I had a very interesting case. I saw a woman in late December and again in late January. She was away for several weeks. Her mechanism of injury was from a rowing machine, and she did have a prominent lower sacrum and an anterior tilt of the pelvis AKA Bilateral anterior Ilium, so she had a predisposition to injury. She brought a fluoroscopy photo with a drawn outline of a subluxed coccyx. The pain Dr did an injection and explained that the subluxation was the cause of her pain and prior x-rays were negative given the fact that the coccyx is oftentimes obscured by bowel. It was distinctly subluxed dorsally by about 25% or greater.
An Orthopedist has suggested surgery as a possibility with limited potential for improvement. She reasoned that it had a mechanical cause and therefore should have a mechanical treatment and found me online, as I post on tailbonedoctor.com web site. In retrospect I believe that she had a true fracture of the sacrococcygeal joint, meaning it had fused some time ago. This is based on the fact that all passive motion tests at the sacroiliac, pelvis, lumbar and thoracic spine revealed lack of motion, yet costal joints had normal motion per passive accessory spring tests.
I treated it with common sense. I distracted it inferiorly and then applied a dorsal to ventral force at the bases for several minutes then a superior force to "seat it". It did help, though she did need the second visit and I then taught her an easier method of self treatment which I spontaneously developed-much like the treatment. Common sense carries much weight.
This is a less common mechanism of injury. All of my efforts at restoring motion through the pelvis failed me. Given fairly normal x-rays and MRI, I suspect that she has a perhaps undocumented type of "soft tissue spinal fusion" that impacts the soft tissue elements of the spine and sacroiliac, perhaps the fibrous connective tissue, fibrocartilage; making it remarkably stiff in the absence of true bony fusion.
I hope to work with her some more and measure spinal flexion and extension with a flexible ruler, and suspect that the outline will be unchanged. She compensates beautifully with full hip motion and no hx of prolonged back pain, no family history to suggest an inflammatory spondylarthropathy such as Ankylosing Spondylitis. I will contact a university Rheumatologist to ask if there is such a thing in the annals.
Jerry Hesch, www.heschinstitute.com. See Doctors and specialists in the USA, Colorado.
See also Jerry Hesch's videos on external manual treatment for a coccyx bent to one side and a hyperextended coccyx.