 2014 Aug; 44(8): 615-21.

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Upcoming Continuing Education Courses

Boundaries, Self-Care, and Meditation - Remote Course

Sep 12, 2020 - Oct 11, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2A - Atlanta, GA (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Emory Healthcare

Nutrition Perspectives for the Pelvic Rehab Therapist - Winfield, IL (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Northwestern Medicine

Low Pressure Fitness for Pelvic Floor Care - Houston, TX (Postponed)

Sep 25, 2020 - Sep 27, 2020
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Sep 26, 2020 - Sep 27, 2020
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Coccydynia and Painful Sitting - Philadelphia, PA (Postponed)

Sep 26, 2020 - Sep 27, 2020
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Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
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Pelvic Floor Level 1 - Milwaukee, WI (Postponed)

Sep 26, 2020 - Sep 27, 2020
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Sep 26, 2020 - Sep 27, 2020
Location: Emory Healthcare

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Sep 26, 2020 - Sep 27, 2020
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Pelvic Floor Level 1 - Colorado Springs, CO Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
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Sep 26, 2020 - Sep 27, 2020
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Pelvic Floor Level 1 - Lansing, MI Satellite Location

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Location: Physical Therapy Services of Lansing

Mobilization of Visceral Fascia: The Urinary System - Phoenix, AZ (Postponed)

Oct 2, 2020 - Oct 4, 2020
Location: Banner Physical Therapy and Rehabilitation

Male Pelvic Floor - Colorado Springs, CO

Oct 2, 2020 - Oct 4, 2020
Location: St. Francis Medical Center

Mobilization of Visceral Fascia: The Urinary System - Medford, OR Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia: The Urinary System - Self-Hosted

Oct 2, 2020 - Oct 4, 2020
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Urinary System - San Diego, CA Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: FunctionSmart Physical Therapy