RE: [OregonDCs] coccyx adjustment

[Guest guest]

Right on Jack

We learned the " internal lift " while in WSCC clinic mid '50's.

It is much easier to administer following 10 - 15 minutes of US to the

coccyx.

Bob

W. Pfeiffer, D.C., D.A.B.C.O.

350 S.W. 1st P.O. Box 606

Pendleton, OR 97801

(541) 276-2550

[OregonDCs] coccyx adjustment

I've seen something less than 2 dozen cases of this presenting in my

clinic for treatment since 1978....so I have limited but very positive

experience with this technique.

and when the coccyx truly is 'anterior' with all the signs taught by

--who was it so long ago?? Not Dr. Stober, but one of his

colleagues...it has proved to be a VERY beneficial technique. I have

not been effective with the 'external tissue pull' approach others when

there is true anterior subluxation.

I've had patients with a variety of mechanisms of injury, from jumping

off the high bridge into the swimming hole (40' or more); one jumped

down backward off a stack of pallets and managed to land with their tail

bone ON a doorknob.....on was kick starting their motorcycle and the

foot slipped, dropping them suddenly on the back of the gas

tank....several were FROM childbirth....some from slip and fall or

sports injuries.....

As odd as it sounded when I FIRST was introduced to it, it is simple,

effective and efficient. And it helped a half-dozen women with a more

regular menstrual cycle, if their reports are to be held credible.

I'd be willing to teach those who are unfamiliar or uneasy with the

process.

Jack Pedersen DC

Happy New Year

All posts must adhere to OregonDCs rules located at:

/

[Guest guest]

Dr. Pfeiffer: Thanks for the ultrasound hint. I have never done that. I think that would increase the effectiveness and tolerability of the adjustment. Ann Goldeen

[OregonDCs] coccyx adjustmentI've seen something less than 2 dozen cases of this presenting in my clinic for treatment since 1978....so I have limited but very positive experience with this technique.and when the coccyx truly is 'anterior' with all the signs taught by --who was it so long ago?? Not Dr. Stober, but one of his colleagues...it has proved to be a VERY beneficial technique. I have not been effective with the 'external tissue pull' approach others when there is true anterior subluxation.I've had patients with a variety of mechanisms of injury, from jumping off the high bridge into the swimming hole (40' or more); one jumped down backward off a stack of pallets and managed to land with their tail bone ON a doorknob.....on was kick starting their motorcycle and the foot slipped, dropping them suddenly on the back of the gas tank....several were FROM childbirth....some from slip and fall or sports injuries.....As odd as it sounded when I FIRST was introduced to it, it is simple, effective and efficient. And it helped a half-dozen women with a more regular menstrual cycle, if their reports are to be held credible.I'd be willing to teach those who are unfamiliar or uneasy with the process. Jack Pedersen DCHappy New YearAll posts must adhere to OregonDCs rules located at:/

[Guest guest]

Another coccyx adjustment I have used, that I have not seen mentioned yet, is a

drop table move.

I put the patient prone with the coccyx just inferior to the pelvic drop on my

Leander Table. With the superior hand, I take a thumb contact on the coccyx and

apply I-S traction. With my inferior hand I cover my thumb to reinforce it. I

set the drop peice a little heavier then I would for a SI move because I take a

lot of pre-adjustive traction, which tends to release the drop peice if it is

too light. As the Leander table flexes I drive with my inferior hand in a

superior direction. I will usaully do the adjustment 3 times per visit.

About half the time the patient gets off the table with immediate relief.

Glenn Sykes, DC

Newberg, OR 97132

503-538-5433

[OregonDCs] coccyx adjustment

>

>I've seen something less than 2 dozen cases of this presenting in my

>clinic for treatment since 1978....so I have limited but very positive

>experience with this technique.

>

>and when the coccyx truly is 'anterior' with all the signs taught by

>--who was it so long ago?? Not Dr. Stober, but one of his

>colleagues...it has proved to be a VERY beneficial technique. I have

>not been effective with the 'external tissue pull' approach others when

>there is true anterior subluxation.

>

>I've had patients with a variety of mechanisms of injury, from jumping

>off the high bridge into the swimming hole (40' or more); one jumped

>down backward off a stack of pallets and managed to land with their tail

>bone ON a doorknob.....on was kick starting their motorcycle and the

>foot slipped, dropping them suddenly on the back of the gas

>tank....several were FROM childbirth....some from slip and fall or

>sports injuries.....

>

>As odd as it sounded when I FIRST was introduced to it, it is simple,

>effective and efficient. And it helped a half-dozen women with a more

>regular menstrual cycle, if their reports are to be held credible.

>

>I'd be willing to teach those who are unfamiliar or uneasy with the

>process.

>

>Jack Pedersen DC

>Happy New Year

>

>

>

>All posts must adhere to OregonDCs rules located at:

>/

>

[Guest guest]

I have done over 200 internal coccyx adjustments, wrote this paper, in

Dynamic Chiro, describing the procedure, I have included both the link

to it, and appended it.

Since writing this paper, I have done this many more times. If I was

updating it, there are a few things I would change.

One, in more longstanding or chronic cases, it can takes 3-6

manipulations to get full correction.

Two, you are unlocking the dura, so it is ideal to pull the coccyx

posteriorly in neutral, with the patient's body in full flexion, and

with the patient's body in full extension.

Three, there are various aspects of the coccyx that can be locked or

restricted. It can be the Sacro-coccygeal junction, it can be the coccyx

1 vs coccyx second segment, or C2 vs C3.

The restrictions can be either in the A-P direction, lateral to medial,

and/or a superior jamming, where you need to grasp the coccyx from

inside and outside, and create long axis distraction.

Of course, you need to look at the SI joint.

PS- I would agree with those who have written to say that the procedure

is relatively simple and not technically difficult to get good at. Its

just intimidating to enter a body cavity you are not familiar with.

For more info, check out www.coccyx.org, a good site about the coccyx,

and various patients' experiences.

The Coccyx- article, follows

http://www.chiroweb.com/archives/22/04/10.html

The Coccyx

------------------------------------------------------------------------

by Marc Heller, DC

We'll finish our tour of the spine and dura with the most caudal

segment, the coccyx, which is key for a number of reasons: It is often

injured, especially in falls on the buttock, and it's the last

attachment of the /dura mater/ and the /filum terminale/. The coccyx can

subluxate secondary to the dural pull on it. This can occur suddenly, as

in a whiplash injury, or gradually, when a disc problem irritates the

dura. Releasing the coccyx can make a profound difference in dural

tension, affecting discogenic pain or other chronic spinal tension patterns.

When the coccyx is under stress, whether from a fall or an accumulation

of factors, it usually seems to be stuck primarily forward. (An

exception to this is a posterior coccyx, post-pregnancy.) The anterior

positioning is rather inconvenient for the chiropractor, as this makes

it more difficult to access. It can simultaneously be pulled to the

right or the left, which will reflect itself in increased tension on the

sacrotuberous ligament. The coccyx can also be jammed superiorly,

creating a compression at the sacrococcygeal joint.

I could give multiple case histories of patients I have helped by

correcting the coccyx, but they basically fall into two categories:

patients who fell on their tailbones and have suffered with coccygeal

pain since, sometimes for weeks, sometimes for years; and patients with

lower back pain who are not responsive to my work on their sacroiliac,

discs, lumbar segments or muscles. Correcting a subluxed coccyx often

makes a dramatic difference in patients' spinal patterns, helping

symptoms and allowing self-stabilization and self-correction.

*Assessment of the Coccyx*

How can we assess the tailbone? You will miss most coccygeal problems if

you strictly palpate down to the sacrococcygeal junction. You need to

reach the tip of the coccyx. The best method I know is to have the

patient sitting, with the doctor behind and to the side. The patient

must loosen his or her trousers; you palpate between the trousers and

underwear. Thong underwear makes the area impossible to feel, so reach

under them (wearing a glove) and under the tailbone, with the patient

leaning forward. As he or she leans forward, slide your index or middle

finger further forward until you reach the anterior tip of the tailbone,

then have the patient sit upright slowly, which will bring the tip of

the tailbone down onto your hand. If the inferior tip of the coccyx

doesn't come into your hand, pull gently posterior and superior with

your finger to find this structure. You'll notice that most men have a

short, stubby coccyx, while most women have a longer coccyx that goes

further anterior. Sometimes, it is difficult to reach the most anterior

part of the coccyx with your finger. Note that the coccyx has multiple

segments, but we treat it as if it were one single bone.

Obviously, you need to tell the patient what you intend to do. The

coccyx is a difficult and sensitive area to get to, being at the very

bottom of the buttock. Be clear, explain with a model if you need to,

and get clear permission for your palpation and correction.

You are looking for tenderness and restriction. When the tailbone is a

problem, it is usually sharply tender. Test with gentle palpation for

restriction in the anterior-posterior direction and assess the

lateral-to-medial direction on both sides. Tenderness and restriction

are usually found together.

*External Coccyx Correction*

How do we correct the coccyx? I'll outline external techniques first.

Some procedures emphasize releasing the sacrococcygeal junction with a

posterior-to-anterior adjustment, hoping that this will bring the coccyx

itself further posterior. I have not found this particularly effective.

I prefer to directly pull the tip of the coccyx further posterior,

simultaneously addressing superior jamming and right or left lateral

bending. To do this, I have to get to the front of the coccyx. This can

usually be done with the patient in the sitting position, as outlined in

the palpation method above, or in a prone or side-lying position.

With any patient position, I use one of two basic techniques. The main

technique I use is " engage, listen, follow, " or ELF. Engage the

beginning of the barrier by bringing the coccyx posterior, left or

right, and inferior, if needed. As the subluxation is never purely

linear, we always fine-tune, so find the exact 3-D direction of the

barrier. You'll feel the coccyx and the associated soft tissues soften

and release over 10-60 seconds. If the area is not releasing, you are

probably pressing too hard, going to the hard end of the barrier. You

just need to back off a bit to allow the patient's body to begin the

correction.

Another useful tool for a coccyx that is not releasing easily is

postisometric contraction. Having the patient hold a very gentle pelvic

floor contraction after you have engaged the coccyx to its initial

barrier can help the whole area release. Repeat three to five times,

having the patient maintain the gentle contraction for three to five

seconds. In the relaxation phase, you are taking the coccyx further into

the receding barrier. A recoil adjustment also enhances the release when

the area feels stuck. In recoil ( " engage-release " ), you engage the

barrier, then suddenly release your pressure. This can be made more

effective by using respiration, either at the end of inspiration or at

the point in the respiratory cycle where the tension suddenly builds.

Note that this is quite different than toggle-recoil.

*Internal Coccyx Correction*

I always start with some variation on the above external techniques. If

they are successful and the tenderness and restriction does not recur -

great! If the area remains tender after one or two treatments, I may

suggest an internal correction to the patient, explaining this in some

detail. I mention that I will be using a lubricated gloved finger to

contact the coccyx through the rectum. I tell the patient that it is

uncomfortable, but not usually painful. I tell him or her that I will

have an assistant in the room.

Trying to explain this technique solely in print is not ideal. Practice

with a colleague or spouse until you are comfortable with the basic

procedure. Next, perform it, when clinically indicated, on a patient

with whom you have a good trusting relationship. You really don't want

to be fumbling around with a new patient in this sensitive area. This

procedure may not be legal in some states, and I recognize that doing an

internal coccygeal correction may carry increased liability risk.

However, I am also very clear that my duty as a chiropractor is to

correct whatever structures need manual correction in the whole

neuromusculoskeletal axis, and if this requires me to work internally on

the tailbone, I will. You want to project perfect clarity, confidence,

and to have clearly explained the procedure to the patient, and obtained

his or her clear consent. Document that you had a PARQ ( " procedures,

alternative, risks, questions " ) conference with the patient. A signed

written consent form is ideal.

Many of your patients will have experienced physical or sexual abuse as

children, and may have issues with touch to sensitive areas. I try to be

aware of this, and when I ask permission to work on a sensitive area, I

am attempting to assess the patient's response. I want the patient to

maintain eye contact with me, and give me a clear " *yes* " - a clear

permission to proceed. If the patient dissociates in any manner, by

closing his or her eyes, looking away, or not stating clear permission,

I am very hesitant to proceed.

How do we perform the internal correction? We start with having the

patient draped and lying on either the side or prone with a pillow under

the belly. To initiate the entrance into the rectum, one must be aware

that there are two anal sphincters. Ask the patient to contract the

anus, and as he or she does, apply a slight pressure to the external

anal sphincter (EAS), then ask the patient to relax. As the patient

relaxes, enter the EAS with a well-lubricated, gloved finger. Repeat the

contract and relax several times to get past both sphincters (the

internal is softer and wider). Another way to do this is with the

patient side-lying. Enter the rectum with the patient having pulled the

legs up into a fetal position, then straightening the legs for the

correction.

Once I find the coccyx, I palpate, and ask the patient where the coccyx

is tender. I note the tender places, and begin my low-force ELF

manipulation. I can use my other methods, including recoil and

postisometric relaxation, in concert with the ELF. I can also use the

other hand or the thumb of my active hand on the external surface. I

engage the coccyx externally while the internal finger listens and

assists. I have the coccyx sandwiched between my two contacts, which

improves my palpatory sense. This enhances the correction, especially if

I need to pull the coccyx inferiorly to correct superior compression. I

always keep both contacts gentle. I need only mild pressure to make the

correction.

Once I've corrected the basic restriction of the coccyx in the A-P and

lateral-to-medial directions, I can assess and correct two other

potential lesions. The first type is a tender spot anywhere on the

anterior surface of the coccyx or sacrum, wherever I can reach. If I

find a tender spot, which will feel stiffer, I again use ELF, more as a

myofascial release, to release the tension in the fascia on the anterior

surface of the sacrum. The second possible correction is for myofascial

tensions at the origin of the piriformis. The piriformis originates from

the lower anterior surface of the lateral aspect of the sacrum. It is

usually within reach. I find the tender spots within this, and use ELF

as a myofascial release. I only want to make this invasive correction

once, so I try to correct every dysfunction I find on the anterior

surface of the coccyx and sacrum.

Once I've completed the corrective procedures, I reassess for

tenderness. I remove my finger slowly, asking the patient to contract

the pelvic floor again. (This prevents the patient from feeling as if he

or she is having a bowel movement.)

The whole internal procedure takes me between one minute and four

minutes. I always make this the last major procedure I do on the patient

during the office visit. I may finish with a balancing of the sacrum's

craniosacral motion, following its inherent motion. This calms the

nervous system and integrates the sacrum and coccyx with the whole of

the spine.

This internal coccygeal correction is one of the most powerful and

effective procedures in my toolbox, and I use it with respect. I almost

never have to repeat it; the coccyx almost always stays corrected,

unless there is a new trauma.

/Resources/

1. Special thanks to Surya Bolom, DC, Mark , DC, and Ramona

Horton, PT, for feedback on this article.

2. Barral JP. /Visceral Manipulation/. 1989, Eastland Press.

3. Barral JP. /Urogenital Manipulation/. 1993, Eastland Press.

4. Urogenital manipulation course, October 2000, St. Etienne, France,

taught by Pierre Barral.

/Marc Heller, DC

Ashland, Oregon/

Marc Heller, DC

mheller@...

www.MarcHellerDC.com

glenntam@... wrote:

>

>

> Another coccyx adjustment I have used, that I have not seen mentioned

> yet, is a drop table move.

>

> I put the patient prone with the coccyx just inferior to the pelvic

> drop on my Leander Table. With the superior hand, I take a thumb

> contact on the coccyx and apply I-S traction. With my inferior hand I

> cover my thumb to reinforce it. I set the drop peice a little heavier

> then I would for a SI move because I take a lot of pre-adjustive

> traction, which tends to release the drop peice if it is too light. As

> the Leander table flexes I drive with my inferior hand in a superior

> direction. I will usaully do the adjustment 3 times per visit.

>

> About half the time the patient gets off the table with immediate relief.

>

> Glenn Sykes, DC

> Newberg, OR 97132

> 503-538-5433

>

> [OregonDCs] coccyx adjustment

> >

> >I've seen something less than 2 dozen cases of this presenting in my

> >clinic for treatment since 1978....so I have limited but very positive

> >experience with this technique.

> >

> >and when the coccyx truly is 'anterior' with all the signs taught by

> >--who was it so long ago?? Not Dr. Stober, but one of his

> >colleagues...it has proved to be a VERY beneficial technique. I have

> >not been effective with the 'external tissue pull' approach others when

> >there is true anterior subluxation.

> >

> >I've had patients with a variety of mechanisms of injury, from jumping

> >off the high bridge into the swimming hole (40' or more); one jumped

> >down backward off a stack of pallets and managed to land with their tail

> >bone ON a doorknob.....on was kick starting their motorcycle and the

> >foot slipped, dropping them suddenly on the back of the gas

> >tank....several were FROM childbirth....some from slip and fall or

> >sports injuries.....

> >

> >As odd as it sounded when I FIRST was introduced to it, it is simple,

> >effective and efficient. And it helped a half-dozen women with a more

> >regular menstrual cycle, if their reports are to be held credible.

> >

> >I'd be willing to teach those who are unfamiliar or uneasy with the

> >process.

> >

> >Jack Pedersen DC

> >Happy New Year

> >

> >

> >

> >All posts must adhere to OregonDCs rules located at:

> >/

> </>

> >