Manipulative treatment of coccygodynia

Surgical clinics of North America

April 1937 pages 579-583.

Hobart, M. H. S.

Department of Surgery, Northwestern Medical School


1. Manipulative treatment of coccygodynia will cure many cases

2. This treatment should always be tried before surgery is resorted to, especially as it is a well-established fact that the resection of the coccyx does not cure in many cases.

3. It is fairly safe, easy and inexpensive.

4. For these reasons this treatment should be brought more generally before physicians for their consideration.

5. If the manipulative treatment does not cure, resection of the coccyx should be resorted to.

6. A higher percentage of relief in private patients may be expected than in charity patients.

Manipulative method:

The patient is anesthetized and placed on the operating table, lying upon her abdomen. With a rubber glove on my right hand, the index finger is well lubricated and inserted into the rectum. First the coccyx is manipulated gently between the thumb on the outside and the index finger inside. The coccyx is moved backward and forward and sideways, if possible. Next I try, without too much force, to push the coccyx back in place to the right. Now with the index finger a gentle massage is done all about the coccyx, rubbing up and down lengthwise, being very careful not to injure the rectal mucosa. It is thought by some that this maneuver loosens adhesions and relieves congestion about the nerve plexus. Upon her awakening, I shall advise the patient to avoid sitting or other trauma to the coccyx for six weeks, using a rubber air ring when sitting is unavoidable.

Results of 15 cases manipulated, after 2 months to 4 years: 67% relieved or cured.

Cured 8

Relieved 2

Not relieved 1

Worse 1

Not reached 2

Results of 2 cases operated, one operated twice

Cured 2


1. Bremer, Ludwig: The Knife for Coccygodynia: a Failure Medical Record, August 1, 1896, p. 154.

2. Christopher, Frederick: Minor Surgery, 2nd Ed., p. 344. W. B. Saunders Co.

3. DeLee, Joseph B.: Principles and Practices of Obstetrics. 2nd Ed., p. 783. W. B. Saunders Co.

4. Foote, Edward M. and Livingston, Edward M. Minor Surgery. 1st Ed.. p. 192. D. Appleton Co.

5. Gellhorn, George: Non-Operative Treatment in Gynecology, p. 231-2, D. Appleton Co., New York, 1923.

6. Kelly, Howard A.: Medical Gynecology, 1st Ed., Vol. I, 1908, p. 245.

7. Klechner, M. S.: Transactions of American Proctologic Society, 1933, pp. 100-107.

8. Lewin, Philip: Surg., Gynec. and Obstet., Vol. 45, pp. 70S-6. Nov., 1927

9. Mock, Harry E.: Principles and Practice of Physiotherapy, Vol. II, Chap. 16. p. 64, W. F. Prior Co., Inc., 1934.

10. Thomas, Henry Bascom: Personal communication.

11. Warbasse, J. P.: Surgical Treatment, Vol. II, p. 358. W. B. Saunders Co.

12. Whitman, Royal: Orthopedic Surgery, p. 134. Lea and Febiger, 1919

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