Tailbone is an ending of the spine, which is a stunted remain of a tail. Tailbone is in humans consisted of five vertebrae (Co1 - Co5), they are firmly ingrown with each other, similarly as the sacrum bone. The arches of these coccyx vertebrae are already ceased due to evolution. The transition between sacrum bone and tailbone is made of cartilage. The vertebrae Co1 - Co2 are exceptionally also connected with cartilage. The tailbone is upwards connected to lumbar vertebrae, and along the both sides it is connected to pelvic bones.
This connection predetermines what problems may occur, when we have problems with the tailbone. The pain is transferred thanks to the ligaments, which connect the tailbone with spine and pelvis, and further with lumbar spine up to the cervical vertebrae and skull, but also pelvis, sacroiliac joints and even internal organs placed in the pelvis. The problems are manifested by pain in the joints of the pelvis, hip joints, spine, head, inability to get pregnant or disorders of the internal organs (for example: disorder of peristalsis of colon - mobility of the intestines).
If you have problems that have been described above, we recommend you to visit physiotherapist. He will examine your body posture, ration in the pelvis, and finding out which muscles in your body are shortened. Examining the latitude of the hip joints, and their range of movement and tension in the muscles of the legs, and that way finding out whether you have an increased asymmetric tension in the pelvic ligaments. This finding has a close relation to the blockage between sacrum and hip bone. Muscles of the pelvic floor are usually in higher tension. Easy test is also a functional test evaluating the area of the spine, for example the so called „S reflex”, that is when physiotherapist works with the muscles alongside the spine. If there is dysbalance in the area of the pelvic floor, it will at the same time lead to elevation of the pelvis.
EXAMINATION THROUGH RECTUM (PER RECTUM)
This examination is performed according to the method of Ludmila Mojžíšová. The examination is usually done while kneeling on all fours (arms are resting on the forearms) or while laying on the side or stomach. The examination is performed by palpation (feeling with the hand) of the coccyx through rectum. The examination is not painful, if it is performed with flare and the client is able to relax the internal anal sphincter enough.
In case of finding out, that the pain of the musculoskeletal system, functional infertility etc. has a connection to disbalance in the area of the pelvic floor, we perform mobilization of the coccyx.
Mobilization of the tailbone
Physiotherapist palpates (touches) the tailbone and tests whether it is springing. In case that it does not spring, it is usually deflecting to one side or there is a muscle disbalance in the surrounding area, mobilization can be performed immediately - repeated gentle bending with the last vertebrae and at the same time relieving (stretching) the ligaments, which are attached to the tailbone and are part of the pelvic floor
Therapy of ligaments in the pelvis
Another used combination of the PIR (postisometric relaxation) and mobilization, is performed this way: physiotherapist touches the hypertonic part of the pelvic floor (by the process described above) where he will „hook” his finger. Then by inhaling, during which will patient slouch in the area of the lumbar spine, meanwhile physiotherapist lightly activates the pelvic floor, achieving overstrain. That is followed by exhale, relieving the lumbar spine and pelvis, physiotherapist performs a gentle and painless massage of the coccyx to the sides and back. According to the need it is repeated.
Very effective is also relieving of the tensioned pelvic ligaments. That is performed with a PIR method, or alternatively PIR method with stretching. We bring the leg into such a position, where the specific ligament will be stretched. It is usually deep bending of the hip and knee, then we give the patient instruction to push the knee against us. After holding the position for a while, you can relax and then repeat with a bigger bending than before. That way we relax the mentioned ligaments.
Exercising the pelvic floor
Exercises of the pelvic floor are ideal for relaxing the pelvic floor, but also its stretching, blood supply and regeneration. Exercising also strengthens the realization of our own pelvic floor, which is usually in higher tension. Ludmila Mojžíšová composed the exercises very well, she taught this composition to athletes, who suffered from back pain. Only later was the technique used by women who couldn’t get pregnant as well.
We use exercises, by which stretching and relieving of the ligaments in the pelvis is switched (without using the gluteal muscles), because it brings us perception of these two differences. Exercises is supplemented with regular breathing. It can be either localized breathing - “breathing” to the pelvic area or activity and relaxation connected to inhale and exhale. You can also exercises particular parts isolated from other muscles of the pelvic floor.
Sometimes exercise of the pelvic floor is supplemented with muscle stretching exercises of the hip joints, lumbar spine or exercising the deep stabilizing system (muscles participating on keeping the trunk straight against the gravitational force), which we choose individually according to the needs of the client.
Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic