Much to be concerned about here. A mid line disc bulge at the thoraco-lumbar region and several segments below can cause coccygeal pain. Any post-op imaging to evaluate canal, discs - such as Ct or Wikipedia reference-linkMRI?
Check the lateral allignment of the ischial tuberosity on both sides in relationto the midline gluteal crease. Check the ischia with respect to A-P, P-A relationships. Also test mobility with medial to lateral, lateral to medial at ischial tuberosity, P-A just above the ischial tuberosity on the ishium (bilaterally). If positive, contact me via my e-mail. There are 4 unilateral pattern that could be at work here, but invariably both sides require treatment. You will not find these described in the literature, someday I will publish.
The coccyx needs to be evaluated mechaically for forward/backward motion dysfunction and side-bending also.
It is relevant to palpate the sacrotuberous ligament. Open your palms fully so that thumbs are nearly 90 degrees away from digits. Bring thumb tips and tips of index fingers together so that they form a triangle. Place the tip of index fingers on the coccyx and the thumbs should then be on the creaes on top of the thighs. The index fingers then lie on top of the sacrotuberous ligaments. Now with tip of thumbs push into the ligament, you willhave to depress the gluteal fat ans muscle several centimeters. You can strum the ligament like aguitar string or simply depress it - just like taking up the slack and performing a mobility test at a joint. Compare the tone side to side. Asymmetry of tone coupled with bony palption and passive mobility testing should be informative, and can guide treatment.
Itwould be worthwhile to read up on Dr Maigne who has some excellent work on thoracolumbar junction mobility dysfunction. More often than not T12-L1 are in hyperextension and a foam roller placed below it with progressive flexion to isolate force at the junction is helpful, say for at least 5 minutes. Becreative, there areseveral ways to accomplish this. More details upon request.
Sitting on rolled towelsinfrontof the ischial tuberosities will unweigh the coccyx, helpful if it is suffering from sitting compression. Mulligan has a sitting wedge, though I was making these in 1983 (Albuquerque, New Mexico, USA), just never did market properly. Best Regards Jerry Hesch, MHS, PT [email protected]