See also personal experiences of manual treatments
First a word of warning: my coccyx pain was made worse by a physiotherapist who pressed hard on the coccyx from the outside, and I have heard of other cases where a doctor or another specialist made someone's pain a lot worse by doing this (or even caused the pain in the first place - see Physical therapist pushed too hard and dislodged my tailbone). So if you do decide to go for manual treatment, make sure it is gentle and is carried out by someone who knows what they are doing.
The idea behind manual treatment is that tense muscles can pull the coccyx out of position, causing pain. The treatment aims to relax and extend the muscles, so that the coccyx can return to its normal position.
Many people who have had manual treatment carried out by a skilled practitioner have reported success. People who had this treatment have suggested that you should allow a week or two between treatments, but that if it doesn't work first time, it probably won't work at all. Manual treatments of the coccyx may be carried out by physical therapists (also called physiotherapists), by chiropractors, osteopaths, or massage therapists.
Dr Marc Heller, a chiropractor, wrote an article in Dynamic Chiropractic (PDF) describing in detail the methods that he uses.
Dr Michael Durtnall, a chiropractor, presented results of a trial of Manipulation for coccydynia. He found that 73% of patients improved by 70-100% over an average of less than 7 treatments using specific manipulation, acupuncture, physical therapy and robust exercise.
There are two versions of manual treatment: external and internal. The details may vary from one therapist to another.
External manipulation of the coccyx consists of pulling the tip of the coccyx backwards through the skin just above the anus.
Internal manipulation of the coccyx is carried out by the therapist placing a gloved finger into the anus of the patient, and gently massaging or stretching the muscles attached to the coccyx. Most therapists also gently pull the coccyx into its normal position, if it is out of position. Some also use the vagina of female patients to get access to the muscles, if the patient agrees.
The figure shows massage of the coccyx, from Gellhorn. He says "The bone is held between the forefinger in the rectum and the thumb on the [skin] outside; it is then moved backward and forward and the soft parts are moved about on the bone."
Dr Lila Abbatte has developed a taping technique which is used together with manual treatment, to hold the coccyx in the correct position between treatments.
Five people have reported that they tried the Bowen technique, which is described as a series of gently rolling connective tissue moves, using a light touch and may be done through clothing. Two of these reported success, and three found no improvement. There are more details of the technique at www.bowtech.com.
There is a chiropractic treatment using an instrument called an Activator, which delivers a small controlled mechanical shock or "punch" to the area it is in contact with. It does not seem to be used much for coccyx problems. There is an abstract of a medical paper on the use of Activator technique in coccydynia (but only on one patient). Another patient reported rapid success with this treatment.
Julie has written about the success she had with a physical therapy designed to straighten out twists in her hips and shoulders.
Grace has had a programme of massage and exercise that has helped her greatly, though not directly related to the coccyx.
One type of therapy that is sometimes offered by physical therapists is ultrasound treatment. Very few people find this has any effect.