COCCYGEAL ADJUSTMENTS
Examination
Place patient on an angle table, i. e., one which rises in the center and slopes away toward either end. Separate the thighs slightly, patient lying face down, and insert the rubber-covered second finger, palmar surface upward, very carefully into the rectum. The tip of the coccyx may then be felt and its movability and position determined. Unless it is immovably fixed in an abnormal position it should not be molested; the movable coccyx responds to mere muscle tension by changes of position and cannot act as a primary cause of nerve impingement.
Usually this examination will be rendered unnecessary by the external palpation which may disclose the movability of the coccyx and at once render further exploration superfluous.
When the coccyx is anteriorly subluxated and ankylosed in that position it may be a factor in producing constipation, hemorrhoids, etc., but its influence in other diseases, especially of the nervous system, has been greatly overrated by those who have not yet fully accepted the doctrine that nerve impingement is the primary cause of all disease.
Fig. 30. Edge contact with “Roll,” q. v. Attitude of patient for coccygeal adjustment.
Movement
When it has been decided that the coccyx must be moved, the position and use of hand is the same as for the palpation. The finger hooks under the tip of the coccyx, draws upon it until a tight contact is secured and then jerks sharply backward upon it with a view to its abrupt fracture. No mitigation of the jerk in the hope of previously loosening or gradually replacing the bone is of value for osseous tissue must be broken before any movement may take place.
This movement is painful and the region of the newly fractured coccyx may remain sore for a period ranging from a few days to several weeks. It is wise to warn the patient of the facts before proceeding.
The fractured coccyx may be absorbed, or may be reankylosed in a proper position or in a new abnormal position, or may remain loose and movable.