(646) 355-8777

Herman & Wallace Blog

An Orthopedic Approach to Coccyx Pain

Most of us spend our day sitting and do not think about the position of our ilia, sacrum or coccyx during the change from standing to sitting. Weightbearing through a tripod of bilateral ischial tuberosities and a sacrum that should have normalized form closure should be easy and pain free. The coccyx typically has minimal weight bearing in sitting, about 10%, just like the fibula, however, it can be a major pain generator, if the biomechanics of the ilia, sacrum and femoral head positions are not quite right.

Coccydynia and Painful Sitting is a course that can be related to all populations that physical therapists treat. A lot of patients will state “my pain is worse with sitting” which can mean thoracic pain, low back/sacral pain and even lower extremity radicular pain. Women’s health providers treat anything regarding the pelvis, so we are seeing a lot of complicated histories and symptoms.

Scanning the literature for coccyx treatment does not always yield the best results for physical therapists. Most literature states what the medical interventions can be, and physical therapy is never at the forefront. However, as we are musculoskeletal and neuromuscular specialists, this is no different on our thinking patterns relating to coccyx pain or painful sitting.

During sitting, the coccyx has a normal flexion and extension moments that will change or become dysfunctional once mechanics above and below that joint change. A simple ankle sprain from 2 years ago can result in chronic knee pain, sacroiliac pain, and can lead to coccyx pain over time. Even the patient who has long standing TMJ (temporomandibular joint) and cervical dysfunction, now has a thoracic rotation and your correction of their coccyx deviation cannot maintain correction.

This course sparks your orthopedic mindset, encouraging the clinician to evaluate the coccyx more holistically. What are the joints doing? How does it change from sitting to standing? Standing to sitting? What is the difference from sitting upright to slump activities? Working through the basics and the obvious with failed results, takes you to the next step of critical thinking within this course. How does the patient present, what seems to be lacking and how to correct them biomechanically to achieve pain free sitting?

Related coccyx musculature and nerve dysfunction can seem like the easiest to treat, but what happens when those techniques fail? This course looks at the entire body, from cranium to feet, to determine the driver of coccyx pain and dysfunction. A better understanding of ilial motion, with accompanied spring tests (Hesch Method), normalizing spinal mechanics and lower extremity function is highlighted in this course. Internal vaginal and rectal release of pelvic floor muscles can lead to normalized coccyx muscle tension that are supported via coccyx taping.

Join me for "Coccydynia and Painful Sitting: Orthopedic and Pelvic Floor Muscle Implications", taking place May 6-7 in Dayton, OH and October 13-14 in Houston, TX.

Continue reading

Upcoming Continuing Education Courses

Mobilization of the Myofascial Layer - Medford, OR Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Asante Rogue Valley Medical Center

Nutrition Perspectives for the Pelvic Rehab Therapist - Seattle, WA (POSTPONED)

Nov 6, 2020 - Nov 8, 2020
Location: MTI Physical Therapy

Mobilization of the Myofascial layer: Pelvis and Lower Extremity- Greenville, SC (Postponed)

Nov 6, 2020 - Nov 8, 2020
Location: Bon Secours St. Francis Health System

Mobilization of the Myofascial Layer Satellite Lab Course

Nov 6, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Mobilization of the Myofascial Layer - Athens, GA Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Thrive Integrated Medicine

Mobilization of the Myofascial Layer - Greenville, SC Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Bon Secours St. Francis Health System

Mobilization of Myofascial - Self-Hosted

Nov 6, 2020 - Nov 8, 2020
Location: Self-Hosted Course

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Athletes & Pelvic Rehabilitation - San Diego, CA (Postponed)

Nov 7, 2020 - Nov 8, 2020
Location: Comprehensive Therapy Services

Pelvic Floor Level 2B - Somerset, NJ Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Sports Medicine Institute

Pelvic Floor Level 2A - Grand Rapids, MI (SOLD OUT)

Nov 7, 2020 - Nov 8, 2020
Location: Mary Free Bed Rehabilitation Hospital

Pregnancy Rehabilitation - Washington, DC (Postponed)

Nov 7, 2020 - Nov 8, 2020
Location: GWUH Outpatient Rehabilitation Center

Bowel Pathology and Function -Middletown, CT (Postponed)

Nov 7, 2020 - Nov 8, 2020
Location: Middlesex Hospital

Bowel Pathology and Function - Remote Course (SOLD OUT)

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2B - Satellite Lab Course

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2B - Marietta, GA Satellite Location (SOLD OUT)

Nov 7, 2020 - Nov 8, 2020
Location: Southern Pelvic Health

Pelvic Floor Level 2B - East Norriton, PA Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 2B - Cranford, NJ Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2B - Manchester, IA Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Physical Therapy Solutions

Pelvic Floor Level 2B - Richmond, VA Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Pivot Physical Therapy

Athletes & Pelvic Rehabilitation - Remote Course

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2B - Self-Hosted

Nov 7, 2020 - Nov 8, 2020
Location: Self-Hosted Course

Pelvic Floor Level 2A - Bay Shore, NY (Postponed)

Nov 8, 2020 - Nov 9, 2020
Location: Touro College: Bayshore

Mobilization of Visceral Fascia: The Gastrointestinal System - Jackson, WY Satellite Location

Nov 13, 2020 - Nov 15, 2020
Location: Four Pines Physical Therapy

Mobilization of Visceral Fascia: The Gastrointestinal System - Fairlawn, NJ (Postponed)

Nov 13, 2020 - Nov 15, 2020
Location: Bella Physical Therapy

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

Nov 13, 2020 - Nov 15, 2020
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Gastrointestinal System - Fargo, ND Satellite Location

Nov 13, 2020 - Nov 15, 2020
Location: Apex Physical Therapy & Wellness Center