The Coccyx and The Stuck Drawer

coloured pelvisThe Coccyx, or tailbone, is often unrecognised as a key component of pelvic girdle and pelvic floor function (and dysfunction!)

For our patients, they often present with a history of a fall on outstretched legs, landing on their rear. For us clinicians, the coccyx becomes a focal point not only for the many attachments of the muscles and ligaments, but also as a differential diagnosis for many pelvic pain conditions (pudendal neuralgia, I’m talking to you!)

Palpating coccygeal movement, which may be small in range, but big in consequence, may also give us an indication of how well our patients are connecting with their pelvic floor muscles. In a 2014 paper, Stensgaard et al wrote of ‘palpation of the coccyx (the coccygeal movement test, CMT) as a possible objective screening tool for the assessment of adequate localization of the pelvic floor muscles (PFMs).’ Their conclusion: ‘the CMT was a useful test to identify women who were able to localize their PFMs compared to those who were not, making it a potentially useful initial screening test in structured training programmes for the PFMs’. This makes sense if we are palpating the coccyx externally, with our patient in sitting, we can detect the forward/elevating motion caused by the contraction of pubococcygeus/puborectalis, pulling the coccyx forward into flexion.

A manual therapy technique that I have used over the years to increase range of motion in flexion/extension is the Stuck Drawer technique. Essentially, this technique works on the premise of a stuck dresser drawer – if the drawer won’t ‘open’, sometimes we gently push it further ‘closed’ and then we can get more ‘opening’…so if the coccyx isn’t fully extending/ is stuck in flexion, we gently encourage it into more flexion by firstly going into lumbar flexion and then asking for a pelvic floor muscle contraction which will flex the coccyx even further. We then ask for a relaxation of the pelvic floor and for the patient to move into lumbar extension, applying very gentle fascial traction over the external coccyx. I hav found that this technique really increases proprioceptive input to both the coccyx and the pelvic floor muscles and can be a great (non-nociceptive!) starting point for re-establishing comfort and function in the pelvis.

 

I hope you enjoy the video!

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Until next time

Michelle

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