Manipulation of asymptomatic anteriorly subluxated coccyx utilizing an internal rectal approach in a patient with chronic SI and LS pain

Objective: To discuss a case of involving severe chronic low back and pelvic pain where asymptomatic subluxation of the coccyx was treated with internal rectal contact coccygeal manipulation utilizing the Wooley-Kemper protocol which resulted in spontaneous relief of chronic lumbar and sacroiliac pain, improved lumbopelvic range of motion and motor strength. Clinical Features: A 5’5” 145 lb. 40-year old female property manager who had suffered from 6 years of increasingly severe and frequent episodes of lumbar, sacroiliac and leg pain. She also experienced numbness in her right foot. Pain levels before treatment was 9-10 on the numeric pain scale (NPS). Palpation revealed severe tenderness at the lumbosacral and sacroiliac joints. The lumbar spine and pelvic floor musculature was also hypertonic. Lumbar flexion was severely reduced (Fig. 1). Minimal tenderness was elicited upon external palpation of the coccyx. Intra-rectal palpation of the coccyx revealed exquisite tenderness and rigidity of the sacrococcygeal segments. X-ray analysis revealed that the coccyx was displaced anteriorly 80 degrees (Fig. 2). The distal coccygeal joint appeared fused. Intervention and Outcome: Chiropractic care was first provided. Then, lumbopelvic and hamstring myofascial stretching was provided to obtain maximum trunk flexion. Trunk flexion was measured (in inches fingertips to floor with the feet together and the knees locked into extension). Motor strength of the internal and external thigh rotators and hamstrings were tested. Informed consent for internal rectal-approach coccyx manipulation was obtained. Then the Kemper-Wooley procedure was provided with excellent results. Immediate increase in coccygeal and lumbar range of motion was measured. Decrease in lumbopelvic muscle hypertonicity and motor weakness was also noted.